Medicine Health Care and Philosophy最新文献

This paper analyses the information disclosures in two biobank consent documents used by biobanks operating under the General Data Protection Regulation (GDPR). The aim of the analysis is to investigate how these documents inform potential sample donors about possible future uses of biobank data. The findings suggest that the consent documents provide potentially misleading information regarding the range of possible future uses of biobank data. Based on these information disclosures, potential sample donors may reasonably believe that the data can only be used for a narrowly defined range of research purposes. However, the range of lawful uses of the data is much broader and less clearly defined. Consent provided based on misleading information is not morally transformative, even if it were legally valid. To facilitate morally transformative biobank consent, this paper provides two recommendations for information disclosure to potential sample donors regarding future uses of biobank data: first, potential sample donors should be informed about the legal scope of consent; and second, they should be informed about the full range of lawful uses of biobank data.

Bioethics has developed approaches to address ethical issues in health care, similar to how technology ethics provides guidelines for ethical research on artificial intelligence, big data, and robotic applications. As these digital technologies are increasingly used in medicine, health care and public health, thus, it is plausible that the approaches of technology ethics have influenced bioethical research. Similar to the "empirical turn" in bioethics, which led to intense debates about appropriate moral theories, ethical frameworks and meta-ethics due to the increased use of empirical methodologies from social sciences, the proliferation of health-related subtypes of technology ethics might have a comparable impact on current bioethical research. This systematic journal review analyses the reporting of ethical frameworks and non-empirical methods in argument-based research articles on digital technologies in medicine, health care and public health that have been published in high-impact bioethics journals. We focus on articles reporting non-empirical research in original contributions. Our aim is to describe currently used methods for the ethical analysis of ethical issues regarding the application of digital technologies in medicine, health care and public health. We confine our analysis to non-empirical methods because empirical methods have been well-researched elsewhere. Finally, we discuss our findings against the background of established methods for health technology assessment, the lack of a typology for non-empirical methods as well as conceptual and methodical change in bioethics. Our descriptive results may serve as a starting point for reflecting on whether current ethical frameworks and non-empirical methods are appropriate to research ethical issues deriving from the application of digital technologies in medicine, health care and public health.

Delivering healthcare to undocumented migrants presents a complex challenge for healthcare providers. Integrating advocacy efforts into their daily practices can be ambiguous in practical terms, stemming from the intricate task of addressing the health needs of this population while simultaneously advocating for their health rights within the constraints imposed on them. This study seeks to consolidate findings from literature regarding the advocacy approaches employed by healthcare providers and the correlated ethical challenges. We conducted a scoping review of qualitative literature by systematically searching four databases-PubMed/Medline, Embase, Cinahl, and Cochrane Library. For developing our search strategy, we employed the PICO (Population, Intervention, Comparison, Outcome) scheme. Our analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman. 30 studies were included, revealing a cumulative total of 915 healthcare providers who were interviewed. A total of 30 themes emerged comprising 14 advocacy approaches and 16 ethical challenges. Healthcare providers made a deliberate choice to engage in advocacy, responding to injustices experienced by undocumented migrants. The spectrum of advocacy initiatives varied, encompassing voluntary participation in healthcare provision, empathetic understanding, and healthcare-focused strategies. We also identified numerous correlated ethical challenges, necessitating healthcare providers to strike a balance between their eagerness to assist and their professional competence, respect the autonomy of undocumented migrants, and establish trust with them. These findings not only offer practical guidance for healthcare providers to enhance accessibility to healthcare services for undocumented migrant patients but also foster awareness of the ethical challenges that may arise in their advocacy roles.

Especially older adults are increasingly stimulated to think about, talk about and record their preferences with regard to future (health)care decisions, preferably in a pro-active manner. In this paper, I analyse these anticipatory choice processes. My goal is twofold: Firstly, to provide a deeper understanding of what it actually means to decide in advance about end-of-life treatments or options. Secondly, to make a theoretical contribution to bioethics and ACP-theories by rethinking the concept of end-of-life choices from a phenomenological viewpoint. To achieve this, I start by presenting a case narrative that elucidates how these anticipatory choices are lived. Secondly, I map out a theoretical framework about choice based on the phenomenology of the will of Paul Ricoeur. Finally, guided by this Ricoeurian framework, I investigate the potential meaning of choice in the context of contemporary advance care planning trajectories. The analysis demonstrates that choice and agency always imply notions of passivity and uncontrollability. It also indicates the significant value of hesitation and ambivalence. Moreover, it highlights the importance of the notion of co-responsibility in the context of anticipated end-of-life choices, and the relevant distinction between a (willed) choice and a wish. To improve care and support regarding end-of-life trajectories and to promote meaningful conversations, it is imperative to integrate these underrated elements more substantially in our theories, language and practical approaches. I conclude by suggesting that, in order to do justice to the real-life complexities, we might even need to revise the notion of advance 'directives'.

Empirical research on moral injury (MI) has rapidly evolved since 2009. Originally developed to address the moral dimensions of traumatic experiences among US veterans, MI has also found application in the context of traumatized refugees. This paper delves into the ethical and epistemological questions that arise when applying a concept originally rooted in a qualitatively distinct experience and a demographically different population to refugees. It is argued that the prevailing clinical and psychological conceptualization of MI may not adequately accommodate the unique needs and experiences of refugee populations. This examination underscores the imperative of conceptualizing to better serve the ethical and epistemic demands of refugee communities.

Recent publications on digital health technologies highlight the importance of 'responsible' use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted a scoping review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher's Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing 'role responsibilities' among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a 'responsibility gap' where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients' accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health.

The present paper highlights the urgency for a revitalization of the field of bioethics. The authors have identified the "malaise" present in contemporary bioethics, and they claim that it has become a boring way to approach medicine and life sciences instead of challenging them. Starting from a brief explanation of the origin of bioethics, this paper analyzes the main issues at the core of its malaise, i.e., its depersonalization and extreme specialization which exclude of a holistic view of the patient. Clinical ethics, an applied branch of bioethics, provides a prime example of a bioethical discipline that operates in real-world contexts, and it contrasts with the more theoretical nature of traditional bioethical frameworks. Thus, the inherent multidisciplinary nature of clinical ethics offers an opportunity to a way of connecting the hard and soft sciences, and, ultimately, of transcending this distinction in the medical humanities. The cure of the malaise of bioethics proposed in this article comes from the medical humanities, specifically from the applied humanities perspective, which offers a comprehensive approach to current world issues, including the fast evolution of technologies with applications to the health field.

Some philosophical and metaethical theories have tried to provide a fundamental background for bioethics but miss the fundamental question about what medicine is, its nature and its end. We argue that the philosophy of medicine, through the development that Edmund Pellegrino and David Thomasma gave to this field of study, allied with Aristotle's practical and teleological ethics, can provide an ontological background for bioethics beyond the tradition of principles and deontology, with particular emphasis on the uniqueness of the doctor-patient encounter. Some difficulties and criticisms of this ontological model are also examined.

Saving as many lives as possible while ensuring equity for vulnerable groups through access to triage resources has been the dominant position since the onset of the COVID-19 pandemic in 2020. However, the exact relationship between the principles of social justice and efficiency remains a controversial and unresolved issue. In this paper, we aim to systematically distinguish between different models of this relationship and show that conceptualizing social justice as a 'moral side-constraint' or adopting a 'balancing approach' that attempt to reconcile social justice with efficiency inevitably lead to significant moral costs that require further justification. Based on this discussion, we propose a novel "threshold model" for trading-off moral costs. According to this model, the structural impact of triage must be considered in order to determine whether one opts for triage with the primary aim of efficiency or social justice. This contextualization further explains why, in some societies and circumstances, social justice can rightly be seen as the primary concern, while in other societies and circumstances, efficiency can be defended as the primary concern.

False hope is costly for individuals, their loved ones, and society. Scholars have defined false hope as one that involves an epistemically unjustified belief. In this paper, I argue that this account of false hope is incomplete and that false hope should be conceptualized in terms of the way in which the agent attends to or focuses on a highly desired but unlikely outcome. I explain how this account better captures the distinctiveness of false hope.