Cambridge Quarterly of Healthcare Ethics最新文献

Medical ethics education is crucial for medical students and trainees, helping to shape attitudes, beliefs, values, and professional identities. Exploration of ethical dilemmas and approaches to resolving them provides a broader understanding of the social and cultural contexts in which medicine is practiced, as well as the ethical implications of medical decisions, fostering critical thinking and self-reflection skills imperative to providing patient-centered care. However, exposure to medical ethics topics and their clinical applications can be limited by curricular constraints and the availability of institutional resources and expertise. Podcasts, among other Free Open Access Medical Education (FOAMed) resources, are a novel educational tool that offers particular advantages for self-directed learning, a process by which learners engage in asynchronous educational opportunities outside of traditional academic or clinical settings. Podcasts can be readily distributed to wide audiences and played at any time, reducing barriers to access and offering a level of flexibility that is not possible with traditional forms of education and is well-suited to busy schedules. Podcasts can also use real voices and storytelling to make the content memorable and eminently human. This paper describes the development, production process, and impact of Core IM's "At the Bedside," a podcast focusing on issues in medical ethics and the medical humanities, intending to supplement standard bioethics curricula in an accessible, relevant, and engaging way. The authors advocate for broad incorporation of podcasts into medical ethics education.

The day has arrived that genetic tests for educational outcomes are available to the public. Today parents and students alike can send off a sample of blood or saliva and receive a 'genetic report' for a range of characteristics relevant to education, including intelligence, math ability, reading ability, and educational attainment. DTC availability is compounded by a growing "precision education" initiative, which proposes the application of DNA tests in schools to tailor educational curricula to children's genomic profiles. Here I argue that these happenings are a strong signal of the geneticization of education; the process by which educational abilities and outcomes come to be examined, understood, explained, and treated as primarily genetic characteristics. I clarify what it means to geneticize education, highlight the nature and limitations of the underlying science, explore both real and potential downstream bioethical implications, and make proposals for mitigating negative impacts.

Many bioethicists have recently shifted from using "physician-assisted suicide" (PAS) to "medical aid-in-dying" (MAID) to refer to the act of voluntarily hastening one's death with the assistance of a medical provider. This shift was made to obscure the practice's connection to "suicide." However, as the charge of "suicide" is fundamental to arguments against the practice, "MAID" can only be used by its proponents. The result has been the fragmentation of the bioethical debate. By highlighting the role of human agency-as opposed to natural processes-in causing death, the term "PAS" makes it easier both to perceive potential risks to vulnerable populations and to affirm suicide as a potentially autonomous choice. As such, "PAS" thus more transparently expresses the arguments of both supporters and opponents of the "right to die," while avoiding the unnecessary stigmatization of suicide and suicidal people which is a result of the usage of "MAID."

Derek Parfit famously opined that causing a person to exist with a life barely worth living can be wrong, although it is not wrong for that person. This conundrum is known as the nonidentity problem. Parfit also held that persons can, in a morally relevant sense, be caused to exist in the distant future by actions that make the agent a necessary condition for a person's existence. When these views are combined, which he did, and applied explicitly to persons with a life not worth living, which he did not, an interesting conditional conclusion can be drawn. If every family line eventually produces a person with a life not worth living, and if causing that person to exist cannot be justified by the benefits befalling others in the family line, it is always wrong to have children. Parfit did not draw this antinatalist conclusion, but an analysis of his introduction of the nonidentity problem shows that he could have. Since Parfit's other views on population ethics continue to be discussed with relative respect, it stands to reason that the antinatalist position should be no exception. Right or wrong, it has its legitimate place in considerations concerning the future of reproduction.

The authors critique the NY Declaration on Animal Consciousness, which does not denounce continued captivity and invasive research in the pursuit of animal consciousness markers. They argue that such research often increases animal suffering by accepting harmful practices. Instead, they propose a nonanthropocentric, ethical framework aligned with the Belmont Report's principle of beneficence, advocating for noninvasive methods in natural habitats. This approach prioritizes animal well-being, recognizing and safeguarding the intrinsic value of all conscious beings.

Whether anorexic patients should be able to refuse treatment when this refusal potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of "terminal anorexia" suggests criteria when a move to palliative care or even physician-assisted suicide might be justified. The author argues that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is in conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision-making capacity. It should therefore be rejected.

Major depressive disorder is one of the most common serious illnesses worldwide; the disease is also among those with the lowest rates of treatment. Barriers to access to care, both practical and psychological, contribute significantly to these low treatment rates. Among such barriers are regulations in many nations that require a physician's prescription for most pharmacological treatments including selective serotonin reuptake inhibitors (SSRIs). These rules are designed to protect patients. However, such regulations involve a tradeoff between the welfare of "visible" victims, who might suffer negative consequences from a lack of regulation, and the well-being of invisible "victims," who likely experience negative consequences that result from increased barriers to care. This article explores these tradeoffs and argues in favor of shifting SSRIs from prescription-only to over-the-counter status.

The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) developed a Bioethics Ambassador Program (BAP); a yearlong educational program to assist clinical and non-clinical staff develop the skills to identify and address common burgeoning ethical issues that can arise during the provision of care to patients with cancer. The goal was to provide greater awareness of the role and services of Ethics, particularly at the institution's geographically-diverse outpatient care centers and to better-instill a culture of preventative ethics. This article discusses the design and implementation of the first two years of the program and analyzes its strengths, weaknesses, and impact on MSK.

This paper describes the content and evolution of a fourth-year course for medical students on teaching pathographies of mental illness. (It is a follow-up to Nathan Carlin's Pathographies of Mental Illness that appeared as an Element in the Bioethics and Neuroethics series published by Cambridge University Press.) The course originally centered on classic (and some contemporary) memoirs; however, responding to student evaluations, newer material now ensures more diversity, with material written by women and people of color, and describes the difference that can make.

There are increasing calls for coverage of medicine during the Holocaust in medical school curricula. This article describes outcomes from a Holocaust and medicine educational program featuring a study trip to Poland, which focused on physician complicity during the Holocaust, as well as moral courage in health professionals who demonstrated various forms of resistance in the ghettos and concentration camps. The trip included tours of key sites in Krakow, Oswiecim, and the Auschwitz-Birkenau concentration camps, as well as meeting with survivors, lectures, reflective writings, and discussions. In-depth interviews and reflective writings were qualitatively analyzed. Resulting themes centered on greater understanding of the relationship between bioethics and the Holocaust, recognizing the need for moral courage and social awareness, deeper appreciation for the historical roles played by dehumanization and medical power and their contemporary manifestations, and the power of presence and experiential learning for bioethics education and professional identity formation. These findings evidence the significant impact of the experience and suggest broader adoption of pedagogies that include place-based and experiential learning coupled with critical reflection can amplify the impact of bioethics and humanism education as well as the process of professional identity formation of medical students.