Cambridge Quarterly of Healthcare Ethics最新文献

This response engages critically with Harzheim's review of Thomas Fuchs' In Defense of the Human Being: Foundational Questions of an Embodied Anthropology. Fuchs' work offers a profound exploration of embodied cognition, arguing that human cognition and existence are deeply shaped by our physical interactions. Harzheim's critique highlights significant aspects of Fuchs' framework, including his critique of functionalist models, the impact of transhumanist technologies, and ethical concerns in healthcare technology. This paper extends Harzheim's review by proposing an integration of functionalist and embodied cognitive models, emphasizing the need for a comprehensive evaluation of technological impacts, and advocating for a more robust ethical framework that considers social equity. Additionally, it addresses the is-ought distinction and explores the implications of technological advancements on human identity and mental health. Doede's critique is also discussed, underscoring the importance of integrating diverse cognitive models and addressing technological determinism. Overall, this response calls for a more nuanced and inclusive approach to the discourse on embodied cognition, aiming to enrich the scholarly conversation and address the complexities and implications of Fuchs' analysis.

This article considers John Harris' work on autonomy, specifically reproductive autonomy, outlined in The Value of Life and developed throughout his career. Harris often used the concept of reproductive autonomy to make the case for liberal approaches to developments in reproductive and genetic technologies. Harris argued that reproductive autonomy should be highly valued, and therefore we need compelling arguments to justify limiting it in anyway. When discussing reproductive autonomy, Harris focused mainly on restrictions on the potential users of reproductive technologies autonomy, that is, prospective parents. This article extends the discussion of autonomy and the appropriate limits to individuals exercising their autonomy to medical professionals working in this area. Given reproductive technologies have become part of routine medical practice, this article considers whether the current restrictions on both patients and clinicians, as imposed by regulators and professional guidelines, remain ethically justified.

Jennifer Blumenthal-Barby (2024) has called for bioethics to end talk about personhood, asserting that such talk has the tendency to confuse and offend. It will be argued that this has only limited application for (largely) private settings. However, in other settings, theorizing about personhood leaves a gap in which there is the risk that the offending concept will get uptake elsewhere, and so the problem Blumenthal-Barby nominates may not be completely avoided. In response to this risk, an argument is presented in support of the idea that the role of philosophers and bioethicists, far from ending talk of personhood, ought to be to clarify the concept, and to do so in nuanced ways, given its application for specific kinds of impairments. The case of dementia is used to illustrate this in the context of person-centered care. Ironically, given the stigma attached to dementia, far from the need to end talk of personhood, bioethicists are needed to rescue the concept and clarify its role.

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.

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.

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.

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.