Journal of Bioethical Inquiry最新文献

Peer review is the cornerstone of scholarly publishing, ensuring the quality and credibility of academic research. As Article Processing Charges (APC) continue to rise, many journals provide only symbolic rewards to reviewers, such as certificates of appreciation and/or minimal discount vouchers, raising ethical concerns about fairness and the marginalization of scholarly labour. This commentary explores the disparity between the financial gains of journals and the no compensation for reviewers, who are crucial to maintaining research standards. It questions whether the current model appropriately recognizes the reviewer's contributions and advocates for actual compensation structures, including financial rewards, substantial reductions in APC, and professional recognition. Additionally, the article highlights the impact of these inequities on early-career researchers and scholars from less affluent regions, suggesting that equitable compensation could improve the sustainability and efficiency of the peer review process. By addressing these ethical concerns, scholarly publishing can better support the essential work of reviewers while fostering a more just and inclusive scholarly environment.

The development of presymptomatic screening for risks to children's mental health holds the promise to prevent or reduce the burden of mental disorders by enabling timely preventive actions. However, such screening programmes also raise ethical concerns related to false positive results, increased anxiety, harmful effects on a child's sense of self, and stigmatization. Stakeholders can provide valuable insights into these ethical concerns from their engagement with practice. Therefore, in this study we conducted six focus group discussions with professionals in the child mental health domain (in clinical, educational, or policy settings) to investigate their views on presymptomatic screening and identify ethical considerations. The discussions took place in six European countries. Three main themes were identified: 1) Promises and concerns about screening for risks to children's mental health, 2) Additional considerations about biomarker screening, and 3) Implications for healthcare systems and society. Ethical considerations included the benefits of screening outweighing the harms, informed and autonomous decision-making, the actionability of screening outcomes, stigmatization, and medicalization. Our findings underscore the importance of exercising caution in the development and implementation of presymptomatic screening for risks to children's mental health. Implications for practice and future research are discussed.

Assisted reproductive technology (ART) is a growing global industry, projected to reach $37.7 billion by 2027. Predominantly offered in private healthcare settings, concerns have been raised about the potential negative impacts of commercialization on ART services. Despite numerous accounts of these impacts, a comprehensive synthesis and critique of arguments are lacking. This scoping review aims to provide a nuanced understanding of commercial impacts on ART by exploring how commercial forces have been identified, studied, and evaluated, and what strategies have been suggested for their management in health-related journals. PubMed, Web of Science, Cinahl, and Scopus were searched between January and July 2023 for articles addressing commercial impacts on ART. Database searches identified 11,873 articles, with 163 articles included in the final review. Commercial impacts on ART were most frequently mentioned in discussions of "add-on" interventions (40/163; 25 per cent of articles). Many articles were critical of commercial impacts on ART; however, several suggested that there may be benefit in the delivery of ART by the private sector. This review offers a number of proposed strategies for the mitigation of potential adverse effects of commerce on ART that may be useful to service providers and policymakers. These include improving patient information, enhancing informed consent processes, and increasing regulatory oversight. The review also alerts us to potential challenges that might arise in the context of regulatory reform and reminds us that enhanced regulation is not universally supported.

This article discusses the most plausible moral basis for using severity as a priority setting criterion in healthcare: prioritarianism or egalitarianism. We argue that prioritarianism is superior, since egalitarianism has several problems that prioritarianism avoids. We have elaborated three such problems. First, egalitarianism arguably needs a non-equality-based reference level in order to determine the magnitude of severity. Second, it has the problem of irrelevant alternatives: the assessment of the severity of one person's illness varies depending on the condition of other persons, even when their health status has not changed. Third, egalitarianism introduces excessive complexity, as it must explain what aspects of inequality matter, and why, in relation to illness severity. By contrast, prioritarianism has some benefits that egalitarianism lacks: it aligns theoretically with the concept of severity as a priority setting criterion in healthcare, and it explains why we always have a pro tanto reason to improve someone's health without having to rely on other theories. In the end, if equality of health matters, it is arguably not because of its connection to severity.

Post COVID-19 Condition (PCC) is a complex condition presenting significant challenges for patients. Individuals suffering from severe PCC are often assessed in rehabilitation medicine departments or specialized post-COVID centres, where their condition is evaluated using the International Classification of Functioning, Disability and Health (ICF). The ICF framework primarily focuses on functional impairments, disabilities, and restrictions in participation, with an emphasis on the concept of "functioning." However, a critical question remains: how does this notion of functioning relate to the well-being of these individuals? This paper explores this issue by examining three fictionalized but typical case studies of PCC patients in relation to two distinct theoretical approaches. First, we engage with theories about well-being from the philosophy of well-being emphasizing the individual's perspective. Second, we explore relational approaches in bioethics and their theoretical underpinnings, which emphasize how people are situated, considering context and relations rather than purely individual conditions. The paper highlights the potential tensions between these approaches while arguing that a more comprehensive understanding of well-being can emerge by integrating insights from both traditions. Through the examination of PCC patient cases, we propose that well-being can be better understood when approached from multiple angles, enriching the understanding of patient outcomes in rehabilitation medicine.

When treatments are deemed not to be cost-effective and face non-reimbursement, policymakers in publicly funded healthcare systems may decide to ration treatments by withholding it from future patients. However, they must also address a critical question: should they also ration treatments by withdrawing it from patients already having access to the treatment, or is there an ethical difference between withdrawing and withholding treatments? To explore this question, we conducted a behavioural experiment (n=1404), examining public support for withdrawing and withholding treatments in reimbursement decisions across eleven different circumstances. Overall, public support for rationing by withdrawing and withholding was low, with no general perceived difference between withdrawing and withholding treatments. However, when we analysed the different circumstances separately, there were multiple circumstances where withholding was deemed ethically more problematic than withdrawing. Moreover, there was an overall preference for allowing individual assessments compared to ensuring that treatments are equally rationed between different healthcare providers. This result may indicate a preference for procedural fairness compared to outcome fairness. In addition, it was deemed more important to allow for individual assessments and to ensure equal rationing when withdrawing treatments compared to withholding. Overall, these findings reveal nuances in public preferences regarding withdrawing and withholding treatments, challenging the prevailing beliefs that withholding treatments is psychologically easier and ethically less problematic than withdrawing. They also challenge assertions of ethical equivalence between these two rationing approaches. If policymakers want to align their policies with public attitudes, our results suggest adopting a nuanced approach towards withdrawing and withholding treatments, recognizing that public support for ethical equivalence between withdrawing and withholding treatments varies depending on the circumstances.

Bio-convergent enhancements for soldiers are becoming increasingly inevitable. Medical professionals, bioethicists, lawyers, and neuroscientists are increasingly aware of the potential for these enhancements to raise significant ethical issues, especially around issues of consent and responsibility for long-term care. This has, in the last few years, led to an increase in research on the ethics of soldier enhancements. The literature on this issue has rightly leveraged decades of bioethics, medical ethics, and research ethics literature. What is missing however from the literature is the perspective of the potential subjects of such enhancements, namely members of special operations forces. This paper seeks to fill this gap, by first arguing that subjective views of special operations members matter for ethical questions and then by reporting results of our interview-based qualitative study on United States Special Operations Forces' perspectives on consent and long-term care.

Thinking, collaborating, and communication happen through interactions of the body, the mind, language, and things in the world. Actions of the body actively express intention, thought, and emotion. Points of the fingers and nods of the head can refer to things in the surrounding world. A string of interrelated gestures can represent an environment, a complex system, an arrangement of ideas, a sequence of actions. Those gestures use marks and actions in space to represent thought more directly than words-as do graphics like sketches, maps, graphs, diagrams, and pictures. Seeing or making gestures or graphics can change thought, both in those who view them and in those who make them. Interactions with gestures and graphics and the surrounding world are often internal, invisible, and unique, not in words, and not easily decomposed. Through those interactions, shared and individual meanings emerge and change in real time. These features of human thought present challenges to current multi-modal AI.

In this article, I explored the application of large language models (LLMs) in analysing linguistic colexification and ambiguity within bioethical scenarios. By employing word embeddings derived from LLMs, I constructed semantic distance matrices that provide insight into the relationships between key terms in bioethical vignettes. These matrices were used to quantify and visualize the degree of linguistic ambiguity and specificity across different versions of each vignette-those with high colexification (ambiguous language) and those with low colexification (specific language). The approach taken involves encoding words according to their semantic adjacency and representing these relationships geometrically through distance matrices. The resulting matrices reflect the nuanced differences in how concepts are related within bioethical contexts, offering a quantitative method for analysing language use. The study demonstrates that LLMs, by facilitating geometric representations of language, can enhance our understanding of complex ethical dilemmas by systematically addressing linguistic ambiguity. Ultimately, this research contributes to the field of bioethics by providing a computational approach to improving clarity in ethical communication, highlighting the potential of LLMs to inform both ethical decision-making and discourse analysis. LLMs, while not capable of performing speech acts in the full philosophical sense-as human beings do-still serve as powerful tools to analyse and understand bioethical language. This distinction-between performing speech acts and analysing their linguistic features-highlights the unique contribution of LLMs as analytical tools rather than ethical agents.