Bioethics最新文献

This article reflects on the role of medical ethics in voluntary assisted dying (VAD) practice from the perspective of the field of regulation. Through employing Regulatory Space Theory, which seeks to understand how individual and institutional behaviour is guided by competing and conflicting sources of normative guidance, the article will make three arguments. First, medical ethics, along with the institutions and individuals that employ medical ethics through various tools in VAD practice (e.g., ethical practice guidelines or ethical advice), are involved in the exercise of regulation. This is the case even if those institutions and individuals employing medical ethics do not necessarily perceive themselves as 'regulatory actors'. Second, drawing on Regulatory Space Theory, the actors and tools that employ medical ethics to undertake regulation are only part of a wider 'regulatory space' that includes other regulatory forces such as law, policy, and system design. Hence, the role of medical ethics in VAD practice cannot be properly understood in isolation. Third, this article maps medical ethics across VAD regulation, showing the breadth of roles that medical ethics plays in VAD practice, including the macro (i.e., State) level, meso (i.e., institutional) level, and micro level (i.e., clinical coalface). This mapping highlights the significant use of medical ethics even by regulatory actors without specific medical ethics expertise and in regulatory tools that are not focused on medical ethics. The article concludes by considering the practical implications of how medical ethics is used in regulating VAD practice.

Doctors are routinely discouraged from engaging in substantive religious discussions with patients, even when such discussions might help patients accept necessary treatment. Recent arguments by Dr. Lauren Notini and Prof. Justin Oakley attempt to justify this prohibition on two grounds: impracticality, and professional boundaries. I argue that while doctors are under no obligation to engage in such discussions, the blanket moral prohibition proposed by Notini and Oakley is unjustified. I offer a critique of their arguments and defend an alternative, individualistic ethical framework. This framework recognises that such discussions may be morally permissible when (1) practical, (2) mutually agreed upon, and (3) free of deception or coercion.

Throughout the decades, the ethical debate on 'slow code' has traversed a spectrum. Most have condemned it as deceptive, while others argued for its usefulness in balancing clinician integrity and family wishes in an otherwise emotionally complex dilemma, albeit desperately and imperfectly. The study by Sprengholz, "Public Preferences Regarding Slow Codes in Critical Care", contributed empirical data to a discourse chiefly shaped by expertise and opinion by exploring the layperson's perception of the practice's ethicality. Sprengholz's attempt, though commendable, falls short in its underdeveloped methodology, thus raising concern about the validity of its claimed conclusion. This article critically evaluates the study's limitations and misguidances, simultaneously beginning to propose modifications for future research designs.

The subject of this article is a critical examination of Marcus T. L. Teo's attempt to apply antinatalism to the domain of procreative ethics. Teo argues that antinatalism supports the Principle of Procreative Beneficence (PPB). In this article, we demonstrate several reasons why this is untenable. PPB is a fundamentally pronatalist principle, bearing no substantive connection to antinatalist philosophy. Moreover, the range of potential suffering that can be averted by PPB-if at all-is extremely limited. Antinatalism, by contrast, is not concerned with the quality of future individuals' lives, since it holds that the quality of all human life will be so poor as to render existence never worth initiating. Finally, we show that the emerging biomedical technologies relevant to reproduction, on which the concept of procreative beneficence depends, are almost invariably pronatalist in character, and hardly ever antinatalist.

Most of us think that death is usually not in the self-interest of the one who dies. Let us momentarily put this belief aside and examine death in a new light. This paper presents a two-step argument to show why death is most in one's self-interest, necessarily. The first step contends that death minimizes one's bad at no loss of one's good, such that if one's life has or will have any bad whatsoever, death is most in one's self-interest. The second step maintains that all possible self-interested lives have extrinsic bad given their potential to be better. Hence, death is most in one's self-interest, necessarily. This paper challenges prevailing notions on death and remains fruitful even for those readers disinclined to accept its conclusion. Attempting to determine where the argument goes awry provides an opportunity to sharpen one's own views on death.

Medically assisted dying (AD) practices have been legalized in several jurisdictions throughout the world over the last two decades. Because of this increased trend, more individuals now have access to a self-chosen death. Despite its legalization and the diversity of frameworks governing AD, it remains fraught with ethical challenges. However, there is a dearth of literature regarding the specific roles clinical ethicists (CEs) may have in AD provision. We sought to address this literature gap by: (1) Gathering healthcare professionals' (HPs) and CEs perspectives on how CEs may contribute; (2) Identifying how CEs may have been involved thus far; (3) Identifying promising practices and pitfalls related to their involvement. An exploratory qualitative study using focus groups, purposive and snowball sampling. Four online focus groups were held. Groups comprised of (1) HPs and (2) CEs from Quebec and Switzerland. Data was analyzed using thematic analysis. Altogether 21 persons participated, among them 10 ethicists and 11 HPs. Four major themes were identified: (1) Specific Roles for CEs; (2) CEs competencies deemed useful in AD provision; (3) Operationalization of CEs' involvement 5) Obstacles/Pitfalls associated to CEs' involvement in AD. Several roles for CEs have been identified that have been associated with specific ethical challenges that arise in AD. Findings indicate that CEs' integration in AD should be context dependent and should consider several misconceptions associated with the field of clinical ethics in general.

This paper examines the moral experiences of Palestinian healthcare professionals working at a specialised referral hospital in East Jerusalem during the early months of the Gaza War. Drawing on semi-structured interviews with hospital staff providing oncology care, it analyses how understandings of what constitutes "good" care in a context of occupation, segregation, and genocidal violence are shaped by competing normative frameworks. Three ethical perspectives initially emerged: medical ethics, which prioritises evidence-based protocols; humanitarian ethics, which emphasises neutrality in line with donor requirements; and communitarian ethics, which understands care as an expression of solidarity and national duty. The paper argues that to fully capture the moral labour of healthcare workers, a fourth frame is needed: care ethics, which highlights the relational and reparative dimensions of care work. This perspective is crucial in a context where occupation and segregation deeply affect the "care triangle" of patients, companions, and healthcare providers. Viewing care as a relational practice that resists division and exclusion also offers a strategy to alleviate the moral distress that can arise when professionals are unable to provide care they themselves see as "good enough." The paper calls on employers, communities, and colleagues to value and support the care work professionals provide beyond their clinical tasks, while also recognising the limits of individual responsibility by acknowledging and addressing the structural barriers they face. Ultimately, an end to occupation and segregation remains the primary condition for enabling good care.

This paper predicts that humans will venture into space and that, to survive and thrive in space, we will need to enhance our capacities radically. Moderate enhancement is insufficient for a humanity that commits to a future in Space. The paper is a partial retraction of the author's claims about the morality and prudential rationality of radical human enhancement. It allows that radical enhancement may be imprudent and immoral for Earth-bound humans, but essential for humans who settle in space. The paper advances a conjecture about how to assess which kinds of radical enhancements are required and which should be rejected. A humanity that commits to a future in Space may make progress on some disputes that today seem intractable.