Journal of Bioethical Inquiry最新文献

Ectogestation, also known as Artificial Womb Technology (AWT), is a revolutionary reproductive technology that is poised to be one of the greatest innovations of our time. However, like most novel technologies, the potential for egregious harm cannot be ignored. In the United States, a country plagued by racist, heteronormative, capitalistic ideology, ectogestation presents a gateway for the severance of parental rights for Black and marginalized pregnant people. Drawing on key scholarship, we first retell the historical devaluation of Black motherhood through social and legal avenues and then connect these to the disproportionality crisis in the Child Welfare system in the United States. Against this background, we then describe contemporary cases of women who were victimized by the medico-legal system, had their bodily autonomy violated, and had their children removed from their custody. We use these cases to demonstrate that the conditions necessary for ectogestation to be used for fetal removal are already in place. Ectogestation thus, can be used to further the separation of families and the severance of parental rights in marginalized communities. We then offer recommendations for preemptive action to prohibit the misuse of ectogestation should it become available in the future.

The partnership approach is part of a broader shift in healthcare that seeks to empower patients in their own care. Accompanying patients (APs) extend the concept of peer support. They are experienced patients who engage directly and individually with new patients, enhancing the partnership model. However, the ethical foundations of this role and the ethical tensions arising from its integration are underexplored. To identify the key skills and values required by APs and the ethical tensions they experience, we conducted a qualitative study based on in-depth interviews with nineteen APs between January and May 2021 in Québec, Canada. Interviews explored motivations, skills, values, and experiences in healthcare institutions. Thematic analysis was complemented by Tannahill's public health ethics framework to interpret the ethical tensions identified. The core values identified for this role were empathy, respect, and altruism. All participants agreed that experiential knowledge was paramount. APs identified independence from healthcare institutions as the key to connecting and developing a trusting relationship with patients. However, they also expressed a need to be part of the healthcare system to ensure the sustainability of their role. Our results show an ethical tension between the philosophical core of APs and their needs to pursue their functions. We conclude that independence and authenticity as an AP is not necessarily incompatible with institutionalization, professionalization, and remuneration. These can be achieved if AP programmes are aligned with the philosophy of patient partnership, structured with flexible criteria, and remain self-regulated.

Bioethics has become a crucial discipline in higher education. This study aims to understand the institutionalization of bioethics within this field and examine documented initiatives related to its integration. To achieve this, a systematic mapping was conducted using Petersen and Kitchenham's methodology, analysing 444 relevant articles. The results indicate a higher concentration of studies addressing the institutionalization of bioethics at the undergraduate level (40.5 per cent), with fewer publications focused on the postgraduate level (19.4 per cent). Most of the studies are concentrated in the health sciences (81.3 per cent), while the remainder are distributed among the social sciences, humanities, biological sciences, and engineering. The analysis revealed a significant lack of studies on comparative practices and the use of replicated experiences (2 per cent), as well as limited evidence on the institutionalization of bioethics research in higher education (10.3 per cent). These gaps underscore the need for further research in these areas. Additionally, the integration of active methodologies and educational technologies has enhanced bioethics programmes (21.4 per cent), fostering more interactive and engaged learning environments. This study highlights a critical gap in the implementation of bioethics based on empirically validated experiences. It proposes the development of an implementation model that adapts these experiences to different educational contexts. Cooperation between institutions and the creation of research networks are recommended as key strategies for sharing best practices, thereby facilitating the more effective and widespread integration of bioethics across various educational settings.

Social egg freezing (SEF) refers to the act of a woman's voluntary decision to preserve her eggs for future use. It is considered an expression of her right to bodily autonomy, allowing her to make decisions about her own reproductive capacity. As a form of exercising personal rights, SEF is aimed at preserving or extending fertility. Owing to the difference in attributes between it and the traditional "medical act," SEF has sparked significant controversies in the academic world that remain unresolved. These debates stem from uncertainty and are often framed through the lens of consequentialist theory-focusing on potential social, ethical, or medical outcomes. For SEF, a more appropriate position should be taken, based on the theory of rights. This perspective centres on the individual's legitimate claim to exercise bodily autonomy, particularly in relation to their reproductive potential. SEF is essentially a specific claim by a woman to exercise her right to control her own body as a means of realising her autonomy over her own eggs. To avoid the abuse of SEF, necessary legal regulations should be put in place.

Even though the last war between Tangata Whenua and the Crown ended over 150 years ago, Tiriti obligations and the rights of Tangata Whenua remain largely unaddressed. Significant disparities persist, with limited discourse on effective solutions. The recently introduced Principles of the Treaty of Waitangi Bill highlights enduring challenges in honouring Te Tiriti o Waitangi. This manuscript examines Te Ao Māori (the Māori worldview) and Western worldviews in Aotearoa, exploring their profound cultural differences and implications for relationships between Tangata Whenua and Tangata Tiriti. We highlight the holistic, interconnected nature of Te Ao Māori, rooted in whakapapa, and contrast this with the rationalism and compartmentalization of Western traditions. To bridge these worldview differences, we propose a relationship framework grounded in Te Tiriti o Waitangi to promote equitable, respectful partnerships. This framework addresses power imbalances and advocates for a two-worldview methodology that honours the mana of both perspectives. By integrating these approaches, we identify pathways for building stronger, inclusive relationships. This pluriversal approach respects the integrity of both worldviews and offers a foundation for coexistence rooted in mutual respect.

Patients seeking to access voluntary assisted dying (VAD) are necessarily at the end of their lives. Hence, they are likely to be concurrently receiving care from institutions (community nursing services, health services, palliative care services, and aged care facilities) with different levels of participation in VAD. This article reports on the various institutional approaches to VAD based on eighteen semi-structured interviews with regulators from Victoria and Western Australia, representing fifteen institutions with varying levels of support for VAD. We generated five main themes from reflexive thematic analysis of the interview data: settling on a position; operationalizing a position and determining level of involvement; local policy decisions on specific VAD activities; transparency; and navigating pluralism and accommodating diverse views. Overall, our findings revealed significant diversity in how institutions approached various VAD activities and that an institution's position on VAD (whether it supports it or not) does not necessarily indicate the extent to which it will facilitate access to VAD. These findings may have relevance for institutions seeking to implement (or revise) their approach to VAD and suggest that greater transparency about institutional approaches to VAD is needed to enable people to make informed decisions about where to seek care.

The use of suicide risk assessments in individual psychiatric treatment is widespread and, in many countries, mandatory. However, these assessments exhibit poor predictive accuracy and offer limited clinical value. This raises the question of whether non-medical reasons underpin their continued use. In this paper, suicide risk assessments are interpreted as medical rituals-formalized, repetitive behaviours imbued with symbolic significance that fulfil social functions. Several such functions are proposed, including uniting care providers around shared values in suicide prevention, fostering a sense of safety and control over suicidal behaviour, projecting accountability, and signalling to the public that action is being taken. However, this practice may inadvertently lead to an increase in non-beneficial compulsory admissions, flawed prioritization of patients, and the proliferation of defensive medicine. While the ritualistic use of suicide risk assessments may serve important societal purposes, their potential to harm individual patients renders them indefensible from a medico-ethical standpoint.Instead, evidence-based suicide preventive interventions are recommended. These include implementing general safety measures, equipping psychiatric patients with safety plans, and providing effective mental health treatment according to medical needs.

Why is healthcare "special" to the extent that it should be distributed more equally than other social goods, as a matter of justice? Norman Daniels claims that healthcare is special because it protects the normal range of opportunities available to us, and therefore can be subsumed under a principle of justice which establishes that opportunity ought to be equally distributed. I argue that subsuming healthcare under such a principle leads to de facto discrimination against certain people in virtue of their healthcare needs. This is because-as a critical discussion of health and healthcare needs importantly illustrates-much of the healthcare that people need simply cannot or does not protect normal species function and therefore does not protect opportunity. And so, such healthcare needs go unfairly unmet on Daniels' view. Instead, I suggest that we ought to subsume healthcare under a principle of equally distributing the social bases of self-respect. Though the healthcare that many of us need cannot protect opportunity, it can still protect our sense of self-respect; as such, those who need such care are entitled to it as a matter of justice on the self-respect view. The self-respect view thus avoids de facto discrimination and ultimately meets healthcare needs more fairly. And because it does so by eschewing a controversial conception of health and healthcare, instead appealing to a conception that appears freestanding with respect to the doctrines that citizens might reasonably disagree about, it better satisfies the requirements of public justification.

Prescribing antidepressants and benzodiazepines for patients with emotional distress is a common practice in primary healthcare that raises certain ethical questions. This paper has three aims. First, to describe the motivations that lead general practitioners to prescribe antidepressants and benzodiazepines in these cases. Second, to reflect on the ethical implications of such prescriptions based on the four principles of biomedical ethics defined by Beauchamp and Childress (autonomy, nonmaleficence, beneficence, and justice). Finally, to propose some recommendations for the mitigation of the medicalization of emotional distress in primary healthcare. Results show that general practitioners seek to alleviate patients' suffering but their prescribing decisions are influenced by some uncertainties in clinical judgement as well as by systemic factors (patients' pressures, time constraints, and unawareness of resources). Ethical issues arise in relation to the potential for dependence, the questionable long-term benefit of prescriptions, the uncritical fulfillment of patients' expectations, and the impediment to address underlying social issues or to develop patients' capabilities. Clinical consultation should be founded on effective communication between doctors and patients and a holistic care approach that acknowledges the psychological, social, and existential dimensions should replace a merely symptomatic approach. Some strategies to mitigate medicalization are proposed: the promotion of regular monitoring visits with patients and multidisciplinary collaboration, the enhancement of physicians' knowledge about non-pharmacological interventions, as well as the establishment of an evidence-base for the effectiveness of these drugs in the primary healthcare setting.

Irreversible alterations to the form and function of youths' physical bodies before sexual maturity, and particularly, the potential foreclosure of youths' fertility options via long-term puberty suppression, is a reason oft-raised in resistance to the provision of puberty blockers (PBs) for minors. Despite the pervasiveness of such assertions by lawmakers and other authorities, the concept of the foreclosure of transgender youths' future has been subject to surprisingly little philosophical scrutiny in bioethical literature. Joel Feinberg's "right to an open future" theory provides a foundation for other discussions about childcare decision-making, such as the choice to raise children in a particular religion or to foster their musical talents over their sporting ones. However, relatively fewer attempts have been made to apply Joel Feinberg's "right to an open future" theory to paediatric transgender medical decision-making. In this article, I consider the relevance of Feinberg's theory to the context of pubertal suppression for transgender youth and advance in this article reasons why transgender youth should be allowed to make their own decisions about the commencement of puberty suppression to a maximally feasible degree, in order to safeguard their physical health, mental health, autonomy, and capacity for future self-fulfilment.