Bioethics最新文献

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.”

Organ Donation after Medical Aid in Dying (OD-MAiD) is currently practised in four countries: Belgium, Canada, the Netherlands, and Spain. While OD-MAiD shares some similarities with MAiD (absent the possibility of organ donation) and with standard organ donation protocols, the combination of OD and MAiD involves unique circumstances that present novel ethical challenges. These challenges revolve around donors' consent and protection, the dead donor rule, and organ allocation. This paper explores these moral challenges and proposes strategies to ensure ethical safeguards in the context of OD-MAiD. An underlying question is whether OD-MAiD, if permitted, should follow the ethical guidelines of living donation or deceased donation, as these two practices commonly operate under distinct moral paradigms. While the living donation paradigm is centred on the protection of donors' interests and emphasises individual choice by allowing donors to decide who receives their organs, the deceased donation framework places more emphasis on enabling recipients to benefit from transplant, and organ allocation is typically based on impartiality. OD-MAiD also raises ethical concerns about how the possibility of donation could influence a patient's decision to seek euthanasia and/or interfere with optimal end-of-life care. Proposing organ donation to individuals considering MAiD could conceivably create pressure to proceed with euthanasia, either to realise a social good or to satisfy the needs of loved ones (if a family member requires an organ). This may undermine the patient's autonomy or well-being at the end of life.

Patients who are diagnosed with anorexia nervosa (AN patients) characteristically refuse to receive medical treatment, including life-saving treatment, for their illness. These refusals are generally not honored on the grounds that AN patients are incapable of making autonomous medical decisions regarding their illness. Despite being widely shared by medical and legal experts, the judgment that AN patients are incapable of medical decision-making lacks a sound theoretical basis in the existing bioethics literature. This paper aims to fill this gap in the literature by offering a novel explanation of AN patients' incapacity. AN patients, I propose, are subject to three sources of incapacity: deep internal conflict, compulsion, and irrationality. I discuss the theoretical and practical implications of my proposal, including the challenge that it poses to the capacity model that is standardly used by clinicians in the United States.

This article challenges the claim that conscientious refusal and conscientious provision in healthcare are mutually exclusive and thus asymmetrical. While US law protects healthcare providers who refuse to perform medical services on moral or religious grounds, it offers no equivalent protections to those who feel morally compelled to provide care when the service is legally prohibited. This legal asymmetry has become more pressing following the Dobbs v. Jackson Women's Health Organization decision, which overturned Roe v. Wade and triggered a wave of state-level abortion bans. Responding to recent arguments by Kulesa and Giubilini, who contend that the symmetry thesis is false and that conscientious refusal and provision cannot be justified within the same professional framework, this article argues that their position misrepresents the symmetry and constructs a strawman. It demonstrates that refusal and provision are not intended to apply simultaneously in identical cases but rather arise in distinct legal and institutional contexts. The article also critiques the rigid distinction between "pathocentric" and "interest-centric" models of medicine, arguing that professional goals in medicine are plural, contested, and often internally conflicted. Denying moral and professional legitimacy to conscientious provision while protecting conscientious refusal undermines ethical consistency, professional integrity, and respect for moral diversity. In a society with conflicting moral frameworks, protecting both negative and positive conscience claims is necessary to uphold justice, respect provider autonomy, and ensure patient care. The symmetry thesis, understood as the equal moral and legal status of conscience-based refusal and provision, is both defensible and essential.

Chronic pain patients frequently encounter not only physical suffering but also emotional dismissal and misrecognition in clinical settings. This paper argues that such experiences reflect a pervasive form of structural harm: emotional injustice. Chronic pain sufferers, especially women and members of marginalized groups, are often subject to emotion policing-the unjust regulation of emotional expression that distorts, suppresses, or discredits their feelings of frustration, sadness, and anger. Stereotypes like "women are emotional" or "boys don't cry" shape how patients' pain is interpreted and whether their emotional expressions are seen as credible, appropriate, or pathological. As a result, patients' emotions are routinely misread, their reports of pain discounted, and their treatment delayed or denied. Through the lens of emotion stereotyping, display suppression, and emotion hegemonizing, I show how dominant emotional norms constrain how chronic pain patients can express distress and advocate for themselves. These practices compromise emotional autonomy-their ability to experience and express fitting emotions in ways that reflect their circumstances, values, and lived reality-and reinforce systemic inequities in healthcare. While these harms intersect with forms of epistemic injustice, I argue that emotional injustice captures a distinct and deeper wrong: the denial of patients' ability to make sense of and communicate their emotional suffering on their own terms. Recognizing emotional injustice in the treatment of chronic pain is crucial for promoting more equitable, respectful, and compassionate care-care that honors the emotional realities of patients' lives.

This paper presents a synthesis of pragmatic and ethical concerns with the Occupational Safety and Health Administration (OSHA), a US government agency, in the context of exploration, colonization, and monetization (with an emphasis on critical metals). OSHA provides worker safety regulations on a federal level, and proponents state that these regulations protect workers, while opponents state that OSHA either does not do enough to protect worker safety or that the increase in worker safety rates is due to market competition rather than federal regulation. This paper aims to state the importance of preemptive regulation in the context of the space race, in lieu of historical reactionary regulations, and to note the intersection of neoliberalism and colonialism that dictates market values, including space exploration. Finally, the paper posits that OSHA can utilize decolonizing ethics to increase worker safety and decrease health disparities associated with race.

Between October 2023 and January 2025, the Israeli military's sustained attacks on Gaza resulted in an estimated 186,000 deaths and the systematic destruction of healthcare infrastructure. Despite the professed commitment to human dignity, justice, and the minimization of suffering within bioethics, major institutions and scholars in the field have largely remained silent or selectively engaged with the crisis. This paper argues that the Gaza genocide exposes a deeper crisis within bioethics: its growing detachment from urgent, real-world ethical challenges. Such detachment erodes public trust and raises fundamental questions about the discipline's relevance and credibility. The article interrogates the possible reasons and motivations for the silence and disengagement in the face of genocide in Gaza, and examines the institutional and disciplinary responsibilities that bioethics bears in response to health-destroying state violence. Framing the inaction as a moral failure with far-reaching implications, the article proposes alternative routes of ethical engagement and outlines steps toward a more inclusive and responsive bioethics. It calls for the urgent reorientation of the field toward a justice-driven, politically conscious practice capable of confronting today's most pressing ethical issues.