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When Suicide is not a Self-Killing: Advance Decisions and Psychological Discontinuity—Part I 当自杀不是自尽时:预先决定和心理中断--第一部分
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-24 DOI: 10.1017/s0963180124000227
Suzanne E. Dowie
Derek Parfit’s view of ‘personal identity’ raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. Part I of this paper argues that this assessment of personal identity undermines the distinction between suicide and homicide. However, rather than accept that an unknown metaphysical ‘further fact’ underpins agential unity, one can accept Parfit’s view but offer a different account of what it implies morally: that the social and legal bases for ascribing a persisting ‘personal identity’ maintain the distinction between homicide and suicide.
德里克-帕菲特关于 "个人身份 "的观点提出了一个问题,即在病人失去心理连续性的情况下,是否应该尊重病人预先做出的拒绝救生治疗的决定;这意味着这些预先决定根本不是自我决定的。本文第一部分认为,这种对个人身份的评估破坏了自杀与他杀之间的区别。然而,与其接受一个未知的形而上学 "进一步的事实 "支撑着行为的统一性,我们倒不如接受帕菲特的观点,但对其在道德上的含义提供一个不同的解释:赋予持续存在的 "个人身份 "的社会和法律基础维持了杀人与自杀之间的区别。
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引用次数: 0
Consciousness and Scientific Discovery: The Iceberg Effect. 意识与科学发现:冰山效应
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-22 DOI: 10.1017/S0963180124000252
Yves Agid
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引用次数: 0
When Two Become One: Singular Duos and the Neuroethical Frontiers of Brain-to-Brain Interfaces 当二者合二为一:奇异二重奏与脑-脑接口的神经伦理前沿
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-12 DOI: 10.1017/s0963180124000197
Hazem Zohny, Julian Savulescu
Advances in brain–brain interface technologies raise the possibility that two or more individuals could directly link their minds, sharing thoughts, emotions, and sensory experiences. This paper explores conceptual and ethical issues posed by such mind-merging technologies in the context of clinical neuroethics. Using hypothetical examples along a spectrum from loosely connected pairs to fully merged minds, the authors sketch out a range of factors relevant to identifying the degree of a merger. They then consider potential new harms like loss of identity, psychological domination, loss of mental privacy, and challenges for notions of autonomy and patient benefit when applied to merged minds. While radical technologies may seem to necessitate new ethical paradigms, the authors suggest the individual-focus underpinning clinical ethics can largely accommodate varying degrees of mind mergers so long as individual patient interests remain identifiable. However, advanced decisionmaking and directives may have limitations in addressing the dilemmas posed. Overall, mind-merging possibilities amplify existing challenges around loss of identity, relating to others, autonomy, privacy, and the delineation of patient interests. This paper lays the groundwork for developing resources to address the novel issues raised, while suggesting the technologies reveal continuity with current healthcare ethics tensions.
脑-脑接口技术的进步带来了一种可能性,即两个或两个以上的人可以直接连接他们的思维,共享思想、情感和感官体验。本文以临床神经伦理学为背景,探讨了这种心灵融合技术带来的概念和伦理问题。作者使用从松散连接到完全融合的假设例子,勾勒出一系列与确定合并程度相关的因素。然后,他们考虑了潜在的新危害,如身份丧失、心理支配、精神隐私的丧失,以及应用于合并思维时对自主权和患者利益概念的挑战。虽然激进技术似乎需要新的伦理范式,但作者认为,只要病人的个人利益仍可识别,以个人为中心的临床伦理在很大程度上可以适应不同程度的思维合并。不过,预先决策和指令在解决所面临的困境方面可能存在局限性。总体而言,精神融合的可能性会扩大现有的身份丧失、与他人的关系、自主权、隐私权和病人利益划分等方面的挑战。本文为开发资源以解决所提出的新问题奠定了基础,同时建议这些技术揭示当前医疗伦理紧张局势的连续性。
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引用次数: 0
Assessing Public Reason Approaches to Conscientious Objection in Healthcare 评估医疗保健领域良心拒绝的公共理由方法
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-11 DOI: 10.1017/s0963180124000112
Doug McConnell
Sometimes healthcare professionals conscientiously refuse to treat patients despite the patient requesting legal, medically indicated treatments within the professionals’ remit. Recently, there has been a proliferation of views using the concept of public reason to specify which conscientious refusals of treatment should be accommodated. Four such views are critically assessed, namely, those of Robert Card, Massimo Reichlin, David Scott, and Doug McConnell. This paper argues that McConnell’s view has advantages over the other approaches because it combines the requirement that healthcare professionals publicly justify the grounds of their conscientious refusals of treatment with the requirement that those grounds align with minimally decent healthcare. This relatively restrictive approach accommodates conscientious refusals from minimally decent healthcare professionals while still protecting good healthcare, the independence of the healthcare professions, and the fiduciary relationships.
有时,尽管病人要求在专业人员的职权范围内进行合法的、有医学指征的治疗,但医护专业人员还是会出于良心拒绝治疗病人。近来,利用公共理性概念来明确哪些出于良心拒绝治疗的行为应予以照顾的观点层出不穷。本文对罗伯特-卡德(Robert Card)、马西莫-赖克林(Massimo Reichlin)、戴维-斯科特(David Scott)和道格-麦康奈尔(Doug McConnell)的四种观点进行了批判性评估。本文认为,麦康奈尔的观点与其他观点相比具有优势,因为它既要求医护人员公开说明他们出于良心拒绝治疗的理由,又要求这些理由符合最低限度的体面医疗。这种限制性相对较强的方法既能满足最低限度体面的医疗保健专业人员出于良心拒绝治疗的要求,又能保护良好的医疗保健、医疗保健专业的独立性以及信托关系。
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引用次数: 0
Adolescent OCD Patient and Caregiver Perspectives on Identity, Authenticity, and Normalcy in Potential Deep Brain Stimulation Treatment 青少年强迫症患者和护理人员对潜在脑深部刺激治疗中的身份、真实性和正常性的看法
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-11 DOI: 10.1017/s0963180124000203
Jared N. Smith, Natalie Dorfman, Meghan Hurley, Ilona Cenolli, Kristin Kostick-Quenet, Eric A. Storch, Gabriel Lázaro-Muñoz, Jennifer Blumenthal-Barby
The ongoing debate within neuroethics concerning the degree to which neuromodulation such as deep brain stimulation (DBS) changes the personality, identity, and agency (PIA) of patients has paid relatively little attention to the perspectives of prospective patients. Even less attention has been given to pediatric populations. To understand patients’ views about identity changes due to DBS in obsessive-compulsive disorder (OCD), the authors conducted and analyzed semistructured interviews with adolescent patients with OCD and their parents/caregivers. Patients were asked about projected impacts to PIA generally due to DBS. All patient respondents and half of caregivers reported that DBS would impact patient self-identity in significant ways. For example, many patients expressed how DBS could positively impact identity by allowing them to explore their identities free from OCD. Others voiced concerns that DBS-related resolution of OCD might negatively impact patient agency and authenticity. Half of patients expressed that DBS may positively facilitate social access through relieving symptoms, while half indicated that DBS could increase social stigma. These views give insights into how to approach decision-making and informed consent if DBS for OCD becomes available for adolescents. They also offer insights into adolescent experiences of disability identity and “normalcy” in the context of OCD.
神经伦理学界一直在讨论深部脑刺激(DBS)等神经调控技术在多大程度上改变了患者的人格、身份和代理权(PIA),但对未来患者的观点关注相对较少。对儿科人群的关注就更少了。为了了解强迫症(OCD)患者对 DBS 引起的身份变化的看法,作者对患有强迫症的青少年患者及其父母/监护人进行了半结构式访谈,并对访谈内容进行了分析。患者被问及 DBS 一般会对 PIA 产生哪些影响。所有受访患者和半数护理人员都表示,DBS 会对患者的自我认同产生重大影响。例如,许多患者表示,DBS 可以让他们摆脱强迫症,探索自己的身份,从而对身份认同产生积极影响。其他人则表示担心,与 DBS 相关的强迫症解决方案可能会对患者的自主性和真实性产生负面影响。半数患者表示,DBS 可以通过缓解症状积极促进社交,而半数患者表示 DBS 可能会增加社会耻辱感。这些观点让我们了解到,如果青少年可以使用 DBS 治疗强迫症,该如何做出决策和获得知情同意。他们还对青少年在强迫症背景下对残疾身份和 "正常性 "的体验提出了见解。
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引用次数: 0
Ethical and Equitable Digital Health Research: Ensuring Self-Determination in Data Governance for Racialized Communities 道德与公平的数字健康研究:确保种族化社区在数据管理中的自决权
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-03 DOI: 10.1017/s096318012400015x
Mozharul Islam, Arafaat A. Valiani, Ranjan Datta, Mohammad Chowdhury, Tanvir C. Turin
Recent studies highlight the need for ethical and equitable digital health research that protects the rights and interests of racialized communities. We argue for practices in digital health that promote data self-determination for these communities, especially in data collection and management. We suggest that researchers partner with racialized communities to curate data that reflects their wellness understandings and health priorities, and respects their consent over data use for policy and other outcomes. These data governance approach honors and builds on Indigenous Data Sovereignty (IDS) decolonial scholarship by Indigenous and non-indigenous researchers and its adaptations to health research involving racialized communities from former European colonies in the global South. We discuss strategies to practice equity, diversity, inclusion, accessibility and decolonization (EDIAD) principles in digital health. We draw upon and adapt the concept of Precision Health Equity (PHE) to emphasize models of data sharing that are co-defined by racialized communities and researchers, and stress their shared governance and stewardship of data that is generated from digital health research. This paper contributes to an emerging research on equity issues in digital health and reducing health, institutional, and technological disparities. It also promotes the self-determination of racialized peoples through ethical data management.
最近的研究突出表明,有必要开展合乎道德和公平的数字健康研究,以保护种族化群体的权益。我们主张在数字健康领域采取促进这些群体数据自决的做法,尤其是在数据收集和管理方面。我们建议研究人员与种族化社群合作,收集能反映他们对健康的理解和健康优先事项的数据,并尊重他们对数据用于政策和其他成果的同意。这些数据管理方法尊重并借鉴了土著和非土著研究人员的 "土著数据主权"(Indigenous Data Sovereignty,IDS)非殖民地学术研究,并将其应用于涉及全球南部前欧洲殖民地种族化社区的健康研究。我们讨论了在数字健康领域践行公平、多样性、包容性、无障碍和非殖民化(EDIAD)原则的策略。我们借鉴并调整了 "精准健康公平"(PRE)的概念,强调了由种族化社区和研究人员共同定义的数据共享模式,并强调了他们对数字健康研究产生的数据的共同治理和管理。本文为新兴的数字健康公平问题研究以及减少健康、机构和技术差距做出了贡献。它还通过合乎道德的数据管理促进了种族化民族的自决。
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引用次数: 0
Welfare, Abortion, and Organ Donation: A Reply to the Restrictivist. 福利、堕胎和器官捐赠:给限制主义者的答复》。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-04-14 DOI: 10.1017/S0963180123000208
Emily Carroll, Parker Crutchfield

We argued in a recent issue of this journal that if abortion is restricted,1 then there are parallel obligations for parents to donate body parts to their children. The strength of this obligation to donate is proportional to the strength of the abortion restrictions. If abortion is never permissible, then a parent must always donate any organ if they are a match. If abortion is sometimes permissible and sometimes not, then organ donation is sometimes obligatory and sometimes not. Our argument was based on the following ideas: (a) that a fetus has full moral status, (b) that parents have special obligations to their offspring, fetus or not, and (c) that this special obligation is to protect them. The result is the conclusion that abortion restrictivists cannot also consistently deny that organ donation should be compulsory.

我们在本刊最近一期的文章中提出,如果限制堕胎,1 那么父母就同时有义务将身体器官捐献给子女。这种捐赠义务的强度与堕胎限制的强度成正比。如果永远不允许堕胎,那么父母就必须捐赠任何匹配的器官。如果堕胎有时允许,有时不允许,那么器官捐赠有时是义务,有时不是。我们的论点基于以下观点:(a) 胎儿具有完全的道德地位,(b) 父母对其后代(无论是否为胎儿)负有特殊义务,(c) 这种特殊义务就是保护他们。结果得出的结论是,限制堕胎论者也不能始终否认器官捐赠应该是强制性的。
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引用次数: 0
On Matti Häyry's "Exit Duty Generator". 关于 Matti Häyry 的 "退出义务生成器"。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-03-24 DOI: 10.1017/S0963180123000142
Karim Akerma

Matti Häyry presents a new ethical theory that he calls "conflict-responsive need-based negative utilitarianism."1 In this commentary, I present my critical observations on his main points against the more general background of utilitarianism and theories of value.

马蒂-海瑞(Matti Häyry)提出了一种新的伦理学理论,他称之为 "冲突反应型基于需求的消极功利主义 "1 。在这篇评论中,我将以功利主义和价值理论为更广泛的背景,对他的主要观点提出批评意见。
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引用次数: 0
Strategic Ambiguity: The Pragmatic Utopianism of Daniel Callahan's "Bioethics as a Discipline". 战略模糊性:丹尼尔-卡拉汉 "作为一门学科的生命伦理学 "的实用乌托邦主义。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-08-22 DOI: 10.1017/S0963180123000440
Mathias Schütz

This article highlights the continuing relevance of a classic bioethical text, "Bioethics as a Discipline," published by the Hastings Center's cofounder Daniel Callahan in 1973. Connecting the text's programmatic recommendations with later reflections and interventions Callahan wrote about the development of bioethics illuminates how the vision Callahan established and the reality this vision helped create were interrelated-just not in the way Callahan had hoped for. Although this portrait relies on an individual perception of the development of bioethics, it might nevertheless, through its unique linkage of different bioethical temporalities, contribute to a broader reassessment of what bioethics became and why.

本文强调了黑斯廷斯中心共同创始人丹尼尔-卡拉汉于 1973 年出版的经典生物伦理学著作《作为一门学科的生物伦理学》的持续相关性。将该文的纲领性建议与卡拉汉后来撰写的关于生命伦理学发展的思考和干预联系起来,揭示了卡拉汉所确立的愿景与这一愿景所帮助创造的现实是如何相互关联的--只是并非以卡拉汉所希望的方式。尽管这幅肖像依赖于对生命伦理学发展的个人看法,但它通过将不同的生命伦理学时空独特地联系起来,可能有助于对生命伦理学的发展及其原因进行更广泛的重新评估。
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引用次数: 0
Applying the Peter Parker Principle to Healthcare. 将彼得-帕克原则应用于医疗保健。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2022-12-16 DOI: 10.1017/S0963180122000275
James E Stahl, William A Nelson

The role of power in healthcare can raise many ethical challenges. Power is ownership, whether given, ceded, or taken of another person's autonomy. When a person has power over someone else, they can control or strongly influence the decision-making freedom of that person. From the principalist perspective1,2 of healthcare ethics, denying a person their freedom to choose, should only occur when justifying conditions related to beneficence and nonmaleficence are sufficiently satisfied. In healthcare, it is rare to be able to identify situations where paternalism is justified. However, experience suggests that abusive power in healthcare is used too frequently without justifying criteria.

权力在医疗保健中的作用会引发许多伦理挑战。权力是所有权,无论是给予、让渡还是剥夺他人的自主权。当一个人对他人拥有权力时,他就可以控制或强烈影响他人的决策自由。从医疗保健伦理学的主体论角度1,2 来看,只有在充分满足了与 "有利 "和 "无弊 "相关的合理条件时,才可以剥夺一个人的选择自由。在医疗保健领域,很少能找到家长式作风合理的情况。然而,经验表明,在医疗保健领域,滥用权力的情况过于频繁,而且没有正当的标准。
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引用次数: 0
期刊
Cambridge Quarterly of Healthcare Ethics
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