Monash Bioethics Review最新文献

This paper is a personal reflection on involvement in the development of the first voluntary assisted dying legislation in Australia. Points of contention are discussed, where plural values were evident, as the legislation progressed towards implementation. Finally, ongoing areas of difficulty with the legislation are listed, where further thought is required to ensure ease of access for those in need.

Background: Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to "misuse" and "overuse", particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice "proper" use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics. This paper seeks to reflect on complex questions about how morality has become embedded /embodied in the AMR discourse as presented in the data collected on antimicrobial prescription, dispensing and use in human and livestock health in Tanzania, primarily focusing on antibiotics.

Methods: This reflection is anchored on Jarrett Zigon's morality framework that is comprised of three dimensions of discourse; the institutional, public, and embodied dispositions. The data we use within this framework are derived from a qualitative study targeting human and animal health care service providers and community members in northern Tanzania. Data were collected through 28 in-depth interviews and ten focus group discussions and analysed through content analysis after translation and transcription. In addition, a review of the Tanzania's National Action Plans on antimicrobial resistance was conducted.

Results: Application of the framework demonstrates points of convergence and divergence in the institutional morality discourse articulated by the Tanzania National Action Plans, the public discourse and the embodied dispositions/ lived experiences of human and animal health care service providers and community members. We demonstrate that AMR is not just associated with "inappropriate" behaviour on the part of drug prescribers, dispensers, and users but also with shortcomings in health systems and service delivery.

Conclusion: Antibiotic dispensing and use practices that may be associated with the development of AMR should not be viewed in isolation from the broader health context within which they occur.

The book Ethics of Artificial Intelligence offers a solid exploration of arguments and real-world examples that enrich the ongoing debate surrounding AI ethics. With 12 insightful chapters, the book delves into pressing ethical issues, such as the enhancement of human abilities, the nature of consciousness, and questions of responsibility and accountability in various contexts where AI technology is used. This work connects technology ethics with broader philosophical discussions and provides valuable perspectives on the societal implications of AI. Engaging and accessible, it can serve as an essential resource for scholars, technology-enthusiasts, policymakers, and anyone with an interest in the transformative potential of AI and its ethical dimensions.

Public health policies designed to improve individual and population health may involve coercion. These coercive policies require ethical justification, and yet it is unclear in the public health ethics literature which ethical concepts might justify coercion, and what their limitations are in applying across contexts. In this paper, we analyse a number of concepts from Western bioethics, including the harm principle, paternalism, the public interest, and a duty of easy rescue. We find them plausible justifications for coercion in theory, but when applied to case studies, including HIV testing in Malawi, vaccine mandates in South Africa, and prohibitions of antibiotic use in livestock in the EU, their limitations become clear. We argue that the context-specificity of ethical justifications for coercion has been overlooked, and there is more work needed to identify context-relevant ethical justifications for coercive policies in various settings and for various populations, rather than relying on universalising Western bioethical justifications across all contexts.

In the ethics of public health, questions of virtue, that is, of what it means for public health to act excellently, have received little attention. This omission needs remedy first because achieving improvements in population-wide health can be in tension with goals like respect for the liberty, self-determination, or non-oppression of various individuals or groups. A virtue-ethics approach is flexible and well-suited for the kind of deliberation required to resolve or mitigate such tension. Public health requires practically wise and careful thinking, which virtue ethics brings with it. Furthermore, too tight a focus on delivering outcomes in determining how public health should act has, in some cases, actually undermined its ability to achieve those consequences. However, the main concern about incorporating virtue into public health in a pluralistic society is likely to be that virtue is generally teleological, and we would surely need some widely agreed upon idea of something like flourishing or the common good for this to work. In this paper, I propose that for public health to express virtue in its work, it must express a commitment to justice as it goes about its business promoting and protecting the health of the population. Justice is both a contributor toward better health for groups in society, and a worthwhile goal in its own right. I will sketch an argument that justice as non-oppression - not merely health equity - is the right telos toward which excellent public health should aim in a pluralist society.

New Zealand and Malaysia have abandoned plans to introduce a generational smoking ban because of concerns that such a policy is incompatible with liberal democracy as it undermines autonomy. This paper challenges this claim by showing that smoking is not an autonomous act. Autonomy requires a deliberation of preferences, wills and inclinations. This does not occur in smokers because of three related factors: nicotine addiction, cognitive biases and psychosocial development in addiction. Nicotine addiction results in strong physical and psychological desires to seek pleasure and to avoid withdrawal. This is further potentiated by conditioned behaviour. Cognitive biases explain why smokers act in ways that are detrimental to their health. Psychosocial development explains how the brains of smokers are unable to make rational decisions. This combination renders smokers unable to reflect on their actions and thus act autonomously. This stance is compatible with Mill's view that actions that devalue autonomy cannot be considered autonomous. Defenders of liberalism should not be quick to dismiss a smoking ban and can instead foster autonomy by supporting it.

Antimicrobial Resistance is a threat to individual and to population health and to future generations, requiring "collective sacrifices" in order to preserve antibiotic efficacy. 'Who should make the sacrifices?' and 'Who will most likely make them?' are ethical concerns posited as potentially manageable through Antimicrobial Stewardship. Antimicrobial stewardship almost inevitably involves a form of clinical cost-benefit analysis that assesses the possible effects of antibiotics to treat a diagnosed infection in a particular patient. However, this process rarely accounts properly for patients - above and beyond assessments of potential (non)compliance or adherence to care regimes. Drawing on a vignette of a pregnant woman of colour and migrant diagnosed with Mycoplasma genitalium, a sexually transmissible bacterium, this article draws out some of the ethical, speculative, and practical tensions and complexities involved in Antimicrobial Stewardship. We argue that patients also engage in a form of cost-benefit analysis influenced by experiences of reproductive and social (in)justice and comprising speculative variables - to anticipate future possibilities. These processes have the potential to have effects above and beyond the specific infection antimicrobial stewardship was activated to address. We contend that efforts to practice and research antimicrobial stewardship should accommodate and incorporate these variables and acknowledge the structures they emerge with(in), even if their components remain unknown. This would involve recognising that antimicrobial stewardship is intricately connected to other social justice issues such as immigration policy, economic justice, access to appropriate medical care, racism, etc.

In this article, building on our multidisciplinary expertise on philosophy, anthropology, and social study of microbes, we discuss and analyze new approaches to justice that have emerged in thinking with more-than-human contexts: microbes, animals, environments and ecosystems. We situate our analysis in theory of and practical engagements with antimicrobial resistance and climate emergency that both can be considered super-wicked problems. In offering solutions to such problems, we discuss a more-than-human justice orientation, seeking to displace human exceptionalism while still engaging with human social justice issues. We offer anthropological narratives to highlight how more-than-human actors already play an important role in environmental and climate politics. These narratives further justify the need for new ethical frameworks, out of which we, for further development outside the scope of this article, suggest a queer feminist posthumanist one.

Residential aged care facilities (RACF) are sites of high antibiotic use in Australia. Misuse of antimicrobial drugs in RACF contributes to antimicrobial resistance (AMR) burdens that accrue to individuals and the wider public, now and in the future. Antimicrobial stewardship (AMS) practices in RACF, e.g. requiring conformation of infection, are designed to minimise inappropriate use of antibiotics. We conducted dialogue groups with 46 participants with a parent receiving aged care to better understand families' perspectives on antibiotics and care in RACF. Participants grappled with value trade offs in thinking about their own parents' care, juggling imagined population and future harms with known short term comfort of individuals and prioritising the latter. Distributive justice in AMR relies on collective moral responsibility and action for the benefit of future generations and unknown others. In RACF, AMS requires value trade-offs and compromise on antimicrobial use in an environment that is heavily reliant on antimicrobial drugs to perform caring functions. In the context of aged care, AMS is a technical solution to a deeply relational and socio-structural problem and there is a risk that carers (workers, families) are morally burdened by system failures that are not addressed in AMS solutions.

Advancements in early diagnosis and novel treatments for children with complex and chronic needs have improved their chances of survival. But many survive with complex medical needs and ongoing medical management in the setting of prognostic uncertainty. Their medical care relies more and more on preference-sensitive decisions, requiring medical team and family engagement in ethically challenging situations. Many families are unprepared as they face these ethical challenges and struggle to access relevant ethical resources. In this paper, Timmy's narrative, situated in the context of what is known about ethical challenges in the care of children with chronic critical illness (CCI), serves as a case study of the gap in available ethical resources to guide families in their approach to difficult decision making for children with significant medical complexity and CCI. Our author group, inclusive of parents of children with complex medical needs and medical professionals, identifies domains of ethical challenges facing families of children with CCI and we highlight the development of family/caregiver-oriented ethics resources as an essential expansion of pediatric bioethics.