Journal of Medical Ethics最新文献

While artificial intelligence's (AI's) potential role in enhancing diagnostic accuracy and personalising treatment is well-recognised, its application in evaluating physicians raises critical ethical concerns as well. The paper examines the impact of AI on the 'comparative abilities' exception to informed consent, which currently exempts physicians from disclosing information about the performance of other providers. With AI's ability to generate granular, accurate comparisons of physician metrics, this exception will be challenged, potentially empowering patients to make more informed decisions. However, AI's use in disclosing physician success rates may exacerbate healthcare disparities, as wealthier patients may have more access to higher-skilled providers. Policymakers and ethicists must proactively address these concerns to ensure equitable access to care as AI technologies advance.

What does it mean to be a bioethicist? How should the role(s) of bioethics be understood in the context of a world of intense value conflict and polarisation? Bioethics is-in all its various forms and traditions-potentially well-positioned to contribute to addressing many of the most pressing challenges of value polarisation and conflict in diverse societies. However, realising this potential is going to require moving beyond currently foregrounded methods and developing new models for engaging with moral disagreement. This paper proposes an approach, 'adversarial cooperation,' drawing on the concepts of 'adversarial collaboration' from the sciences and 'antagonistic cooperation' from the humanities. Adversarial cooperation aims to combine the rigour and structured methodology of adversarial collaboration with the cultural sensitivity and expansive vision of antagonistic cooperation. The paper also addresses key challenges to adversarial cooperation, including ethical considerations, tensions between substantive and procedural values, the problem of misinformation and the need for decision-making amidst ongoing disagreement. Ultimately, adversarial cooperation suggests a reimagining of bioethical expertise, emphasising skills in mediation, the arts and humanities and participatory decision-making alongside established philosophical competencies. This implies a model of normative bioethical authority grounded in the ability to facilitate inclusive and trustworthy processes of moral deliberation. Realising the potential of adversarial cooperation will require significant changes in bioethics training and practice, as well as a commitment to reflexivity, humility and the amplification of marginalised voices. By embracing this approach, bioethics can play a vital role in navigating the complex moral landscapes of pluralistic societies.

Background: Clinical ethics reasoning is one of the unique contributions of clinical ethicists to healthcare, and is common to all models of clinical ethics support and methods of case analysis. Despite being a fundamental aspect of clinical ethics practice, the phenomenon of clinical ethics reasoning is not well understood. There are no formal definitions or models of clinical ethics reasoning, and it is unclear whether there is a shared understanding of this phenomenon among those who perform and encounter it.

Methods: A scoping review of empirical literature was conducted across four databases in July 2024 to capture papers that shed light on how clinical ethicists undertake or facilitate clinical ethics reasoning in practice in individual patient cases. The review process was guided by the Arksey and O'Malley framework for scoping reviews.

Results: 16 publications were included in this review. These publications reveal four thinking strategies used to advance ethical thinking, and three strategies for resolving clinical ethics challenges in individual patient cases. The literature also highlights a number of other influences on clinical ethics reasoning in practice.

Conclusion: While this review has allowed us to start sketching the outlines of an account of clinical ethics reasoning in practice, the body of relevant literature is limited in quantity and in specificity. Further work is needed to better understand and evaluate the complex phenomenon of clinical ethics reasoning as it is done in clinical ethics practice.

In 2024, new legislation introduced significant changes to the rules, procedures and institutions governing research ethics in Brazil. One of its objectives was to limit sponsors' post-trial access (PTA) obligations. However, a presidential veto weakened this reform. This veto maintained the sponsors' indefinite duty to provide the tested intervention until it becomes available in the National Health System. In Brazil, where courts often order the public funding for treatments not included in the health system's lists and protocols, a substantial reduction in the sponsors' PTA obligations would likely increase litigation seeking state-funded PTA. This dynamic adds an extra layer of complexity to the ethical analysis of the regulation of PTA in Brazil, as its distributive impact on the public health system must be considered. Therefore, any argument for reducing sponsors' PTA obligations must go beyond simply demonstrating that sponsors do not owe participants an ethical obligation to provide them with indefinite access to the tested intervention or that such obligation discourages research. It must also make a compelling case for why the state, rather than sponsors, should bear the responsibility for funding PTA.

This paper asks how bioethics navigates, and should navigate, value pluralism in the increasingly global spaces in which bioethics operates. We juxtapose the ethical approaches suggested by East Asian societies, drawing primarily on Confucian ethics, with approaches more prevalent in Western societies, especially North America and Western Europe. Drawing on the Confucian virtue of li () (ritual propriety and decorum), we argue for greater tolerance, respect, epistemic justice, cultural humility and civility. We show how to translate these values into practice using the examples of international bioethics policies governing abortion practice, artificial intelligence governance and climate change. The 'Introduction' section raises the question of how to engage in bioethics across borders. The section, 'Leading Views of Bioethics are WEIRD' explores how the field of bioethics currently navigates value pluralism. It characterises leading bioethics approaches as WEIRD-Western, educated, industrialised, rich and democratic. The section, 'East Asian and Western Views of Personhood' illustrates WEIRD approaches, juxtaposing Eastern and Western accounts of personhood in three cases: social robots, prenatal human life, and nature. The section, 'Epistemic Justice and Value Pluralism' argues that bioethics' WEIRDness violates epistemic justice by assigning excess credibility to the West while deflating the credibility of the East. We propose a pluriversal alternative and apply it to bioethics practice by drawing on the Confucian virtue of li The paper concludes that bioethicists should embrace a pluriversal approach to global value diversity.

People in vulnerable positions who need support in their daily lives often face challenges in receiving timely access to care; for instance, due to disabilities or individual and situational vulnerabilities. There has been an increasing turn to technology-mediated ways to improve access to care, which has raised ethical questions about the appropriateness and inclusiveness of digitalising care requests. Specifically, for people in vulnerable positions, digitalisation is meant to facilitate requests for access to healthcare resources and to simplify the process of navigating the healthcare system. In a multidisciplinary research project, we examined the use and value of a 'sensitive' virtual assistant that can accommodate different needs of target groups through inclusive design, adaptive technology and artificial intelligence. This paper presents empirical findings from focus groups with care recipients and caregivers about the sensitive virtual assistant and relates the findings to five larger ethical issues associated with the use of virtual assistants in healthcare settings and care practices more generally. It highlights the risk that, even with the inclusion of target groups in the design of digitalised care assistants, some people may benefit significantly less than others.

A survey study by Haining et al reported significantly higher percentages of Singaporeans approving of human cognitive enhancement via reprogenetic technologies, as compared with American respondents in a similar previous survey study conducted in the USA. Some caveats on human cognitive enhancement with reprogenetic technologies, such as polygenic embryo screening and germline gene editing, are thus discussed based on the local sociocultural context of Singapore. First, within a hypercompetitive shame-based Confucian society such as Singapore, the autonomy of the cognitively enhanced offspring would likely be curtailed by the heavy-handed 'tiger-parenting' approach of their parents, who, after investing so much money in enhancing their cognitive ability, would have 'heightened' expectations of their academic performance. Second, cognitive enhancement may not improve the personal happiness, sense of fulfilment and overall well-being of the offspring, particularly if their unique motivations and aspirations do not align with the idealised visions and expectations of their parents, and if they are unable to fulfil the unrealistic and unreasonable expectations imposed by their parents and broader society. Third, cognitive enhancement may not necessarily improve the future prospects and life success of the offspring if this further exacerbates an unbalanced job market with an oversupply of university graduates. Fourth, cognitive enhancement is anticipated to be very expensive and hence be afforded only by the affluent, thereby further aggravating existing socioeconomic disparities. Last, the high costs of such technologies could further accelerate demographic decline due to the heavy financial burden on prospective parents. Hence, Singapore must carefully consider these caveats before permitting such cognitive-enhancing technologies.