Monash Bioethics Review最新文献

The growing integration of the medical humanities in medical school curricula highlights its importance in the development of culturally safe, patient-centred clinicians. Internationally, medical schools attempt to increase student engagement through course electives, different modes of assessment and diverse content delivery. At the University of Melbourne, the Professional Practice program aims to provide an easy, engaging way of exposing students to the medical humanities, including reflective practice, collaborative practice, leadership, advocacy, professional identity formation, medical ethics and law. However, students' perceptions of the medical humanities may prevent desired outcomes from being reached. We discuss the student experience of the Professional Practice curriculum through a collaboration between a student, tutor and course designers focusing on student engagement and perspectives of the program. Overall, students felt uncomfortable with the flexibility and ambiguity of the medical humanities when compared to the rigidity of biomedical knowledge. Additionally, modes of assessment typically used in the humanities such as reflective writing were found to be unpopular. Students' involvement in the co-facilitation of classes helped develop communication skills and leadership but overall participation was still dependent on individual factors. Ultimately, the medical school and student body must work together to develop a medical humanities curriculum that is both complementary and viewed as of equal importance to the clinical curriculum.

The advent of artificial intelligence (AI) is radically transforming healthcare by introducing innovative tools that enhance diagnosis, personalized therapies, and medical training. However, this technological progress raises ethical and social questions, particularly regarding the centrality of human relationships in care. Medical Humanities (MH), a field combining the humanities and medicine, provide a critical framework to balance technological innovation and empathy. Through interdisciplinary approaches, MH fosters healthcare education that integrates technical expertise with humanistic sensitivity, preventing the dehumanization of care. In this context, narrative medicine emerges as a vital tool to emphasize patients' individual stories, with AI amplifying its impact through advanced data analysis. This article offers a conceptual analysis examines the dialogue between AI and MH, highlighting the challenges and opportunities of this synergy. It also discusses strategies to mitigate algorithmic biases and ensure an ethical and inclusive approach, envisioning a future where technology and humanity coexist harmoniously in medical practice. This integration is key to promoting patient-centered care while preserving the core values of therapeutic relationships.

There has been a shift of dynamic in the relationship between technology and healthcare, with technological advancements progressively driving change in the delivery of care and, at times, causing disruption to the traditional doctor/patient partnership. This shift is significant in the context of medical devices. Increasingly complex devices are being introduced which require a level of technical expertise outside of the scope of the traditional training of doctors, with this knowledge gap progressively filled by medical device representatives (MDRs), a role that began as devoted to sales and has now expanded to that of adviser and trainer. This change in role represents a blurring of lines between sales and support and has potentially flourished within a regulatory gap. This paper addresses the challenge of the evolving relationship between MDRs, surgeons and patients and is based on the findings of a broader project "Support or Sales? Medical device representatives in Australian hospitals". It provides an overview of the outcomes of a series of interviews with stakeholders highlighting their perceptions and experiences at this point of intersection between care and sales. It then examines the existing regulatory framework and considers whether there is a real or perceived regulatory gap. This analysis of current regulatory measures in areas such as hospital safety, privacy and professional regulation and conflicts of interests, leads to a conclusion that the evolving relationship between MDRs and surgeons has not taken place in a regulatory vacuum and sufficient frameworks are in place to protect the public. However, they rely heavily on translation into local policies and concurrent adaptations to best practice behaviour which does appear to be lagging, resulting in insufficient transparency and recognition of emerging contexts requiring novel applications. This lag could threaten patient safety and patient trust in the healthcare system.

This article challenges a subtle critique of ectogenesis-what I call the "social coercion argument" (SCA). The SCA holds that if ectogenesis becomes a standard gestational option, those who prefer pregnancy might be pressured into adopting it, thereby infringing on their autonomy and reinforcing inequality. On this view, ectogenesis might not be a morally sound solution to gender inequality. I first analyze the SCA within the liberal framework that underpins it. While its descriptive claim-that future women who prefer pregnancy may face pressure-may be valid, it cannot justify discounting the emancipatory potential of ectogenesis. I then examine some women's preference for pregnancy over ectogenesis through feminist insights into adaptive preferences (APs). I argue that such preferences may be harmful and shaped by injustice, suggesting that gestational preferences are dynamic, and that addressing gender inequality requires strategies beyond cultural and social inclusivity. I conclude that the SCA's core concern should be separated from the ethical evaluation of ectogenesis and addressed by continually "levelling up" choices.

While on the surface the rapid adoption of generative artificial intelligence (AI) in healthcare signals a new technological innovation that may sideline the social sciences, arts, and literature comprising the medical humanities, we argue that one way to understand the applications of AI based on large language models (LLM) in healthcare is as a deeply narrative project. LLM-based AI endorses narrative and humanistic value insofar as it is trained on vast amounts of narrative data as inputs and generates outputs in narrative formats. We contend that the medical humanities, rather than being replaced by AI in healthcare, are all the more essential to understand the practical and ethical opportunities and constraints for responsible use and integration of such tools. By analyzing two case studies of generative AI in healthcare reported in literature, we show that narrative medicine and the medical humanities provide crucial theoretical frameworks and disciplinary skills to assess, integrate, and critique the roles and impacts of such technologies in healthcare. Rather than offsetting narrative practice via AI, responsible use of LLM-based AI in healthcare requires attention to the functions of narrative in medicine and the importance of the medical humanities.

This article illustrates the contribution of Chinese philosophy to the field of medical humanities by focussing on the ideas and conduct of Confucius. Drawing on a Chinese philosophical classic, the Analects (Lunyu), this study proposes a Confucian reinterpretation of Beauchamp and Childress' principle of respect for autonomy in medical ethics. The paper begins by critiquing Beauchamp and Childress' three conditions of autonomous action, namely intentionality, understanding, and the absence of controlling influences that determine one's action. It is contended that the three conditions over-emphasise rationality and overlook the role of emotions and morality in autonomy. The second part of the article proposes a Confucian reformulation of the three conditions that is derived from the concepts of xin (heart-mind) and li (normative behaviour). The modified conditions are moral intentionality, the integration of understanding and emotions, and the absence of controlling influences that determine one's action and underlying values, beliefs, attitudes, feelings and predispositions. From a Confucian perspective, Beauchamp and Childress' positive obligation for the principle of respect for autonomy requires medical professionals to render empathetic treatment towards patients. By challenging and reconstructing major theories and assumptions in medical ethics, this paper demonstrates the saliency of non-Western philosophical traditions in medical humanities.

The aim of this article is to complicate and rethink histories of non-Western responses to vaccination, as well as to see how a historical perspective may contribute to contemporary discussions of vaccines within the medical humanities. This is done through a case study approach. The focus of this article is a collection of essays written by a Bengali prophet-astrologer and published during the plague pandemic in Calcutta, British India, at the turn of the twentieth century (1899). While one essay in the collection was critical of the plague vaccine, another essay, in a later section of the same collection, celebrated the vaccine and its developer Waldemar M. Haffkine. The first part of the article situates the context of the text's production, as well as the background of the author. In the second part, it analyses the reasons why the plague vaccine was criticised. In the third part, it looks at how the author celebrated the plague vaccine in a later section of the collection. In the fourth section, it attempts to answer why the astrologer changed his view on vaccination. Finally, in the conclusion, it discusses how this case study intervenes historiographically, and how certain themes raised by the source persist today, reiterating the importance of a historical perspective.

Thoracoabdominal normothermic regional perfusion (TA-NRP), a new method of controlled donation after circulatory death, seems to provide more and better organs for patients on organ transplant waiting lists compared to standard controlled donation after circulatory death. Despite its benefits, the ethical permissibility of TA-NRP is currently a highly debated issue. The recent statement published by the American College of Physicians (ACP) highlights the reasons for these debates. Critics' main concern is that TA-NRP violates the Dead Donor Rule. This paper presents an ethical analysis of the objections raised by the ACP against TA-NRP and argues that TA-NRP is not only morally permissible but also morally required where it is financially and technically feasible. To support this conclusion, the concepts of 'resuscitation,' 'intention,' 'irreversibility,' 'permanence,' 'impossibility,' and 'respect' in the context of TA-NRP are explored. Additionally, the ethical permissibility of this procedure is evaluated through the lenses of Utilitarianism, Kantianism, the core principles of bioethics, and the Doctrine of Double Effect. This ethical analysis demonstrates why the ACP's objection lacks a solid moral foundation and conflates moral and legal considerations. This paper also argues that extra measures are needed to ensure the moral permissibility of TA-NRP, emphasizing the importance of informed consent, additional brain blood flow and activity monitoring, and a contingency plan to abort the organ procurement process if a sign of morally relevant brain activity is detected.