Bioethics最新文献

Classical bioethics examines moral issues in terrestrial medicine and the life sciences. According to Konrad Szocik, space bioethics merely relocates those questions to harsher environments. We argue that this view is incomplete: space bioethics is a genuinely original domain. Unprecedented conditions-chronic radiation exposure, partial gravity, closed ecologies, long communication delays, and severe resource constraints-reconfigure risk and responsibility. Survival-oriented interventions-human bio-enhancement, human-machine integration, germline editing for adaptation and off-world reproduction (potentially via ectogenesis)-pose dilemmas with no close terrestrial analogue. Moreover, some technologies may be developed and adopted in space before diffusion to Earth, generating ethical challenges in advance. These scenarios strain the portability of standard moral norms and cannot be addressed by simply importing frameworks from military or extreme-environment medicine.

During the last years, more and more countries have introduced a practice of assisted dying in their medical system and regulated it by separate laws or by additions to the existing body of criminal law. In this respect, the two neighboring countries, Germany and Switzerland, are exceptional cases. In both countries, there exists a long-standing and largely uncontested legal prohibition of euthanasia, but only minimal state regulation concerning assisted suicide. Right-to-die organizations face the challenge of filling the gap by defining their own rules. In this, the largest right-to-die organizations in both countries are advised by individual ethicists or ethics committees, with the mission to uphold ethical standards. The paper compares the role of ethical counseling in these organizations (in which the authors are the heads of the respective ethics committees) and describes the scope of their counseling work and the extent of their responsibility for maintaining an ethically defensible practice.

Semaglutide (Wegovy), a glucagon-like peptide-1 receptor agonist (GLP-1 RA), has attracted global attention for its appetite-suppressing and weight-loss effects. Approved by the U.S. FDA in 2022 for adolescents aged 12 and older, it has since been authorized in several other countries. Despite this, its use among youth remains limited, with ongoing concerns about its long-term safety, efficacy, and suitability during periods of growth and development. Advocates see Wegovy as an important tool for addressing pediatric obesity and its psychological burdens, while critics caution against widespread use in such a vulnerable population. This paper examines an underexplored ethical dimension of Wegovy's use in children: its impact on mental health. We argue that Wegovy may offer mental health benefits for children-such as reducing weight stigma, improving self-esteem, and avoiding invasive interventions such as bariatric surgery. However, these potential benefits are constrained by barriers to access, supply shortages, risks of misuse, and the possibility of reinforcing stigma and class-based discrimination. In light of these considerations, we argue that while Wegovy offers promising health benefits for children, its long-term effects on growth, development, and mental health remain uncertain, warranting further study before definitive policy decisions are made. If future evidence confirms its value, it is our view that access should be equitable and accompanied by reforms to reduce stigma, regulate prescribing, and prevent misuse. Until then, clinicians should prescribe cautiously, ensuring clear medical need and implementing safeguards against risks such as weight regain, treatment interruption, and bias in care.

While informed consent is widely recognized as a cornerstone of ethical research with human participants, applying this principle to space exploration research creates some unique challenges and dilemmas. In this article, we examine ethical issues related to informed consent for participation in space exploration research and offer some suggestions for policy development and further investigation. We argue that: (1) informed consent for space exploration research should be required, but exceptions can be justified for research involving public records, de-identified medical records, secondary use of de-identified, biospecimens or data, emergency medical research, and research critical to mission success or crew safety; (2) organizations that conduct space exploration research should take steps to minimize the potential for undue influence by, for example, ensuring that informed consent discussions will be private and that information about research participation will be kept confidential; (3) prospective spaceflight participants should be provided with information about research activities or other types of data and specimen collection (such as quality assurance) that will take place; and (4) since existing laws and regulations do not apply to most of the research activities conducted by private companies, space companies should give serious thought to developing guidelines for the protection of human research participants.

Assisted dying (AD) presents a range of challenges for clinical ethicists (CEs) and healthcare institutions seeking to involve them in its provision. Questions regarding the legitimacy, scope, and nature of CE involvement remain underexplored in the literature. This article addresses this gap by first outlining the professional standards that guide CE practice and presenting arguments for the value of ethics expertise in AD contexts. We then examine the Canadian MAiD landscape and draw on the experiences of CEs-particularly within a healthcare institution in Quebec-to propose a typology of roles that CEs have occupied at various moments and levels throughout the emergence and institutionalization of AD. These roles span micro to macro levels of involvement and reflect both practical contributions and normative considerations. In the final section, we return to the foundational normative questions raised at the outset-not to offer definitive answers, but to contribute meaningfully to ongoing reflection about CE involvement in AD. By analyzing professional standards alongside the diverse roles CEs have played, we assess the benefits and challenges of their participation in this ethically complex domain and offer guidance for institutions seeking to engage ethics expertise in AD policy and practice.

The eventual goal of space exploration is to colonize exoplanets and their moons outside our solar system. This is a dangerous and immoral endeavour. The extraterrestrial life forms encountered would be hostile, vulnerable or both, and the descendants of the original pioneers would be involuntarily exposed to hazardous conditions and totalitarian regimes. They would have little or no control over their lives, reproduction, or death. Even in the unlikely event that homo sapiens, the species responsible for degrading its own home planet, could be expected to fare better in a new habitat in the future, the sacrifices thrust upon the non-consenting interim generations would be ethically unacceptable.

End-of-life legislation and the authorization of euthanasia or assisted suicide are highly debated topics in France. The challenges raised by the right to access continuous deep sedation and requests for assisted dying outside the current legal framework present many ethical challenges in clinical settings. Between 2017 and 2023, our Clinical ethics center was solicited 30 times regarding assisted dying requests and conducted full-fledged clinical ethics consultations in 14 of these situations. This experience offers a valuable opportunity for enhancing our understanding of these clinical situations and of the ethical considerations involved in several ways. First, it allows us to identify the tensions that requests for assisted dying may cause at the patient's bedside. Secondly, our experience allows us to confirm the relevance of clinical ethics consultations for all stakeholders involved in these situations. Finally, taking a closer look at the arguments exchanged by all concerned parties during the consultation process provides novel insights about the ethical debate about continuous deep sedation and assisted dying, in both the French context and internationally, by highlighting the issues of ambivalence, timing, and personal as well as professional responsibility.

Debates in public health ethics have been dominated by the assumptions of Western liberalism: a priority given to liberty and autonomy over other values, an individualistic view of social ontology, a focus on personal responsibility, a minimal set of obligations (only created through consent), and a marginalization of social, cultural, and religious context. Examining issues in public health ethics from the perspective of a different moral tradition reveals that such assumptions are not timeless truths, but rather choices that require justification. In this paper, we briefly outline a view of Confucianism and explore how this approach can be used to articulate a critical approach to much contemporary public health ethics. Confucianism suggests a radically different perspective toward obligations, agency, and responsibility, as well as a more relational conception of social ontology and a shared notion of well-being. Of course, some discussion in public health ethics, within the constraints of Western traditions, has pushed in this direction before. In offering a Confucian perspective on public health ethics, we are not suggesting that Confucianism is the one true approach to ethics and that everyone should become a Confucian. We are, however, seeing our discussion as a source of epistemic critique of Western liberalism, exposing the need for more active defense of assumptions at its core, as well as providing an opportunity to broaden the set of values that inform justifiable public health policy.

This paper contributes to the ongoing debate over the authority of advance directives in cases where patients with dementia express desires that conflict with their earlier wishes. Drawing on Harry Frankfurt's concept of second-order volitions, I argue that the preferences of the pre-dementia self (the "then-self") should, in most cases, take precedence over those of the post-dementia self (the "now-self")-particularly in instances where the now-self has lost the capacity to form second-order volitions and is no longer able to meaningfully repudiate prior values and commitments.