Bioethics最新文献

In ethical debates on assisted dying, the principle of respect for autonomy is usually invoked to justify respecting requests for assisted dying. However, there are not only autonomy-based obligations, but also obligations arising from the principle of beneficence towards persons requesting assisted dying. What beneficence requires from persons providing assistance in dying is, however, far less obvious. We will argue that obligations of beneficence, in contrast to autonomy-based obligations, cannot fulfil a gatekeeping function in regulating access to assisted dying, that is, differentiate between ethically justified and unjustified cases. Nevertheless, they can and should play an important role in this context: Based on philosophical considerations on the concept of well-being, which is the focus of the principle of beneficence, we elaborate three different roles of beneficence-based obligations in the context of assisted dying: providing high standards of care, supporting autonomous decision-making and offering ethical guidance for health care professionals who consider providing assistance in dying. As we will show, these beneficence-based obligations can also support ethics consultation in assisted dying, especially in cases where there is ethical uncertainty among the assisting persons about whether they should follow the request and provide assistance in dying. Based on a principle-based approach to integrated ethical decision-making, we will demonstrate how an elaborated understanding of well-being and the specified beneficence-based obligations can contribute to balancing competing ethical obligations and promote ethically sound decisions in requests for assisted dying. The suggested approach can be used as a guidance for ethics consultation in requests for assisted dying.

Artificial intelligence (AI) based clinical decision support systems (CDSS) are becoming ever more widespread in healthcare and could play an important role in diagnostic and treatment processes. For this reason, AI-based CDSS has an impact on the doctor-patient relationship, shaping their decisions with its suggestions. We may be on the verge of a paradigm shift, where the doctor-patient relationship is no longer a dual relationship, but a triad. This paper analyses the role of AI-based CDSS for shared decision-making (SDM) to better comprehend its promise and associated ethical issues. Moreover, it investigates how certain AI implementations may instead foster the inappropriate paradigm of paternalism. Understanding how AI relates to doctors and influences doctor-patient communication is essential to promote more ethical medical practice. Both doctors' and patients' autonomy need to be considered in the light of AI. This article is protected by copyright. All rights reserved.

Patients diagnosed with familial hypercholesterolaemia (FH) are advised to disclose their diagnosis to at-risk relatives, as early knowledge of genetic risk allows relatives to manage their cholesterol levels. Debates in the bioethical literature regarding familial disclosure of genetic risk tend to revolve around rights: the right of the patient to autonomy and confidentiality, against the right of the family members to receive information that is clinically relevant or genetically shared. However, empirical studies found that patients' reasoning was frequently relational, suggesting a need to reexamine the values used in guidelines. This study aimed to examine patient values that affect the familial disclosure of familial hypercholesterolaemia. Twenty-one patients were interviewed. The results showed that patients' decisions were driven by two factors: beneficence and emotional proximity. As interview questions did not ask specifically about responsibility, it is noteworthy that various notions of obligations to others emerged unprompted. Patients perceived responsibilities based on the knowledge they held, and the nature of familial relationships; in particular, duties to vulnerable relatives. My results suggest that responsibilities, rather than rights, are a decisive moral issue that motivated patients' decisions.

This paper explores the ethical implications of emerging weight-loss medications such as Semaglutide (Ozempic) and Tirzepatide (Mounjaro), analysing their therapeutic applications for obesity and potential use as enhancement drugs. These medications promise significant benefits, including improved individual health outcomes, reduced healthcare costs and, potentially, reduced environmental harms. However, their widespread adoption raises various concerns, such as unknown long-term side effects, the exacerbation of weight-based discrimination, and the reinforcement of socioeconomic disparities. The paper argues that, with robust regulatory frameworks in place, the potential benefits of these medications are likely to outweigh the risks. Nonetheless, ongoing monitoring of their effect on individuals and society at large remains essential.

Novel biological entities such as cell lines and organoids do not typically fit into established conceptual categories, such as 'human' or 'nonhuman', 'gift' or 'property'. This makes developing robust ethical principles or policy solutions difficult. In this article, we present a new approach to the ethics of novel biological entities, which we call 'liminal bioethics'. We argue that some entities are best understood as liminal; we should not try to shoehorn them into existing categories or modify our concepts to suit them. However, we must investigate which concepts help articulate an entity's liminal status most precisely. The choice of concepts, in turn, may suggest correspondingly liminal ethical principles or solutions for that entity. To demonstrate how this method works, we focus on immortalised cell lines as a test case, while also considering its implications for more recent breakthroughs in cell culture technology relating to organoids and assembloids. First, we demonstrate why the gift-property distinction is inadequate for framing the liminality of cell lines. We then argue for cell lines as being located in a liminal conceptual space between body part and organism, and discuss the conceptual shift that this entails for understanding the status of cell lines and organoids. We suggest that ethical principles in relation to cell lines should reflect this particular liminality; for example, commercial exchange of cell lines seems more acceptable than with body parts, but some means of respecting cell lines' continuing human connection should still be in place.

Recent literature has seen a growing endorsement of the so-called autonomy-only approach to assisted dying, which rejects suffering as a necessary criterion for access. Proponents argue that this model is most suitable to safeguard individuals against value-based judgments of healthcare professionals about whether their lives are still worth living when it comes to decisions on assisted dying. In this paper, I challenge the assumption that the autonomy-only approach successfully avoids the shortcomings of a joint view at assisted dying that also relies on beneficence-based criteria. Based on the example of Germany, a country that follows the autonomy-only approach towards assisted suicide, I contend that, despite its emphasis on personal freedom, this approach may in practice not truly serve the ideal of autonomy as it claims. Referring to critical medical ethics, I argue that Critical Theory offers the epistemic tools needed to identify underlying social contradictions and to evaluate the concept of autonomy in relation to its real-world application. Drawing on the work of Herbert Marcuse, I highlight the importance of considering how individual needs are shaped and mediated by social conditions in ethical deliberations on assisted dying. I conclude that ethical considerations have to avoid both submitting to short-sighted conceptions of autonomy and taking a paternalistic stance that dismisses individual pledges for assisted suicide if they disagree with supposedly objective reasons.

The recent addition of the diagnostic criteria for prolonged grief disorder has attracted criticism and concern about the undue medicalisation of grief and other existentially distressing yet normal life events. However, prolonged grief disorder currently forms the only pathway to VAD access for those suffering from extremely prolonged or unrelenting grief in the Netherlands, as this satisfies the requirement that the request must be due to a medical condition, and these criticisms of the disorder could jeopardise that access. A potential solution to this tension could be the currently debated autonomy-only approach to VAD, which circumvents issues of medicalisation by removing VAD from the medical domain. However, this approach raises other problems that require investigation in the context of grief specifically. In this article, I will first consider how VAD for grief is currently treated within Dutch VAD policy. This will involve an examination of prolonged grief disorder as a diagnosable condition, and how it relates to the general concern of undue medicalisation. Following this, I will consider possible ways in which persistence of a death wish due to grief can be established without the use of a medical diagnosis, as would be the case according to the autonomy-only framework for VAD. Ultimately, I will borrow some guidelines from the field of prepubescent gender care as an area that shares many morally relevant features with the question of VAD for grief and propose what I will be calling the "watchful grief affirming waiting" model.

The paper explores the impact of artificial intelligence (AI) in medicine through a three-dimensional model of medical understanding, which encompasses understanding of disease (via the biomedical perspective), illness (through first-person experience) and sickness (which is seen as a social role). By linking these dimensions to the epistemic aims of transparency, certainty and empathy, the analysis highlights how AI's potential to enhance and undermine medical understanding can be debated. While AI may increase the transparency of bodily processes, improve diagnostic certainty and challenge dominant paradigms of clinical empathy, it also threatens to obscure value-laden aspects of illness, erode confidence in subjective and social experiences of sickness and complicate mutual understanding in clinical encounters. Rather than offering an exhaustive empirical analysis of AI applications, this paper provides a conceptual framework for assessing AI's epistemic impacts in medicine, thereby serving as a foundation for future studies to examine specific implementations of AI.

Neuroscience's accelerating advances have reached a pivotal point in the study of the human brain, including neurotechnologies capable of recording large amounts of data and acting with greater precision. However, the use of neurotechnology has raised a number of ethical, legal, and social implications (ELSI). To that end, sufficiently robust policy and governance structures must be considered. To date, no published review of United States policies governing neuroscience and neurotechnology exists. To address this, we review US polices and various ethical frameworks overseeing neuroscience and neurotechnology. This policy review highlights where gaps in neuroscience and neurotechnology policy and governance might exist. Overall, our review shows that “soft policies” make up the present-day US neurotech-governance universe at the federal level, with neurodata specific state-legislation emerging. The included analysis can aid researchers, technology developers, neuroethicists, research ethicists, legal scholars, and others in facilitating ethically and socially responsible implementation of neuroscience and neurotechnology as they move from “bench to bedside and beyond.”