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The mutuality account of parenthood: a subjective approach to parent-child relationships. 亲子关系的相互性:亲子关系的主观方法。
IF 1.6 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-07-11 DOI: 10.1007/s40592-024-00198-y
Isabella Holmes, Rosalind McDougall

Stimulated by development of reproductive technologies, many current bioethical accounts of parenthood focus on defining parenthood at or around birth. They tend to exclude from their scope some parent-child relationships that develop later in a child's life. In reality, a parent-child relationship can emerge or dissolve over time: the parents of person A as an adolescent or adult may be different to her parents when she is a young child. To address this aspect of parenthood, we propose a new 'mutuality account' of parenthood, grounded in the concept of ontological security. We argue that in most cases a parent-child relationship exists if there is mutual ontological security between the parent and child. We suggest that this mutual ontological security is constituted and sustained by shared frameworks of reality and cohesive personal narratives. Our intention is to broaden the conceptual understanding of parenthood, to include parent-child relationships that do not fall neatly into current bioethical accounts, and to argue against the notion that objective physiological, causal, or social ties are necessary to 'make' a parent.

在生殖技术发展的推动下,目前许多关于父母身份的生物伦理论述都侧重于界定出生时或出生前后的父母身份。它们往往将儿童生命后期发展起来的一些亲子关系排除在外。在现实生活中,亲子关系会随着时间的推移而出现或消解:青少年或成年人 A 的父母可能不同于她年幼时的父母。针对亲子关系的这一方面,我们提出了一种新的亲子关系 "相互性解释",其基础是本体安全概念。我们认为,在大多数情况下,如果父母与子女之间存在本体论上的相互安全感,亲子关系就会存在。我们认为,这种相互的本体论安全感是由共同的现实框架和有凝聚力的个人叙事构成和维持的。我们的目的是拓宽对亲子关系的概念性理解,将那些不完全属于当前生命伦理学范畴的亲子关系纳入其中,并反对客观的生理、因果或社会关系是 "造就 "父母的必要条件这一观点。
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引用次数: 0
Biosafety, biosecurity, and bioethics. 生物安全、生物安保和生物伦理。
IF 1.6 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-07-30 DOI: 10.1007/s40592-024-00204-3
David B Resnik

The COVID-19 pandemic has highlighted the importance of biosafety in the biomedical sciences. While it is often assumed that biosafety is a purely technical matter that has little to do with philosophy or the humanities, biosafety raises important ethical issues that have not been adequately examined in the scientific or bioethics literature. This article reviews some pivotal events in the history of biosafety and biosecurity and explores three different biosafety topics that generate significant ethical concerns, i.e., risk assessment, risk management, and risk distribution. The article also discusses the role of democratic governance in the oversight of biosafety and offers some suggestions for incorporating bioethics into biosafety practice, education, and policy.

COVID-19 大流行凸显了生物医学科学中生物安全的重要性。虽然人们通常认为生物安全是一个纯粹的技术问题,与哲学或人文学科关系不大,但生物安全提出了一些重要的伦理问题,而这些问题在科学或生物伦理学文献中尚未得到充分研究。本文回顾了生物安全和生物安保历史上的一些关键事件,探讨了引发重大伦理问题的三个不同的生物安全主题,即风险评估、风险管理和风险分配。文章还讨论了民主治理在生物安全监督中的作用,并就将生物伦理纳入生物安全实践、教育和政策提出了一些建议。
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引用次数: 0
Deference or critical engagement: how should healthcare practitioners use clinical ethics guidance? 遵从还是批判性参与:医疗从业人员应如何使用临床伦理指南?
IF 1.6 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-02-29 DOI: 10.1007/s40592-023-00186-8
Ben Davies, Joshua Parker

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of 'critical engagement' rather than deference.

医疗从业人员可以获得一系列伦理指导。然而,这些指导在伦理决策中的规范作用却未得到充分探讨。本文探讨了医疗从业人员对待伦理指导的两种方式。我们首先概述了服从伦理指导的观点,说明服从的态度如何引发三个关键问题:道德价值、道德理解和道德错误。然后,我们借鉴哲学文献,主张将伦理指导作为同事道德见证的一种形式,并建议以 "批判性参与 "的精神而非敬畏的态度对待伦理指导,这是一种更有前途的态度。
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引用次数: 0
COVID-19 ethics: unique aspects and a review as of early 2024. COVID-19 伦理学:独特方面和截至 2024 年初的审查。
IF 1.6 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-07-13 DOI: 10.1007/s40592-024-00199-x
Wayne X Shandera

COVID-19 presents a variety of ethical challenges in a set of arenas, arenas not always considered in past pandemics. These challenges include issues related to autonomy, distributive ethics, and the establishment of policies of equity and justice. Methods are a literature review based on regular editing of an online textbook during the COVID-19 outbreak and a literature review using key ethical terms. Patients are confronted with new issues related to autonomy. Providers need to expand their concepts of ethical issues to include decisions based on proportionality and public health ethics. The public health sector needs to assess the beneficence of alternative modes of disease control. The research community needs to redefine the concept of informed consent in emergent conditions. All elements of the medical spectrum-physicians, scientists, and the community-at-large including the pharmaceutical industry-need to consider the multifaceted methods for preventing future pandemics. This will require giving particular emphasis to public health funding and ending the documented discrimination that exists in the provision of proven therapies. The developing world is especially at risk for most of the ethical issues, especially those related to equity and justice. The ethical issues associated with the COVID-19 outbreak are not unique but provide a diverse set of issues that apply to patients, providers, social groups, and investigators. The further study of such issues can help with preventing future outbreaks.

COVID-19 在一系列领域提出了各种伦理挑战,这些领域在以往的大流行病中并不总是得到考虑。这些挑战包括与自主权、分配伦理以及公平和正义政策的制定有关的问题。研究方法是在 COVID-19 爆发期间定期编辑在线教科书的基础上进行文献综述,以及使用关键伦理术语进行文献综述。患者面临着与自主权相关的新问题。医疗服务提供者需要扩展他们的伦理问题概念,将基于相称性和公共卫生伦理的决策纳入其中。公共卫生部门需要评估其他疾病控制模式的益处。研究界需要重新定义紧急情况下的知情同意概念。医学界的所有成员--医生、科学家和包括制药业在内的整个社会--都需要考虑预防未来流行病的多方面方法。这就需要特别重视公共卫生资金,结束在提供行之有效的疗法方面存在的歧视。在大多数伦理问题上,特别是与公平和正义有关的问题上,发展中国家尤其面临风险。与 COVID-19 爆发相关的伦理问题并非独一无二,但却提供了一系列适用于患者、医疗服务提供者、社会团体和研究人员的不同问题。对这些问题的进一步研究有助于预防未来的疫情爆发。
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引用次数: 0
Contact investigation in multidrug-resistant tuberculosis: ethical challenges. 耐多药结核病的接触调查:伦理挑战。
IF 1.6 Q2 ETHICS Pub Date : 2024-06-01 Epub Date: 2024-03-02 DOI: 10.1007/s40592-024-00188-0
Hnin Si Oo, Pascal Borry

Contact investigation is an evidence-based intervention of multidrug-resistant tuberculosis (MDR-TB) to protect public health by interrupting the chain of transmission. In pursuit of contact investigation, patients' MDR-TB status has to be disclosed to third parties (to the minimum necessary) for tracing the contacts. Nevertheless, disclosure to third parties often unintentionally leads the MDR-TB patients suffered from social discrimination and stigma. For this reason, patients are less inclined to reveal their MDR-TB status and becomes a significant issue in contact investigation. This issue certainly turns into a negative impact on the public interest. Tension between keeping MDR-TB status confidential and safeguarding public health arises in relation to this issue. Regarding MDR-TB management, patient compliance with treatment and contact investigation are equally important. Patients might fail to comply with anti-TB therapy and be reluctant to seek healthcare due to disclosure concerns. In order to have treatment adherence, MDRTB patients should not live through social discrimination and stigma arising from disclosure and TB team has a duty to support them as a mean of reciprocity. However, implementation of contact investigation as a public health policy can still be challenging even with promising reciprocal support to the patients because MDR-TB patients are living in different contexts and situations. There can be no straight forward settlement but an appropriate justification for each distinct context is needed to strike a balance between individual confidentiality and public interest.

接触调查是一种以证据为基础的耐多药结核病(MDR-TB)干预措施,通过阻断传播链来保护公众健康。在进行接触调查时,患者的耐多药结核病状况必须(在必要的最低限度内)向第三方披露,以便追踪接触者。然而,向第三方披露病情往往会无意中导致 MDR-TB 患者遭受社会歧视和羞辱。因此,患者不太愿意透露自己的 MDR-TB 感染情况,这成为接触者调查中的一个重要问题。这一问题无疑会对公众利益造成负面影响。在对 MDR-TB 病情保密和保护公众健康之间,出现了与此相关的矛盾。关于 MDR-TB 的管理,患者遵从治疗和接触调查同样重要。患者可能无法坚持抗结核治疗,并因担心泄露而不愿寻求医疗服务。为了保证治疗的依从性,MDRTB 患者不应因披露而遭受社会歧视和羞辱,结核病团队有责任为他们提供支持,以实现互惠互利。然而,由于 MDRTB 患者的生活环境和处境各不相同,即使承诺为患者提供互惠支持,作为公共卫生政策的接触调查的实施仍具有挑战性。没有一劳永逸的解决办法,但需要为每种不同的情况提供适当的理由,以便在个人保密和公共利益之间取得平衡。
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引用次数: 0
Justification for coercion in a public health crisis: not just a matter of individual harm. 公共卫生危机中的胁迫理由:不仅仅是个人伤害问题。
IF 1.6 Q1 Arts and Humanities Pub Date : 2024-05-18 DOI: 10.1007/s40592-024-00196-0
Lucie White

The COVID pandemic was an exceptional public health situation - which brought with it unprecedented restrictions across the global populace. But what was it about this pandemic which caused us to implement such drastic restrictions on liberty? Much of the ethical debate on restrictive measures such as lockdowns and vaccine requirements focused on the potential harm that individuals cause to other individuals by the risk of infection. I will suggest that this may come from a reliance on J.S. Mill's harm principle as providing the ultimate justification for coercion - i.e., the well-accepted principle that state coercion is justified in order to prevent the imposition of unacceptable risk of harm to others. Though there have been attempts, in the wider public health ethics literature, to use the harm principle as a basis for restricting contribution to collective harms, I will suggest that these attempts cannot rely on the harm principle alone. I will then turn to the ways in which an individual-based line of reasoning does not capture a distinctive sort of harm posed by the COVID pandemic (and others like it): the potential failure of healthcare systems. I will draw out three ways in which a focus on the harm that an individual poses to another individual fails to capture the full scope of harm wrought by the collapse of healthcare systems. First, it can't adequately capture the cumulative and "looping effects" of the harm caused by strained healthcare systems. Second, it fails to capture the widespread ripple effects the failure of a central societal institution can have on other institutions. And third, the failure of a healthcare system can impose "psychic costs", affecting the moral character of all members of society, reducing trust in institutions, and potentially posing an existential threat to the fabric of society. Finally, I will sketch some implications of the recognition of this distinctive sort of harm for the justification of coercive public health measures.

COVID 大流行是一次特殊的公共卫生事件--它给全球民众带来了前所未有的限制。但究竟是什么原因导致我们对自由实施如此严厉的限制?关于封锁和疫苗要求等限制性措施的伦理辩论大多集中在个人因感染风险而对他人造成的潜在伤害上。我认为,这可能是由于人们依赖 J.S. 密尔的伤害原则,将其作为强制的最终理由--即国家强制是为了防止对他人造成不可接受的伤害风险,这一原则已被广泛接受。尽管在更广泛的公共卫生伦理学文献中,有人试图将伤害原则作为限制集体伤害的基础,但我将指出,这些尝试不能仅仅依赖于伤害原则。然后,我将论述基于个体的推理如何无法捕捉到 COVID 大流行(以及其他类似流行)所造成的一种独特伤害:医疗保健系统的潜在失灵。我将从三个方面来说明,关注个体对他人造成的伤害并不能全面反映医疗系统崩溃所造成的伤害。首先,它无法充分捕捉到医疗系统紧张所造成的伤害的累积效应和 "循环效应"。其次,它未能反映出一个核心社会机构的失败可能对其他机构产生的广泛连锁反应。第三,医疗系统的失灵会造成 "心理成本",影响社会所有成员的道德品质,降低对机构的信任,并可能对社会结构的存在构成威胁。最后,我将简要说明认识到这种独特的伤害对强制性公共卫生措施的合理性的一些影响。
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引用次数: 0
Gender and equity considerations in AMR research: a systematic scoping review. AMR 研究中的性别和公平考虑因素:系统性范围界定审查。
IF 1.6 Q1 Arts and Humanities Pub Date : 2024-04-27 DOI: 10.1007/s40592-024-00194-2
Ingrid Lynch, Lorenza Fluks, Lenore Manderson, Nazeema Isaacs, Roshin Essop, Ravikanya Praphasawat, Lyn Middleton, Bhensri Naemiratch

Research on gender and antimicrobial resistance (AMR) beyond women's biological susceptibility is limited. A gender and equity lens in AMR research is necessary to promote gender equality and support the effectiveness, uptake, and sustainability of real-world AMR solutions. We argue that it is an ethical and social justice imperative to include gender and related intersectional issues in AMR research and implementation. An intersectional exploration of the interplay between people's diverse identities and experiences, including their gender, socio-economic status, race, disability, age, and sexuality, may help us understand how these factors reinforce AMR risk and vulnerability and ensure that interventions to reduce the risk of AMR do not impact unevenly. This paper reports on the findings of a systematic scoping review on the interlinkages between AMR, gender and other socio-behavioural characteristics to identify priority knowledge gaps in human and animal health in LMICs. The review focused on peer-reviewed and grey literature published between 2017 and 2022. Three overarching themes were gendered division of caregiving roles and responsibilities, gender power relations in decision-making, and interactions between gender norms and health-seeking behaviours. Research that fails to account for gender and its intersections with other lines of disadvantage, such as race, class and ability, risks being irrelevant and will have little impact on the continued and dangerous spread of AMR. We provide recommendations for integrating an intersectional gender lens in AMR research, policy and practice.

除了女性的生理易感性之外,有关性别和抗菌药物耐药性(AMR)的研究还很有限。AMR 研究中的性别和公平视角对于促进性别平等和支持现实世界中 AMR 解决方案的有效性、吸收和可持续性是必要的。我们认为,在 AMR 研究和实施中纳入性别和相关交叉问题是伦理和社会正义的当务之急。对人们的不同身份和经历(包括性别、社会经济地位、种族、残疾、年龄和性取向)之间的相互作用进行交叉探讨,有助于我们了解这些因素是如何强化 AMR 风险和脆弱性的,并确保降低 AMR 风险的干预措施不会产生不均衡的影响。本文报告了一项关于 AMR、性别和其他社会行为特征之间相互联系的系统性范围审查结果,以确定低收入国家人类和动物健康方面的优先知识缺口。综述重点关注 2017 年至 2022 年间发表的同行评审文献和灰色文献。三个首要主题是:护理角色和责任的性别分工、决策中的性别权力关系以及性别规范与寻求健康行为之间的相互作用。如果研究未能考虑性别因素及其与种族、阶级和能力等其他不利因素的交叉关系,就有可能失去意义,对急性呼吸道感染的持续和危险蔓延影响甚微。我们建议在 AMR 研究、政策和实践中纳入性别交叉视角。
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引用次数: 0
Suicide-preventive compulsory admission is not a proportionate measure – time for clinicians to recognise the associated risks 预防自杀的强制入院措施并不相称--临床医生该认识到相关风险了
IF 1.6 Q1 Arts and Humanities Pub Date : 2024-04-13 DOI: 10.1007/s40592-024-00190-6
Antoinette Lundahl
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引用次数: 0
Cause for coercion: cause for concern? 胁迫的原因:令人担忧的原因?
IF 1.6 Q1 Arts and Humanities Pub Date : 2024-02-13 DOI: 10.1007/s40592-024-00187-1
Maxwell J Smith

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.

理查德-科克尔(Richard Coker)在 2000 年出版的《从混乱到强制》(From Chaos to Coercion:理查德-科克尔(Richard Coker)在其 2000 年出版的《从混乱到强制:拘留与结核病控制》一书中,就使用强制公共卫生措施应对传染病威胁提出了许多重要的看法和论点。特别是,科克尔认为,我们往往忽视公共卫生威胁,然后要求立即采取行动,这可能使政策制定者的有效选择更少,可能需要(或被认为需要)采取更激进的强制措施来实现公共卫生目标。科克尔提出了一个令人信服的理由,说明为什么当政府发现自己处于这种境地并诉诸强制手段时,我们应该认为这在伦理上是有问题的,但悬而未决的问题是,如果政府和卫生当局发现自己处于这种境地时,是否应该排除使用强制手段的可能性。在本文中,我将论证,当政府因为忽视公共卫生威胁、其原因以及其他可能的应对措施而诉诸强制手段时,我们应该认为这在伦理上是令人反感的,但这并不一定就排除了在这种情况下使用强制手段的可能性;为什么要考虑使用强制手段,这在伦理上是令人反感的,但这并不一定或自动导致我们认为在这种情况下使用强制手段是不合理的。我对这一论点提出了反对意见,并就如何评价政府在公共卫生领域使用强制手段得出了几点结论。
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引用次数: 0
How to love animals: and protect our planet Henry Mance New York: Vintage Books, 2022; paperback, 400 pp., £9.99, ISBN: 9781529112146. 如何爱护动物:保护我们的地球》 亨利-曼斯 纽约:平装本,400 页,9.99 英镑,ISBN:9781529112146。
IF 1.6 Q1 Arts and Humanities Pub Date : 2023-12-21 DOI: 10.1007/s40592-023-00185-9
B V E Hyde
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引用次数: 0
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Monash Bioethics Review
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