Hec Forum最新文献

One of the main objections to life extension is that life extension will cause severe overpopulation. This objection presents both moral and demographic issues. To explore the demographic issue, we present an updated and improved version of the formula in chapter six of New Methuselahs for projecting the demographic impact of life extension. The new version includes additional demographical factors such as non-aging related causes of death. According to projections generated with this revised formula, moderate life extension (a life expectancy of 120 years) will not significantly increase population at the fertility rates current in the developed world, but radical life expectancy (halting aging completely, leading to an average life expectancy of 1000 years) can lead to severe overpopulation even at very low fertility rates. This formula also enables us to ascertain what fertility rate and birth spacing will prevent life extension from causing severe overpopulation. The moral issues arise if radical life extension causes overpopulation severe enough to outweigh the benefits it brings. New Methuselahs proposed a reproductive policy for avoiding severe overpopulation by limiting reproduction for those who use life extension. We then consider a moral objection to this policy that was not discussed in New Methuselahs: it is not likely that society will succeed in imposing limits to reproduction, therefore, it is likely that radical life extension is morally wrong. We respond to this objection and defend our response against two further objections.

The concept ethics defines health care ethics as a professional practice. Yet the meaning of "ethics" is often unclear in the theory and practice of clinical ethics. Clarity on this matter is crucial for understanding the nature of clinical ethics and for debates about the professional identity and proper role of ethicists, the sort of training and skills they should possess, and whether they have ethics expertise. This article examines two different ways the ethics of clinical ethics can be understood: Real Ethics, which consists of objective moral norms grounded in moral truth; and Conventional Ethics, which consists of conventional norms grounded in bioethical consensus. Drawing on the bioethics literature and features of professional practice, it shows that Conventional Ethics is the dominant paradigm. Then it presents a critique of Conventional Ethics, arguing that it cannot avoid the challenge of moral pluralism, it fails to address vitally important moral questions, and it is incapable of providing an essential service to the people ethicists aim to help. It ends with suggestions about how the practice of clinical ethics might overcome these problems.

Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees' experiences of implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed.

In a November 2024 article of this journal Don A. Merrill suggested Tom Koch's (2023) article "A Skeptic's Report" either misunderstood or did not understand a "slippery slope argument". That article was an attempt to answer earlier authors who asked if the concerns of researchers prior to enabling legislation had been fulfilled. The "slippery slope" was one. In this article, the nature of those early concerns are again considered in relation to the nature of the "slippery slope event" that has resulted in an increasing annual number of deaths with progressively looser requirements for early medical termination. Like the original article, it uses Health Canada data to describe what has occurred, not a predictive argument on what may be.

Florida is currently collecting data on the "costs of uncompensated care for aliens who are not lawfully present in the U.S." (Statutes of Florida, 2023). The Florida data collection law, enacted in 2023, is part of aggressive anti-immigrant legislation. Hospitals accepting Medicaid must inquire about patients' immigration status and submit de-identified reports. In August 2024, the Governor of Texas signed an Executive Order comparable to the Florida statute. Although presented as a data-collection measure, the legal requirements have far-reaching consequences. The potential adverse impacts on immigrants' health pose bioethical concerns. Immigration-related inquiries create barriers to healthcare access and advance care planning, exacerbating healthcare disparities and presenting ethical concerns. This article examines the effects on immigrants and the resulting ethical challenges, including respect for persons, beneficence, non-maleficence, and justice. The article proposes recommendations for mitigating these challenges, including community outreach, patient education, policy development, in-service education, and advocacy. While the legal requirements apply specifically to Florida and Texas, the ethical issues have nationwide relevance.

Should we implement biomedical interventions like psychopharmaceuticals or brain stimulation that aim to improve morality in society? Since 2008, moral bioenhancement (MBE) has received considerable attention in bioethics, generating wide scholarly disagreement. However, reviews on the subject are few and either outdated or not structured in method. This paper addresses this gap by providing a scoping review of the last 15 years of debate on MBE (from 2008 to 2022). To enhance clarity, we map the debate into three key areas: the conceptual foundations of MBE (foundational questions), the practical feasibility of MBE (practical questions), and the normative legitimacy of MBE (normative questions). Beyond identifying specific research gaps within these domains, our analysis reveals a general lack of empirical evidence either supporting or opposing MBE, as well as a shift in the literature from a universal interpretation of MBE to a more pragmatic one, targeting specific groups.

Health care professionals experience moral distress due to challenging ethical decision-making during patient care. Self-awareness can be associated with moral distress. This study determined the levels of and relationship between moral distress and self-awareness of health care professionals. A convenience sample of physicians and nurses was recruited. Data were collected using the Moral Distress and Self-Awareness Scales. In total, 168 physicians and 201 nurses participated with a mean age of 30.54 ± 7.87 and clinical experience of 6.40 ± 6.22 years. Moderate levels of moral distress (127.07 ± 71.90) and high levels of self-awareness (70.20 ± 11.37) were found. A weak positive correlation was found between self-awareness and moral distress (r = 0.21, p < 0.001) and weak negative correlation between moral distress (r = - 0.115, p = 0.03) and age. Nurses were more self-aware, but no differences were observed in moral distress based on sex and clinical settings. A weak correlation between self-awareness and moral distress may suggest that self-awareness can increase intrapersonal tensions, contributing to distress. Further research is needed to support any conclusive relationship between moral distress and self-awareness.

In 2021, Canada revised its Medical Assistance in Dying (MAID) law, removing the "reasonably foreseeable death" requirement. Opponents of MAID voiced concerns about a "slippery slope" leading to broader access, with some arguing the line has already been crossed. I examine the arguments against expanded eligibility, particularly those presented by Tom Koch (2023). Koch's reasoning, I submit, is flawed, lacking nuance in its understanding of the slippery slope and relying on a problematic argument about healthcare access.

An essential element of determining surgical candidacy is an accurate understanding of the risks to a given patient. While surgeons remain largely responsible for the selection of their patients, and surgeons' intuition has been shown to be a good indicator of postoperative outcomes, the recent focus in medicine towards minimizing the impact of physician bias has spurred a push towards prioritizing risk assessment tools in candidacy decisions. This has rekindled the debate surrounding what should determine surgical candidacy. Risk assessment tools are proven to be moderately to highly accurate at assessing the risk due to objective and proven risk factors, such as the impact of age or comorbidities. However, they fail to account for the humanity of both the surgeon and the patient and do not measure less easily quantifiable risk factors, such as a surgeon's comfort with a procedure or a patient's health beliefs, when determining risk. In this project, we offer an ethical analysis that highlights these less acknowledged factors. We argue that these factors need to be given greater consideration in risk assessment and surgical candidacy decisions, as they too can affect postoperative risks and outcomes.

Certain moral beliefs and/or values about what is good or harmful can cause nurses and other healthcare professionals to object to participating in some clinical actions. Such objections are also called conscientious objections. Invocation of a conscientious objection (CO) can produce complexities in patient care and health care delivery and must be mindfully evaluated for its soundness. In this manuscript, a recently developed framework, The Ethical Evaluation of a Nurse's Conscientious Objection (EENCO), is applied to expose hidden elements and nuances in a proposed or actual CO by nurses or other healthcare professionals, thereby illuminating strategies that can lessen associated harms. The EENCO is utilized to explore two types of situations where a nurse makes a CO claim. Scenario 1 involves a nurse's reluctance to follow provider medication orders intended to relieve pain and suffering at the end-of-life. In scenario 2, nurses object to a visitation policy during the COVID-19 pandemic. Additionally, we provide a summary of the necessary elements of institutional policy to address claims of CO using the EENCO. Drawing on the EENCO, the two scenarios were analyzed for their ethical implications. This framework contributes to the exposure, scrutiny, and clarification of potentially unappreciated aspects of CO claims. Steps for developing institutional policy are identified. Application of the EENCO guides the analysis of the two scenarios. CO claims are explored more deeply, thereby revealing implications for those involved. Additionally, the EENCO provides guidance for the development of institutional CO policies.