Monash Bioethics Review最新文献

One important role the medical humanities might and should play relates to public education. In this instance, we mean helping persons to think about their own aims or purposes as potential receivers of enhancement interventions, and similarly helping to inform the developers of said interventions. This article argues that, in the light of real and speculative applications of emerging biotechnologies and artificial intelligence aimed at human enhancement-including germline genetic engineering, the linking of the human brain with an artificial general intelligence by way of a brain-computer interface, and various interventions directed toward life extension-historians would do well to consider the following three practices as they participate in the medical humanities and the shared task of public education: (1) Taking under scrutiny a broad swath of topics and timeframes as it relates to past efforts aimed at human enhancement; (2) Focusing on past engagement with enhancement efforts and their perceived relation to the pursuit of living well; and (3) Entering into debates on enhancement as equal participants. In support of these assertions, this article takes efforts directed towards the prolongation of life in medieval Europe as an illustrative example. It also highlights continuities and discontinuities between past and present justifications for human enhancement, and addresses how similarities and differences can shape and challenge contemporary bioethical arguments.

Children with complex care needs lack access to Specialized Pediatric Palliative care in Canada. At the same time, death is increasingly being handled in a mechanized and specialized manner, with hospitals becoming the expected place for death to occur. Although this is true for some children, the meaning of dying and death is obscured for dying children in Canadian healthcare. Specifically, discussions about dying and death, what they are and what they mean to children are relatively absent in Canadian healthcare contexts. This lack of death talk is a problem for children with medically complex conditions and their families since death is a part of living, and palliative care is essential for children who are living and dying with medical complexity. To address the health disparity that these children face concerning access to pediatric palliative care and having honest conversations about death, it is essential to attend to the bioethics and care frameworks undergirding pediatric healthcare to understand how the meaning of living, dying and death is being valued for this population. Subsequently, in this paper, we will explore a personalist bioethics approach to mitigate these end-of-life disparities.

Despite the rise of the medical humanities in general in recent decades, theological bioethics-during a very similar period of time-was marginalized from many central bioethical discussions. This is problematic for a number of reasons. First, because theologians invented the discipline of bioethics and deserve a place at the table. Second, because the marginalization is often ideologically motivated. And third, because the vision of the human person that theologians bring to the table is essential for understanding the moral status of the proundly disabled.

This paper challenges the typical function of narrative in the medical humanities to advocate for a medical posthumanities: an approach that destabilizes the centrality of "the human" and instead embraces patient narratives that are embodied, fragmented, and provisional. To make this claim, we first challenge the stability of the "humanity" described in the "medical humanities" and reiterated in the genre that we call "the medical romance." In this genre, illness and suffering destabilize a sense of identity and coherence, which is then restored through introspection and interpretation of the patient narrative. To challenge this genre, we turn to surface reading, a literary studies technique that sees traditional interpretation as too hurriedly foreclosing on meaning. Through a close reading of Franz Kafka's The Trial and Henrik Ibsen's Hedda Gabler, we demonstrate both what surface reading looks like and also how it embraces generic and interpretive instability. Finally, we focus this approach to narrative on physician-assisted suicide (PAS), particularly attending to PAS and disability, to argue that both medical romance and its entailed traditional narrative interpretation overvalue "the human" as an agential individual seeking a "good death." This at once affirms the tendency to encourage the allegedly meaningful death of disabled people by PAS, and also excludes from narrative focus the structural and environmental sources of suffering. The medical posthumanities, in its attention to embodiment, networks, environment, and the decentralizing of individual agents, would better make room for patient narratives that value the messiness and interconnectedness of lived experience.

Ethics are concerned with maximising the thriving of individuals and societies. One cannot maximise the thriving of a person unless one has some idea about what sort of creature that person is. Ethics follow ontology. Many answers have been suggested to the question 'What is a human?' and the less fundamental question 'What are the defining attributes of a human'? Many of those answers are theological, and hint that the essence of a human is indefinable; that humans are unknowable, contradictory and mysterious. This article contends that, since behaviourally modern humans have been hunter-gatherers for an overwhelming proportion of their history, we are still foundationally hunter-gatherers, and that accordingly useful insights into our constitution can be gained by examining the quintessential characteristics of Upper Palaeolithic people. Those characteristics are wandering, a relationship with the non-human world, consciousness, story-telling and a consequential ethical sense, a metaphysical instinct, and an operating system based on symbolism and metaphors. Those characteristics (many of which overlap with the conditions of human thriving described by Martha Nussbaum) have ethical corollaries. The article builds on the work of Peter Hacker in contending that it is not only legitimate but necessary to derive ethics from biology and evolutionary history. Humans emerge from this examination, as they emerge from theological speculation and from the work of most creative artists, as unfathomable. The mysteriousness of humans is a reason for according them moral weight. The article suggests that ethicists should take the lead from creative artists, not vice versa.

Children with complex medical conditions including those with severe intellectual disability are living longer. For some, support with medical technology such as Long-Term Ventilation can prolong their lives further. Such technological supports can have significant implications for the child and her family and consume considerable resources though they can also offer real benefits. Sometimes clinicians question whether children with very severe cognitive impairments should have their life prolonged by technology, though they would be prepared to provide the same treatment in equivalent cases without cognitive disability. We describe and analyse four ways in which this view might be justified. Although it could be claimed that children with severe cognitive disability have lives that are not worth living, in most cases this view can and should be rejected. However, the burdens of life-prolonging technology may outweigh the benefits of such treatment either in the present or in the future. Consequently it might not be in their interests to provide such technology, or to ensure that it is provided as part of a time-limited trial. We also consider circumstances where medical technology could offer modest benefits to an individual, but resources are scarce. In the face of resource imitation, treatment may be prioritised to children who stand to benefit the most. This may in some circumstances, justify selectively withholding treatment from some medically complex children.

Healthcare delivery and access, both in the United States and globally, were negatively affected during the entirety of the COVID-19 pandemic. This was particularly true during the first year when countries grappled with high rates of illness and implemented non-pharmaceutical interventions such as stay-at-home orders. Among children with special healthcare needs, research from the United Kingdom (U.K.) has shown that the pandemic response uniquely impacted various aspects of their care, including decreased access to care, delays in diagnosis, and poorer chronic disease control. In response to these findings, and to begin to comprehend whether the concerning findings from the nationalized system of healthcare in the U.K. extend to the highly dissimilar United States (U.S.) healthcare context, we reviewed the literature on alterations in access to and delivery of care during the early stages of the COVID-19 pandemic for children with special healthcare needs in the U.S. We then utilize these findings to consider the ethical and policy considerations of alterations in healthcare provision during pandemics and crisis events in the U.K. and U.S. and make recommendations regarding how the needs of CSHCN should be considered during future responses.

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.