Journal of Bioethical Inquiry最新文献

Codes of ethics have a long history in healthcare and, for many, are important documents. Codes however have also been extensively criticized for a range of reasons, from the guidance they provide to their meta-ethical assumptions. This review sought to explore the theoretical literature to critically examine the function of codes in healthcare, with a particular focus on their strengths and shortcomings in relation to these functions. A systematic search was combined with a critical interpretive review. The final sample included twenty-four papers. Results of this synthesis suggest that codes fulfil multiple purposes, from providing guidance on ethical issues, to assertions about acceptable and unacceptable behaviour, to establishing and maintaining the status and identity of the professions. Codes also fulfil a number of social purposes, conveying information to the public and others. The extent to which a code does each of these things varies substantially however. We discuss these functions in relation to the many critiques that have been advanced in relation to these documents. We then put these findings into conversation with the broader literature on codes and discuss the challenges that this presents for normative analysis, namely in needing to first identify what a code should do before assessing its shortcomings. If the primary purpose of a code of ethics is to provide guidance, many fail here, the devil is in the detail however. To what extent should codes provide guidance?

The rapid growth in psychedelic research raises novel ethical challenges for both research and psychedelic-assisted therapy. Despite these challenges, there is no consensus among researchers, clinicians, patients, and regulators on how these ethical issues may be avoided or managed. This study aimed to identify key ethical issues in psychedelic research and practice in the literature. A scoping review was performed, identifying fifty-one relevant articles. Content analysis revealed five main ethical concerns in the literature: 1) standards of practice, 2) equity, 3) integrity, 4) cultural appropriation, and 5) epistemic justice. A consultation workshop highlighted several key concerns that were neglected in the literature: 1) post-trial care, 2) lack of consensus on models of care and psychedelic practitioner competencies, and 3) how current research and its associated ethical issues will be translated into practice. Based on these findings the following future directions are recommended: designing clear competency frameworks, increased consultation with Indigenous and priority populations (e.g. ethnic and cultural minorities, under-served groups), guidelines for Indigenous recognition, management of post-trial care in clinical trials, and adequate governance of psychedelic prescribing practices.

In a world where physicians are experiencing unprecedented burn-out, our communities are progressively losing trust in the medical system, and healthcare costs continually increase to astronomical levels without improving outcomes, it seems clear that we need to make changes in how we care for our patients. Current healthcare conditions can evoke nostalgia for an idealized past, where physicians were valued members of their communities, making house calls, doing all they could to comprehensively support their neighbours in health and life. As a young physician who envisioned such a career where I could apply my years of hard work and studying towards helping those around me in their moments of greatest need, I often feel that the system we have built thwarts this ideal at every turn. Here I share a story from my intern year of training that marked me, demonstrating just how disconnected we are becoming from our patients. My story involves a clinical situation with which I believe many can relate, highlighting the dire need for us clinicians to care with more humanity.

Rationale: Persons with chronic pain report that their voices are marginalized in healthcare, despite efforts to achieve person-centred care.

Aims and objectives: This study aims to explore the healthcare experiences of persons with chronic pain through the lens of epistemic injustice to advance person-centred care.

Method: A secondary analysis of cross-sectional interviews with twenty German-speaking Swiss participants, originally collected as part of the DIPEx Switzerland project, was conducted. Data were examined using thematic analysis.

Results: Results revealed two overarching themes. Under Epistemic Challenges, participants felt dismissed, misunderstood, or relegated to passive roles by a system privileging quantifiable measures over subjective experiences. This overreliance on objective data fosters epistemic injustice by discounting patient testimonies and perpetuating systemic inadequacies. Under Epistemic Opportunities, participants reported more effective knowledge exchange when their expertise was acknowledged, empathy was shown, and professionals recognized their own limitations.

Conclusions: Findings underscore the need to balance objective assessments with patients' subjective perspectives, recognizing persons with chronic pains as legitimate collaborators. By integrating their lived expertise, healthcare systems may mitigate epistemic injustices and provide more empathetic, effective care.

Ethics in Pharmacy Practice: A Practical Guide offers a comprehensive and timely resource for navigating the complex ethical challenges faced by pharmacists. This book presents a thorough exploration of ethical decision-making through a blend of moral philosophy and real-world case studies, making it accessible to both students and practicing professionals. Divided into two sections, the text covers fundamental ethical principles, before delving into contemporary issues like reproductive healthcare, end-of-life decisions, vaccine ethics, and the ethical implications of emerging technologies. Its practical approach ensures that readers can apply these ethical concepts directly to their practice. Ideal for pharmacy educators and students, the book serves as both a textbook for academic study and a guide for addressing everyday ethical dilemmas. However, its coverage of rapidly evolving topics may require periodic updates to remain relevant. This work is an essential resource for those seeking to enhance their ethical decision-making skills in an ever-evolving healthcare environment.

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.

Memory modification technology (MMT) refers to the use of neurotechnologies to intervene in memories. Many scholars have reflected on the ethical issues in MMT, but a comprehensive review of this topic has not been seen. This article presents the first scoping review study of ethical issues in MMT using a bibliometric and systematic approach. After thorough examination, 133 records of key literature are included in this scoping review. Six core ethical themes are extracted: (1) self, identity, and authenticity; (2) autonomy and informed consent; (3) welfare and happiness; (4) safety and risks; (5) responsibility and obligation; (6) social and legal justice. More detailed analyses are conducted on the moral stances and reasons held by different scholars concerning these ethical themes. As can be seen, current debates exhibit certain shortcomings, including ambiguous ethical concepts and a restricted scope of analysis. Therefore, we call for deeper reflections on the philosophical foundations, more precise definitions of ethical terms, and more comprehensive examinations of neurotechnological applications, in order to better address the ethical challenges in the future.

Background Social workers (SWs) who support older people encounter ethical dilemmas and experience value conflicts when working with other professionals while fulfilling their responsibilities. We explored these experiences by interviewing SWs engaged in care for older people in Japan. Methods We conducted a qualitative interview survey with a targeted sample, employing a narrative analysis method. The participants included twenty-one SWs (four male, seventeen female) employed across acute-care hospitals, convalescent rehabilitation hospitals, home healthcare, and nursing homes. Results SWs described experiences of ethical dilemmas in supporting older people due to conflicting obligations and value priorities. They highly prioritize understanding the life backgrounds and values of patients to be able to discharge their duty to advocate patient autonomy and promote the best interest of the patients. However, SWs faced ethical dilemmas due to their responsibility to the organization, conflicting obligations toward the patient's family versus the patient's wishes, and differing prioritized values compared with medical professionals who prioritize the patient's physical function. Additionally, the relationship between SWs and medical professionals poses challenges in addressing these ethical dilemmas. Conclusion It is crucial to appreciate the significance of individuals from diverse professions by comprehending their respective roles and specialties, fostering equitable relationships, and capitalizing on their distinct expertise through collaboration.

Paediatric Intensive Care Units (PICU) are complex interdisciplinary environments where challenging, high stakes decisions are frequently encountered. We assert that appropriate decisions are more likely to be made if the decision-making process is comprehensive, reasoned, and grounded in thoughtful deliberation. Strategies to overcome barriers to high quality decision-making including, cognitive and implicit bias, group think, inadequate information gathering, and poor quality deliberation should be incorporated. Several general frameworks for decision-making exist, but specific guidance is scarce. In this paper, we provide specific guidance on collaborative complex decision-making for PICUs. The proposed approach is on principles of procedural justice and pragmatic hermeneutics. The process encompasses set-up/planning, information gathering, question formulation, analysis (perspectives, values, and principles), action plan development, decision documentation, and a review and appeal mechanism. The process can be adapted to suit other clinical contexts. Research evaluating the process, exploring how best to develop education for clinicians, and how to build a culture that values high quality deliberation, is worthwhile.

Political opportunism of the far-right threatens the efficacy of public health policies and political stability in general. In this commentary, we outline some of the ways that the European far-right has misused public health concerns as propaganda tools. This is a significant threat to the goals of making health and science more inclusive, and we recommend some policies for mitigating the racist effect of the far-right. Notably, we recommend (a) transparency in health policies and robust implementation of the rule of law, (b) the use of operative public values and human rights in health policy making, and (c) investment in decolonizing mindsets which may be corrosive of health policies.