Journal of Bioethical Inquiry最新文献

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.

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.

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.

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.

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.

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.