Journal of Bioethical Inquiry最新文献

In the context of the current war, the question "Is the Israeli state effecting genocide in Gaza?" suggests a threshold legal excursus, a definitional contestation, or a cry of moral outrage. This article does not take any of those paths. It lives the pain of the unethical deaths of tens of thousands of civilians in Gaza, while beginning the longer-term task of seeking a way beyond deploying the concept of "genocide" as a performative gesture of shock and horror. The article argues that the meaning of genocide is being emptied out by an unsettling of the grounding conditions of political debate and the relativization of political language. While the evidence is strong that crimes against humanity are being perpetrated in Gaza, both by the Israeli state in its attack upon civilians and by Hamas in holding hostages, the provisional ruling by the International Court of Justice that there is a case to be answered is the most resolute that we can be at this point. Clearly, the war has to stop. In the meantime, the article suggests an alternative way of naming the horror.

Suffering is an elusive aspect of healthcare, erroneously assumed to be located solely within the patient in the clinical encounter-an assumption that fails to acknowledge the pervasiveness of suffering endured by the physician. This flawed perception is morally problematic in the context of treating contested invisible disabilities (CIDs), which are often associated with medical ambiguity and uncertainty. In this paper, we argue for a relational reconceptualization of suffering in the context of CID to promote more effective care and improved physician-patient relationships. We propose, through the lens of an ethics of care, that a relational ontology of suffering makes salient certain aspects of patient-physician relationships that co-produce suffering, such as professional incompetence, empathetic distress, and epistemic and hermeneutic injustice, rendering the experience of having and treating a CID more visible. We then discuss the important implications of this understanding for this invisibly disabled identity and the therapeutic alliance between physician and patient and explore the potential of narrative-based medicine to better equip physicians with the knowledge, guidance, and skill to fulfil their ethical responsibility to care for and respond to not only the suffering of this population, but their own suffering as well.

Background: In Italy, clinical ethics is not well institutionalized. On February 7, 2023, the Italian Ministry of Health published four long-awaited decrees regarding the reorganization of ethics committees.

Aim: The aim of this article is twofold: firstly, we aim to briefly summarize the development of clinical ethics in Italy from a legislative point of view; secondly, we aim to examine how Italian regions are implementing the part of the new decrees on the organization of ethics committees that concerns clinical ethics.

Methods: As for the first aim, we conducted a critical interpretive review (CIR). The search was restricted to the opinions offered by the Italian National Bioethics Committee (CNB) and to the major Italian legislative decrees on the topic. Regarding the second aim, we conducted an online search through Regional Official Bulletins of each Italian region.

Results: Our analysis showed that despite the recommendations from the CNB to differentiate Research Ethics Committees (RECs) and Clinical Ethics Committees (CECs), over the years legislative attention has mainly focused on RECs and pharmacological matters. The new decrees allow regions to be flexible in organizing their activities. However, it emerged that only four regions (Veneto, Friuli-Venezia Giulia, Puglia, Emilia-Romagna) have split the roles, while all the other regions have entrusted both roles to a single committee.

Conclusion: The risk for Italy is to take a step backward in the development of clinical ethics. Possible solutions could be either making Local Ethics Committees (CELs) mandatory or institutionalizing Ethics Consultation services (ECSs).

Non-communicable (chronic) and communicable (infectious) diseases constitute the leading causes of death worldwide. They appear to impact populations in developed and developing nations differently with changing trends in the landscape of human conditions. Greater understanding of changing disease burdens should influence the planning of health programmes, the implementation of related interventions, and policymaking efforts on a national and global scale. However, the knowledge of disease burdens does not reflect how states and global health organizations prioritize their efforts in addressing them. This work aims to address the discrepancy in public health priority setting by improving our understanding of how the two disease categories impact the human condition. It reviews two case studies, COVID-19 and type 2 diabetes, as representative cases of an infectious and a chronic disease, respectively, to answer the following question. How does biopolitics, as the governance of human bodies, at the nexus of infectious and chronic disease, impact national and global public health priorities? This work contextualizes and reframes the relationship towards disease categories by focusing on three primary themes: risk, current public health interventions, and funding priorities for each case study analysed. It argues that the politics over life at the nexus of chronic and infectious diseases, best conceived as future-oriented economic optimization, directs the efforts of prioritization in healthcare based on risk and responsibility-based relationship between multiple stakeholders.

We argue that Aged Residential Care (ARC) facilities should be allowed to create and adopt an informed "No Chest Compression" (NCC) policy. Potential residents are informed before admission that staff will not provide chest compressions to a pulseless resident. All residents would receive standard choking care, and a fully discussed advance directive would be utilized to determine if the resident wanted a one-minute trial of rescue breaths (to clear their airway) or utilization of the automatic defibrillator in case of arrest. The benefits of chest compressions for residents in ARC are dubious, and the burdens are high. For frail elderly people without a pulse, chest compressions are arguably unethical because the chance of benefit is minuscule, the procedure is violent, painful, and challenging to perform correctly, and procedures detract from a peaceful end of life. These burdens fall on residents, their families, ARC facilities providers, and society. We further argue that limitations on universal invasive resuscitation, such as advance directives, need to be more consistently sought and applied. The goals of an informed NCC policy are twofold: removing added suffering from a person's end-of-life experience and increasing ARC residents' understanding of the burdens of ineffective treatments for pulselessness.

This short perspective piece argues that wars are often conducted in settings where ethical injunctions are ignored or overridden and where ethical oversight is avoided or circumvented. This is particularly the case with intrastate conflicts and is exacerbated by novel military technologies. In these and other settings ethics is often invoked actually to promote or prolong war.

Scholars usually distinguish between testimonial and hermeneutical epistemic injustice in healthcare. The former arises from negative stereotyping and stigmatization, while the latter occurs when the hermeneutical resources of the dominant community are inadequate for articulating the experience of one's illness. However, the heuristics provided by these two types of epistemic predicaments tend to overlook salient forms of epistemic injustice. In this paper, we prove this argument on the example of the temporality of patients with drug dependence. We identify three temporal dimensions of epistemic injustice affecting drug-dependent patients: the temporal features of their cognitive processes, their individual temporal experience, and the mismatch of social temporality. Notably, the last aspect, which highlights the disparity between the availability of care and its accessibility, does not fit neatly into the categories of testimonial or hermeneutical injustice. (We should note that the International Network of People Who Use Drugs (INPUD) and The Asian Network of People who use Drugs (ANPUD) consider the term "drug addiction" to be associated with disempowerment and negative stereotyping. Instead, they suggest the expression "drug dependence" (INPUD 2020). However, the concept of "drug addiction" is still being used in the current public health, philosophy, and sociology debates that concern the specific field of addiction studies. Replacing the notion of drug addiction with "drug dependence" would not eliminate existing epistemic injustices or allow us to avoid creating new ones, such as those related to ignoring pain claims (O'Brien 2011). Still, for the sake of clarity we will use the notion "drug dependence" when speaking of people while retaining the term "drug addiction" for labelling healthcare practices and the topic for philosophy of healthcare.).

This paper sets forth and defends a pluriversal approach to religion in the context of an increasingly global bioethics. Section I introduces a pluriversal view as a normative technique for engaging across difference. A normative pluriversal approach sets five constraints: civility, change from within, justice, non-domination, and tolerance. Section II applies a pluriversal approach to religion. It argues that this approach is epistemically just, recognizes diverse standpoints, and represents a productive, preferred, way to tackle global bioethics concerns. Section II also considers an opposing viewpoint, which holds that religious perspectives have no place in bioethics. We show that this viewpoint would have adverse effects on bioethics publishing, conferencing, and training programmes. The paper concludes (in Section III) that bioethicists should engage with people who hold different worldviews, including religious worldviews, and should do so in accordance with pluriversal ethical constraints.

The COVID-19 and Monkeypox pandemics and the ongoing Marburg outbreak in Rwanda provide a stark reminder of the importance of espousing a One Health (OH) approach to zoonoses as well as other public health and global health issues. Recent years have in fact seen an exponential rise in biomedical and public health journals and publications explicitly adopting the name of OH. Not all research that pertains to be OH however is indeed OH research, insofar as it does not comply with the proclaimed OH goals of benefiting humans, animals, and the environment. Thus, to ensure such compliance a checklist or toolkit for an ethical analysis of research in OH (EAROH) should be required prior to publication in scientific journals or grant applications. Such a toolkit should be developed by a working group of scholars with expertise in OH ethics, animal ethics, and environmental ethics.