Monash Bioethics Review最新文献

The following text is the de-identified and edited transcript of an invited presentation by Fiona Patten, who was a member of the Victorian Legislative Council between 2014 and 2022, and leader of the Reason Australia Party. Fiona's presentation addressed the topic of 'Balancing different views in the contexts of voluntary assisted dying, Safe Access Zones around reproductive health clinics, and the proposed Health Legislation Amendment (Conscientious Objection) Bill.' Fiona's presentation formed part of the Conference on Accommodating Plural Values in Healthcare and Healthcare Policy, which was held in Melbourne, Australia, on Monday, October 30, 2023. This conference was a key output of the Australian Research Council Discovery Project grant DP190101597, 'Religion, pluralism, and healthcare practice: A philosophical assessment'. Fiona's presentation was introduced by the project's principal investigator and Deputy Director of Monash Bioethics Centre, Professor Justin Oakley.

Greater attention should be given to place when considering whether to, and how to, implement restrictive measures in response to infectious disease outbreaks and pandemics. Human beings cannot experience the world except in place, while place allows us to act ethically and in relation to other persons. Some have described place as a location with meaning to humans. Our individual and collective sense of meaning and identities are partly created in and by the places we live, while our sense of agency and security are shaped by them. Although taking the concept of place seriously is central to other disciplines and cultures, it is- with some notable exceptions- absent in the bioethics literature, including that of public health ethics. This paper attempts to outline how attending to the normative aspects of place can help explain some of our lingering COVID19-related trauma, as well as be used constructively in responding to future outbreaks when we cannot avoid the use of restrictive measures.

The following text is the de-identified and edited transcript of an invited presentation by Professor Clare Delany on the topic of 'How clinical ethics discussions can be a model for accommodating and incorporating plural values in paediatric and adult healthcare settings.' Professor Delany's presentation formed part of the Conference on Accommodating Plural Values in Healthcare and Healthcare Policy, which was held in Melbourne, Australia, on Monday, October 30, 2023. This conference was a key output of the Australian Research Council Discovery Project grant DP190101597, 'Religion, pluralism, and healthcare practice: A philosophical assessment'. Professor Delany's presentation was introduced by Doctor Lauren Notini, Research Fellow and Lecturer at Monash Bioethics Centre, Monash University.

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.

Patient visitor restrictions were implemented in unprecedented ways during the COVID-19 pandemic and included bans on any visitors to dying patients and bans separating mothers from infants. These were implemented without high quality evidence they would be beneficial and the harms to patients, families and medical personnel were often immediately clear. Evidence has also accumulated finding strict visitor restrictions were accompanied by long-term individual and societal consequences. We highlight numerous examples of restrictions that were enacted during the COVID-19 pandemic, including some that continue to be in place today. We outline six specific concerns about the nature and effects of the visitor restrictions seen during the COVID-19 pandemic. These considerations may help provide both an ethical and science-based framework, through which healthcare workers, families and government entities can work towards safeguarding patient and family rights and well-being.

In his 2000 book, From Chaos to Coercion: Detention and the Control of Tuberculosis, Richard Coker makes a number of important observations and arguments regarding the use of coercive public health measures in response to infectious disease threats. In particular, Coker argues that we have a tendency to neglect public health threats and then demand immediate action, which can leave policymakers with fewer effective options and may require (or may be perceived as requiring) more aggressive, coercive measures to achieve public health goals. While Coker makes a convincing case as to why we should find it ethically problematic when governments find themselves in this position and resort to coercion, left outstanding is the question of whether this should preclude governments and health authorities from using coercion if and when they do find themselves in this position. In this paper, I argue that, while we should consider it ethically objectionable when governments resort to coercion because they have neglected a public health threat, its causes, and other possible responses to that threat, this should not then necessarily rule out the use of coercion in such circumstances; that there are ethically objectionable antecedents for why coercion is being considered should not necessarily or automatically cause us to think coercion in such cases cannot be justified. I address an objection to this argument and draw several conclusions about how governments' use of coercion in public health should be evaluated.

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.

Healthcare professionals routinely navigate complex value conflicts that span personal, interpersonal, and organisational domains. This paper examines the concept of moral craftsmanship-the skilled practice of understanding, analysing, and working through value conflicts in healthcare settings-and argues that value pluralism provides a more realistic framework for healthcare ethics than approaches seeking overarching moral consensus. Through analysis of cases spanning clinical genetics, paediatric end-of-life care, and institutional resource allocation, the paper explores how value conflicts manifest across interconnected domains and explores the practical reasoning processes through which healthcare professionals successfully navigate seemingly intractable moral disagreements. Drawing on examples from clinical genetics counselling and recent analyses of dissensus in paediatric care, the paper argues that deep value pluralism is compatible with reasoned decision-making and that moral craftsmanship represents an essential skill for effective healthcare practice. Oversimplified ethical frameworks risk creating dangerous gaps between institutional processes and lived moral experience, potentially undermining public trust in healthcare systems. Healthcare institutions must develop approaches that acknowledge genuine value plurality while supporting practical decision-making, maintaining mechanisms for incorporating diverse public values, and addressing the moral residue that persists beyond immediate decisions.

The workshop, Coercing for Health: Transdisciplinary Approaches to the Ethics of Coercive Public Health Policies was held at the University of Oxford on July 3rd and 4th, 2024. This paper provides both a summary of the workshop proceedings and reflections and directions for future research on coercive public health measures. The workshop consisted of four key parts: defining coercion; history and legal analysis of coercion; public health ethics perspectives on coercion; experiences of coercive public health measures. According to our reflections, some important questions remaining for further research include: what is the difference between coercion and enforcement? Who gets to define and address coercion? How do structural factors affect health and experiences of coercion? We encourage others to continue to work on this important area, to ensure the ethically acceptable and thoughtful implementation of any future coercive measures in the sphere of public health.