Journal of Medical Ethics最新文献

Just culture is a recent perspective on responding to accidents or incidents in organisations. It refers to the importance of doing justice to the situation and the people involved, aimed at strengthening safety in the workplace and preventing future harm. There are two main conceptualisations of just culture, implying different views on justice, namely retributive and restorative justice. The concept of retributive justice emphasises individual responsibility for failures and the enforcement of given norms about right vs wrong via sanctions and punishment. Restorative justice emphasises the systemic and cultural dimension of accidents or incidents and aims to foster learning conditions for groups as well as the organisation involved. Elaborating on the theoretical presuppositions of the concept is important, both for theorising about just culture and for fostering just culture in practice. We extend the literature by looking into two approaches in contemporary philosophy and ethics that can deepen our understanding of what a restorative approach to just culture entails and how to foster it in practice: dialogical hermeneutics and care ethics. We show that dialogical hermeneutics and care ethics enable us to specify repair as a relational practice, understanding as an interpretation of the situation and identification of needs and moral learning as dialogical and democratic processes of joint reflection. By providing a concrete example of fostering restorative justice in a healthcare organisation, we demonstrate how the theoretical characteristics of a restorative justice inspired by dialogical hermeneutics and care ethics can be translated into practical processes of organisational moral learning.

This paper aims to critique the argument constructed by Anna Smajdor and Joona Räsänen that pregnancy is a disease. Their argument that pregnancy fits the features of disease they enumerate stems from an analysis based on an ontological framework I term the 'logic of the list'. This framework fails to grasp the essential and pervasive nature of the biological trade-offs that characterise complex phenomena like pregnancy. This paper argues that the generative logic behind many of the negative features of pregnancy differs significantly from that of true pathological processes. They are not signs of pathological dysregulation, but rather the structural costs that a complex adaptive system must pay in its process of reproduction.

In a recent exchange in this journal on responsibility for healthcare scarcity in Gaza, McMahan argues that bioethicists should unconditionally condemn Hamas yet insists that the group's actions do not diminish the protections owed to civilians. He further argues that Israel bears the greatest responsibility for civilian suffering, having violated the principles of proportionality, necessity and discrimination. On this basis, he maintains that while all parties must be held accountable for breaches of ethical and humanitarian norms, Israel's conduct should be condemned as unjust, impermissible and as carrying the primary burden of responsibility. In this response, I argue that McMahan's position suffers from several shortcomings: it relies on controversial sources while not engaging with credible alternatives, and it privileges a particular strand of just war theory while failing to present alternative frameworks, many of which are likely unfamiliar to bioethicists. This is unsurprising, given that McMahan has developed one of the most influential contemporary theories of just war. Nevertheless, if bioethicists are to issue judgements on the allocation of responsibility in armed conflict and to condemn the conduct of warring parties, they would be better equipped to do so through rigorous engagement with the full range of available evidence and through measured consideration of the diverse ethical frameworks that govern war and armed conflict.

Julian Kanu has recently defended a pro-life perspective on abortion by arguing for a novel theory of the badness of death called the biological account of death (BAD). BAD is a deprivationist account similar to Jeff McMahan's time relative interest account (TRIA). Kanu argues that BAD explains our intuitions about the badness of death as well as TRIA, except in one special case regarding a comatose infant. In this case, BAD accommodates our intuition that such an infant would be seriously harmed by death, but TRIA does not. All else being equal, BAD is a better theory than TRIA. I argue that not all is equal between the two theories; TRIA accommodates intuitions that BAD cannot, and there is reason to doubt our intuitions regarding the comatose infant.

The world faces an organ shortage, resulting in thousands of deaths each year. By allowing organ markets, we could increase the supply of organs, thereby saving many lives and enriching many organ sellers. One defence of organ markets points out that by prohibiting them, we are taking away what would-be organ sellers regard as their best option, and we thus doom them to stay in their dire circumstances. However, we should not take away what people regard as their best option, and hence we should not prohibit organ markets. Andreas Albersen claims this argument fails because justice requires we offer would-be organ sellers an even better option. However, I show that organ markets are always the best option.

In their recent Authors Meet Critics contribution to the Journal of Medical Ethics, Nancy S Jecker and Caesar Alimsinya Atuire invite a re-examination of personhood that extends beyond Western individualism and incorporates relational, cross-cultural insights. Their account effectively recentres moral discourse on community, continuity and mutual recognition. This response agrees with Jecker and Atuire that personhood cannot be reduced to autonomy or cognitive capacity alone, but it argues that a further conceptual distinction is needed to preserve clarity between moral and institutional recognition.I propose a dual-layered framework of personhood. The metaphysical person is the enduring subject of moral concern whose identity persists through time, relation and narrative; the legal person is the socially constructed bearer of rights and duties recognised within juridical and political systems. While the two frequently overlap, conflating them risks conceptual ambiguity and ethical inconsistency, particularly in cases such as dementia, embryonic life and artificial intelligence.Jecker and Atuire's relational model richly captures the metaphysical dimension of personhood but leaves open the question of how legal and moral status diverge and interact. The proposed two-layer approach clarifies this interface: moral personhood provides grounding for respect and care, while legal personhood institutionalises those obligations within normative systems. Recognising these distinct yet complementary layers retains Jecker and Atuire's relational insights while safeguarding conceptual precision across diverse bioethical contexts.

Is there a place for blame in healthcare? An interesting exchange on this question took place between Daniel Tigard and Elizbeth Duthie, Ian Fischer and Richard Frankel in 2019. In his central appeal to self-blame, I argue that Tigard was successful-and actually did not go far enough-in identifying a place for 'notions of blame' in healthcare. However, I contend that his critics were right to disavow the culture of blame and his notion of taking the blame for unavoidable harm. I argue that even outside a culture of blame, there can still be a (minor) place for blaming others as well as ourselves for avoidable medical errors (even the first-time unintentional ones).

Scholars in philosophy of medicine and bioethics have recently turned their attention to transformative experiences: experiences that teach something new that one could not have known before having the experience, while simultaneously changing one as a person. Sanne Elisa van der Marck recently argued, drawing on the work of Fiona Woollard, that the subjective experience of pregnancy should be included in moral debates on abortion, since pregnancy is a transformative experience. Van der Marck implicitly suggested that such a view strengthens autonomy-based pro-choice abortion arguments because only pregnant people have crucial knowledge of what it is like to be pregnant. However, as I will show, the upshot of her argument is that it undermines the autonomy-based pro-choice arguments. This is because if pregnancy is a transformative experience, then it becomes increasingly difficult to give informed consent for abortion, since only by going through pregnancy would one gain the knowledge of 'what it is like' that is necessary to make the rational choice of having the abortion in the first place. Thus, her argument has a counterintuitive conclusion-it limits rather than reinforces reproductive autonomy.