Journal of Medical Ethics最新文献

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.

'Live tissue training', using an anaesthetised live animal substituted for a human patient for the practice of surgical skills, is a controversial topic. Although simulator technologies have developed significantly for inclusion in many areas of surgical education, it is contested that training to manage traumatic injuries requires a model that can bleed and has a dynamic circulation. This article uses the published literature to explore the values at stake regarding live tissue training in the context of trauma with the aim of considering whether such training is ethically justifiable, to any degree. We present criteria for the ethical evaluation of live animal use in trauma simulation alongside descriptions of the pro- and contra-arguments present in the literature. Our conclusion is that justification is challenging and must be considered on a case-by-case basis-it is important that the difference gained from using a live animal compared with the best alternative simulator has to be greater than the clear ethical downside of using animals.

Institutional review boards (IRBs) play a crucial role in ensuring the ethical conduct of human subjects research, but face challenges including inconsistency, delays, and inefficiencies. We propose the development and implementation of application-specific large language models (LLMs) to facilitate IRB review processes. These IRB-specific LLMs would be fine-tuned on IRB-specific literature and institutional datasets, and equipped with retrieval capabilities to access up-to-date, context-relevant information. We outline potential applications, including pre-review screening, preliminary analysis, consistency checking, and decision support. While addressing concerns about accuracy, context sensitivity, and human oversight, we acknowledge remaining challenges such as over-reliance on artificial intelligence and the need for transparency. By enhancing the efficiency and quality of ethical review while maintaining human judgement in critical decisions, IRB-specific LLMs offer a promising tool to improve research oversight. We call for pilot studies to evaluate the feasibility and impact of this approach.

Traditional female genital practices, though long-standing in many cultures, have become the focus of an expansive global campaign against 'female genital mutilation' (FGM). In this article, we critically examine the harms produced by the anti-FGM discourse and policies, despite their grounding in human rights and health advocacy. We argue that a ubiquitous 'standard tale' obscures the diversity of practices, meanings and experiences among those affected. This discourse, driven by a heavily racialised and ethnocentric framework, has led to unintended but serious consequences: the erosion of trust in healthcare settings, the silencing of dissenting or nuanced community voices, racial profiling and disproportionate legal surveillance of migrant families. Moreover, we highlight a troubling double standard that legitimises comparable genital surgeries in Western contexts while condemning similar procedures in others. We call for more balanced and evidence-based journalism, policy and public discourse-ones that account for cultural complexity and avoid the reductive and stigmatising force of the term 'mutilation'. A re-evaluation of advocacy strategies is needed to ensure that they do not reproduce the very injustices they aim to challenge.

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.