Bioethics最新文献

International Humanitarian Law (IHL), specifically Article 18 of the IV Geneva Convention, affords special protection to civilian hospitals. This special protection is waived, however, under certain circumstances specified in Article 19. Such conditions to waive the special protection of hospitals are now being used by Israel to justify the attack on civilian hospitals and healthcare institutions in Gaza. This paper critically evaluates Article 19 and the conditions for the removal of the immunity of hospitals in general and in the specific case of Gaza. The substance and language of Article 19 are found to be flawed in this case. The paper thus argues that Article 19 should be revised to better reflect the special protection hospitals generally and in Gaza specifically should have. This paper is primarily geared at fellow bioethicists who wish to contribute to and lament the injustices occurring in Gaza and elsewhere but are unsure as to how ethical arguments may do so. This paper also addresses international law scholars, inviting further commentary on a novel and ambitious ethical argument to revise long-standing international law. Additionally, the paper is a call to the wider, global public and healthcare providers to actively condemn unjust attacks on healthcare in Gaza and elsewhere in the world. Lastly, the paper is written in a meager attempt at standing in solidarity with the People in Gaza and elsewhere whose healthcare systems are being targeted by unjust governments.

Nudging consists of interventions that aim to alter behavior in a certain way by changing the presentation or framing of options, without coercion or changing economic incentives. This paper discusses the effectiveness of nudging and the ethical implications of this effectiveness. Section 2 suggests that—if publication bias is adequately accounted for—recent comprehensive meta-analyses as well as high-quality experiments show that nudging is much less effective than previously assumed. Sections 3 and 4 discuss the ethical implications. I argue that the lack of effectiveness of nudging is an additional moral consideration against it. There are two reasons: First, reduced effectiveness makes nudging less cost-effective. Second, reduced effectiveness reduces the benefits of nudging but does not, to the same degree, weaken the moral reasons speaking against nudging. However, a comprehensive assessment of the effectiveness of various forms of nudging in diverse contexts, as well as their ethical permissibility, requires further empirical and ethical research.

The advent of new biomedical technologies has given rise to an emerging area of sociocultural discourse. The sociocultural perception of these technologies is contingent upon a number of factors, including the prevailing attitudes within dominant religious traditions. Religious bioethics is fundamentally distinct from secular bioethics. The former is grounded in unchanging sacred scriptures and traditions, which inform its normative provisions. Consequently, a shift in the perception of technology must be accompanied by a corresponding shift in how religious institutions interpret scripture and tradition. This article employs the Russian Orthodox Church (ROC) as a case study to investigate how religious institutions can adapt to changing societal and cultural demands, and whether religious moral decrees can evolve in response to shifting sociocultural discourse. A discourse analysis of the ROC's interactions with the medical community and the general public reveals the following: To maintain influence with its followers, a religious institution should not categorically reject new advances in biomedicine. Rather, it should engage in a comprehensive bioethical analysis of the challenges posed by each emerging technology. In this process, it is valuable to define boundaries based on religious doctrine—limits that a believer must not exceed to maintain communion with the deity—while allowing for the use of new biomedical solutions.

Doctors are often motivated by a desire to avoid causing their patients worry. In this paper, we provide a defence of disclosing diagnostic uncertainty information to patients, even if such disclosures are worrying. We first consider whether making a patient worry harms them, arguing that worry can be harmful in some—but not all—situations. Although worry is an aversive emotion, sometimes, worry can be beneficial (e.g., if the worry drives adaptive behaviours that are ultimately good for the patient's well-being). In contrast, worry that is excessive, or is related to events outside the patient's control, can be considered harmful. Even if worry is harmful, communicating worrying information can still sometimes be justified—for example, by applying a consequentialist harm–benefit analysis to consider whether the other benefits of the disclosure (broadly defined) might outweigh the harm created by the worry. We summarise the growing empirical evidence that suggests that patients often prefer their doctors to communicate transparently throughout the diagnostic process, even if the acknowledgement of serious but uncertain diagnoses induces some worry. We do, however, note the difficulty in predicting how an individual patient will respond to the disclosure of potentially worrying information (as the preference for greater communication of diagnostic uncertainty may not be universal). We conclude that a holistic consideration of the expected consequences of communication—including self-assessment by the doctor to avoid unwitting bias or unwarranted projection of their own values—often supports the communication of diagnostic uncertainty information, even if it worries the patient.

There is a rapid increase in disease registries all over the world, propelled by innovations in electronic health records and computer technologies. Unlike the developed world, where many registries are well established, many disease registries in the developing world are still in their incipient stage. Establishment of disease registries is blighted by many ethical concerns. These include but are not limited to data capture and data transfer happening without explicit patient consent; data sharing with third parties for various purposes including research, policy making and advocacy; and retrospective consent waiver. This is compounded by the lack of ethical guidelines and international best practices. This paper presents an ethical analysis of the ethics of informed consent for data registries.

This essay begins from the point that developments in antinatalism, or the view that it is wrong to bear children, place legitimate pressures on prospective parents to seriously consider the harms of bringing their prospective children into existence. This essay does not defend antinatalism but instead considers an upshot of bioethical import if one takes these antinatalist pressures seriously. Attending to the debate on the normative legitimacy of Savulescu's Principle of Procreative Beneficence (PPB), I argue that antinatalist pressures give rise to reasons that count in favor of the PPB. I show how an antinatalist-corollary version of the PPB might be derived and how we might respond to the PPB's main criticisms and conceptual difficulties.

Health systems contribute to the environmental crisis. Yet, addressing this problem seems to generate a resource allocation dilemma for hospitals: investing in healthcare delivery seems to mean sacrificing environmental goods, and vice versa. We question this zero-sum thinking. After presenting the benefits of investing in the two seemingly competing goods—environmental goods and health goods—we propose that the apparent dilemma arises due to a tendency to think in dualisms. Consequently, health and environmental goods seem, respectively, to correspond to opposing sides of four dualisms: human/nature, local/global, present/future and therapy/prevention. We argue, instead, that a relational frame that considers the human person in their relational context should be used to approach the problem. A relational understanding of the human person as a meaning-making subject in relationship to all that is shows us that choosing between either health goods or environmental goods is frequently a false dichotomy: both can serve the well-being of human beings adequately understood. Such an approach, then, widens our conception of health and healthcare to include environmental goods. This wider conception of health and healthcare means that hospitals should (1) look for co-benefits in the first instance when allocating resources, thereby often resolving zero-sum thinking that gives rise to the competing goods dilemma, and (2) in the remaining cases where co-benefits are not achievable, use classic resource allocation principles, such as proportionality of benefits and burdens, to reach allocation decisions about a now wider range of goods (i.e., health and environmental, rather than merely health goods).