Journal of Bioethical Inquiry最新文献

Health equity is a primary principle of healthcare delivery, aiming to ensure that all healthcare recipients have access to quality healthcare equally, regardless of their social, demographic, and economic characteristics. The current paper explores the role of nurses in advancing healthcare equity and quality of care. A scoping review was conducted to investigate the relevant international and national articles in major databases, including CINAHL, MEDLINE, Google Scholar, EBSCO, and SCOPUS, using relevant keywords such as "Health Equity," "Quality of Care," and "Role of Nurses." The review highlighted that, as nurses are the frontline healthcare providers in diverse healthcare settings, their roles extend beyond routine healthcare to incorporate more advanced roles in health education, advocacy, and support services, significantly improving access, quality, and equity in healthcare. Several barriers and issues have limited nurses' impact in reducing disparities, but other strategies could be employed to address them. They include telehealth and school-based health centrer. Nursing professionals are in an exceptional position to be transformative in achieving health equity and delivering good quality and accessible healthcare to all individuals and communities.

Patient and public involvement (PPI) with forced migrants can have positive impacts on health research, but empirical knowledge on the ethics of involving forced migrants is scarce. Unsolved ethical issues risk hindering meaningful involvement and jeopardize the research process, as well as harming the public contributors and causing moral distress. In this article, we aimed to identify ethical issues in PPI with forced migrants and present case examples, based on qualitative data and using thematic analysis, as well as analyse the issues using the ethical principles by Beauchamp and Childress as well as PPI-centred values. The ethical issues identified were "Treating forced migrant public contributors as a vulnerable group can inhibit autonomy"; "Non-inclusive communication strategies can contribute to injustice"; "Regulations around payment risk excluding the most vulnerable from involvement"; "Public contributors risk being excluded from partaking in decision-making," and "If trust is not established, public contributors do not feel safe sharing honest input." Further, we discussed the ethical issues using relational ethics, with a focus on how to conduct PPI with forced migrants in an ethical way.

Following the recent surge in neurotechnology innovation and commercial investment, numerous academic bodies, government bodies, multilateral organizations, and industry leaders have produced ethical guidelines to govern neurotechnology innovation. Many highlight the need for new regulations to protect the rights and welfare of vulnerable individuals, while others warn about unnecessarily impeding innovation that provides urgent treatments to intractable conditions. Consensus on appropriate governance of neurotechnological innovation remains elusive. To fill this gap, we conducted a scoping review of the academic literature concerning the governance of neurotechnology development, identifying the ethical issues addressed, highlighting gaps or underdeveloped areas of neurotechnology governance, and the country in which they were developed. Fifty-one academic articles from the peer-reviewed literature were extracted, selecting those that referred to neurotechnologies and presented normative ethical guidelines or frameworks for their governance. We identified six common ethical themes (justice, beneficence and nonmaleficence, privacy and brain data, autonomy and informed consent, and, identity, dignity, and moral status) and six governance strategies proposed to address these themes (social responsibility and accountability, interdisciplinary collaboration, public engagement, scientific integrity, epistemic humility, legislation and neurorights). Discussions surrounding these themes lacked adequate consideration of diverse viewpoints, such as from the Global South, and were often underdeveloped, lacking both practical specificity and guidance to help developers balance competing priorities. Specifically, animal ethics and binding governance approaches were not adequately addressed, while neurorights were given undue consideration. Future guidelines should engage with these areas to aid in the development of more comprehensive and specific governance documents.

Rodger and Venter have proposed a monopsony system in which the National Health Service (NHS) in England, as the single buyer, allows living kidney donors to opt-in to receive £35,000 tax-free financial compensation while preserving the right to donate without such compensation. This approach aims to alleviate the severe and growing shortage of kidneys available for transplant in England and is projected to generate substantial economic savings for the NHS. This paper sets out to strengthen their proposal by: (1) presenting updated figures on the increasing kidney transplant wait list in England to highlight the urgency for intervention; (2) detailing the rigor of the existing donor evaluation process to mitigate concerns about exploitation and coercion in compensated living donation; (3) outlining the various kinds of living kidney donation and the U.K. Living Kidney Sharing Scheme, to demonstrate that the proposal's projected economic benefits are likely to be underestimations; (4) suggesting five modifications to the proposal that do not significantly alter its underlying structure; and (5) providing additional arguments against the major objections to such proposals-that financial compensation is exploitative, coercive, and likely to "crowd out" altruistic donors-and showing how the five suggested modifications could strengthen the proposal by bolstering it against those objections. The paper strengthens existing arguments for a pilot project of financial compensation for living kidney donors in England.

Both minors enrolled in human subject research and their parents often receive compensation for the former's participation. While considerable literature addresses the ethics of such compensation, the existing literature does not yet consider the challenge of minors and parents who may have divergent views regarding how such compensation should be expended. Since parents generally have broad legal authority over both monetary and in-kind compensation received by their children, ensuring that compensation earmarked for minor subjects are actually expended in accordance with the subjects' interests may prove challenging. This paper assesses the existing legal and ethical landscape in this area and proposes several potential mechanisms through which researchers and IRBs might address this largely overlooked dilemma.

Since standard measures of health effect ascribe negative value to disabilities, it is commonly believed that a cost-effective scheme for allocation of healthcare resources discriminates against people with disabilities. It is still a question for discussion, however, when and why such discrimination is justified. In this paper I account for the central normative substance of this disability discrimination problem, and I defend the claim that it is more justifiable to discriminate against disabled people based on lifespan considerations than on assessments of their reduced quality of life. I term this the asymmetry intuition. Based on some prior attempts to explain the asymmetry intuition, I offer the Reasonable Impartial Interest Argument as the best possible way to defend it. If my argument is sound, this moves us a step further towards a cost-effective priority setting that does not unjustly discriminate against people with disabilities.

African traditional medicine provides treatment for various illnesses and is widely used across Africa since it is readily available and affordable. Concepts of informed consent, however, are grounded in a Western ethical tradition that foregrounds the individual's rights to autonomy and bodily integrity. This study aimed to explore whether the basic elements of informed consent-information disclosure, comprehension, voluntariness, and agreement-are observed in traditional medicine practice in KwaZulu-Natal province, South Africa. Semi-structured in-depth interviews were conducted with eight traditional healers-four nyanga and four sangoma, and thematic content analysis was applied to the transcribed and translated data. Four major themes emerged from this analysis: 1) the practice of traditional medicine in KwaZulu-Natal; 2) the importance and amount of information disclosure by traditional healers; 3) methods used to obtain consent or agreement from patients and the voluntariness of this process; 4) the benefits of and barriers to obtaining informed consent in African traditional medicine. The study found that African traditional healers do indeed disclose information on diagnosis, risks, benefits, and treatment options to their patients.