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On the Immunity of Hospitals in Gaza: A Reply to Lederman. 关于加沙医院的豁免权:对莱德曼的答复。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-11-13 DOI: 10.1111/bioe.70054
Simon Lucas

Zohar Lederman critically assesses the special protections afforded to hospitals under international humanitarian law, arguing that the conditions for revoking immunity are overly permissive and fail to safeguard medical facilities. Framing his argument within a conventionalist approach-where legal norms reflect historically refined moral principles-he neglects a central requirement of conventionalist ethics: explaining how such laws and conventions acquire normative authority. This omission produces internal inconsistencies that render his conclusions unpersuasive and risk making a strategically significant military operations morally impermissible. Furthermore, a restrictive interpretation of civilian immunity may create perverse incentives, encouraging rogue actors to exploit civilian infrastructure and exposing the very patients that these protections aim to shield to greater harm.

Zohar Lederman批判性地评估了根据国际人道主义法给予医院的特殊保护,认为撤销豁免的条件过于宽松,未能保护医疗设施。他将他的论点建立在传统主义的方法中——法律规范反映了历史上精炼的道德原则——他忽略了传统主义伦理学的一个核心要求:解释这些法律和惯例是如何获得规范权威的。这一遗漏产生了内部矛盾,使他的结论缺乏说服力,并有可能使具有重大战略意义的军事行动在道德上不被允许。此外,对平民豁免的限制性解释可能会产生不正当的激励,鼓励流氓行为者利用民用基础设施,并使这些保护措施旨在保护的病人受到更大的伤害。
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引用次数: 0
Empowering End-of-Life Decision-Making: Utilizing Brochures to Support Muslim Patients and Families in Canada 授权临终决策:利用小册子来支持加拿大的穆斯林患者和家属。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-11-13 DOI: 10.1111/bioe.70056
Maram Hassanein

Canada is a multicultural country with diversity across faiths and ethnicities. Although Islam is the second-largest reported religion, healthcare providers often lack familiarity with Islamic beliefs, values, and how they impact end-of-life decision-making compared to the more commonly encountered faiths, such as Christianity. For Muslims, guidance on end-of-life decision-making is sought from the teachings of the Quran, Sunna, and Islamic rulings. However, decision-making may be influenced by a lack of awareness among Muslim patients, their families, and healthcare providers regarding the Islamic permissibility and prohibitions related to end-of-life care. Additionally, there may be a limited understanding of the prevailing healthcare legislation that structures end-of-life care in Canada. This adds to the existing barriers faced by Muslim patients and their families when making decisions that are both religiously and culturally informed while residing in a non-Muslim majority country and receiving care from non-Muslim providers. With the goal of increasing awareness, promoting autonomy, and empowering patients to actively participate in their healthcare and make informed decisions, this paper explores the development and potential value of a decision-making tool: a brochure that integrates Islamic perspectives on end-of-life care with the Canadian healthcare legislation and policy. Although the brochure is primarily intended for Muslim patients and families, it also aims to support healthcare providers and raise awareness when a Muslim Chaplain or Imam is unavailable.

加拿大是一个多元文化的国家,拥有不同的信仰和种族。尽管伊斯兰教是报告的第二大宗教,但与基督教等更常见的信仰相比,医疗保健提供者往往不熟悉伊斯兰教的信仰、价值观以及它们如何影响临终决策。对于穆斯林来说,关于临终决定的指导来自古兰经、逊那和伊斯兰教的教义。然而,穆斯林患者、其家属和医疗保健提供者对与临终关怀有关的伊斯兰允许和禁止缺乏认识,可能会影响决策。此外,对加拿大现行的临终关怀医疗立法的理解可能有限。这增加了穆斯林患者及其家属在做出宗教和文化决定时面临的现有障碍,因为他们居住在一个非穆斯林占多数的国家,并接受非穆斯林提供者的护理。为了提高意识,促进自主权,并使患者能够积极参与他们的医疗保健和做出明智的决定,本文探讨了决策工具的发展和潜在价值:一本小册子,将伊斯兰教对临终关怀的看法与加拿大医疗保健立法和政策相结合。虽然这本小册子主要是为穆斯林病人和家属准备的,但它也旨在支持医疗保健提供者,并在没有穆斯林牧师或伊玛目时提高人们的意识。
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引用次数: 0
Laypeople's Views on the Narrative Identity and Societal Treatment of Genetically Modified People. 外行人对转基因人叙事身份与社会待遇的看法。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-11-13 DOI: 10.1111/bioe.70051
Derek So, Yann Joly, Robert Sladek

Genome editing in human embryos could raise new ethical issues by changing future people's narrative and numerical identity. Most philosophers agree that some genetic modifications would have larger effects on identity than others, but they disagree on what criteria might explain these differences and have not supported their claims experimentally. We recruited 416 Americans through the crowdsourcing website Mechanical Turk. Participants were presented with 30 genetic modifications commonly discussed in bioethics and completed a questionnaire about how each modification might affect future people's narrative identity and social treatment. Perceived effects of genome editing on narrative identity correlate moderately with effects on social treatment, suggesting a large role for social construction. The largest changes to identity were associated with changing biological sex, enhancing intelligence, adding abilities from other species and introducing or preventing deafness. The smallest changes to identity were from making people right-handed, lowering the need for sleep, preventing dementia and changing eye or hair colour. Modifications of the same characteristic in opposite directions, such as making someone more or less aggressive, generally had significantly different effects on societal treatment but not on narrative identity. Specifying gender by describing the genetically modified person as a 'son' or 'daughter' did not have significant effects. These findings offer a new direction for research on genome editing and the identity of genetically modified people.

人类胚胎基因组编辑可能会改变未来人们的叙事和数字身份,从而引发新的伦理问题。大多数哲学家都认为,一些基因修饰会比其他基因修饰对身份产生更大的影响,但他们在解释这些差异的标准上存在分歧,也没有得到实验的支持。我们通过众包网站Mechanical Turk招募了416名美国人。研究人员向参与者展示了30种生物伦理学中经常讨论的基因修饰,并填写了一份问卷,内容是每种修饰如何影响未来人们的叙事身份和社会待遇。基因组编辑对叙事认同的感知效应与对社会待遇的影响适度相关,表明对社会建设有很大作用。最大的身份变化与改变生物性别、提高智力、增加其他物种的能力以及引入或预防耳聋有关。最微小的身份变化包括:使人成为右撇子、减少对睡眠的需求、预防痴呆以及改变眼睛或头发的颜色。对相同特征进行相反方向的修改,比如使某人更具攻击性或更少攻击性,通常会对社会待遇产生显著不同的影响,但对叙事身份没有影响。通过将转基因人描述为“儿子”或“女儿”来指定性别并没有显著影响。这些发现为基因组编辑和转基因人身份的研究提供了新的方向。
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引用次数: 0
Digitizing Dignity: Analyzing Digital Twins Through the Lens of Multidimensional Human Dignity. 数字化尊严:从多维人类尊严的视角分析数字孪生。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-11-01 DOI: 10.1111/bioe.70045
Andrew J Barnhart

In precision medicine, digital twins-virtual models of patients created using personalized data and advanced machine learning-are potentially changing healthcare by predicting health outcomes and guiding medical decisions. However, their use raises complex ethical questions, particularly concerning their relationship to human dignity. Patients often regard dignity as central to their healthcare experience, and failing to incorporate this principle into the design and application of digital twins risks undermining personal autonomy, misusing sensitive data, eroding patient-provider trust, and creating broader ethical challenges. This paper argues that digital twins are not mere data sets or predictive tools, but symbolic extensions of the dignity of the individuals they represent. Using David Kirchhoffer's multidimensional framework of human dignity, this study examines how digital twins engage with both absolute (inherent) and contingent (socially constructed) dimensions of dignity. The analysis begins by exploring the multidimensional concept of human dignity, followed by a discussion of how digital twins embody these dimensions, illustrated through examples such as digital brain twins, posthumous digital representations, and disability contexts. Finally, the paper addresses the ethical implications of these findings, emphasizing the moral responsibilities of researchers, developers, and clinicians to treat digital twins as representations of patient dignity, thereby ensuring these technologies advance healthcare without compromising the fundamental respect owed to every individual.

在精准医疗领域,数字双胞胎——使用个性化数据和先进的机器学习创建的患者虚拟模型——通过预测健康结果和指导医疗决策,有可能改变医疗保健。然而,它们的使用引起了复杂的伦理问题,特别是关于它们与人类尊严的关系。患者通常将尊严视为其医疗保健体验的核心,未能将这一原则纳入数字孪生的设计和应用中,可能会损害个人自主权,滥用敏感数据,侵蚀患者与提供者的信任,并产生更广泛的道德挑战。本文认为,数字双胞胎不仅仅是数据集或预测工具,而是它们所代表的个人尊严的象征性延伸。利用David Kirchhoffer关于人类尊严的多维框架,本研究考察了数字双胞胎如何与绝对(固有)和偶然(社会建构)的尊严维度相结合。分析首先探讨了人类尊严的多维概念,然后讨论了数字双胞胎如何体现这些维度,并通过数字大脑双胞胎、死后数字表现和残疾背景等例子进行了说明。最后,本文阐述了这些发现的伦理意义,强调了研究人员、开发人员和临床医生的道德责任,将数字双胞胎视为患者尊严的代表,从而确保这些技术在不损害对每个人的基本尊重的情况下推进医疗保健。
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引用次数: 0
Dual Use Research of Concern-The Necessity of Global Bioethics Engagement. 关注的双重用途研究——全球生物伦理参与的必要性。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-10-30 DOI: 10.1111/bioe.70046
Daniel J Hurst, Christopher A Bobier

Dual use research of concern (DURC) refers to research conducted for legitimate scientific purposes that could also be misused to pose a significant threat to public health and safety, agricultural crops and other plants, animals, the environment, or national security. Scant discussion of bioethics in relation to DURC has taken place, with even less attention to DURC within a global bioethics framework. Herein, we demonstrate the connections of global bioethics-due to globalization, solidarity and cooperation, the precautionary principle, and collective consent-to DURC and present a number of questions that the field can help clarify.

双重用途关注研究(DURC)是指为合法科学目的进行的研究,但也可能被滥用,对公众健康和安全、农作物和其他植物、动物、环境或国家安全构成重大威胁。关于DURC的生物伦理学讨论很少,在全球生物伦理学框架内对DURC的关注甚至更少。在此,我们展示了全球生物伦理学与DURC的联系——由于全球化、团结与合作、预防原则和集体同意,并提出了该领域可以帮助澄清的一些问题。
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引用次数: 0
Exploring Repro-Timing Harm and Benefit 探索生殖计时的利弊。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-10-27 DOI: 10.1111/bioe.70040
Davide Battisti, Gary David O'Brien

It is plausible that time of birth affects one's prospects for wellbeing. Being born during a war or recession might have a negative impact on early life and lifetime wellbeing. In natural reproduction, delaying conception does not result in the same child being born later, but rather a different child altogether; therefore, prospective parents cannot harm/benefit their children by choosing their time of birth. However, we argue that for prospective parents undergoing the IVF process, things are different. Since it is possible to freeze and store embryos indefinitely before implantation, parents can choose their child's time of birth. Because certain birth timings may better support wellbeing, this introduces the possibility of repro-timing harms and benefits. This paper explores this new concept by outlining its theoretical assumptions and examining the moral reasons prospective parents in IVF might have for delaying implantation in the short, medium, and long term.

出生时间影响一个人的幸福前景似乎是合理的。在战争或经济衰退期间出生可能会对早期生活和终身健康产生负面影响。在自然生育中,推迟受孕并不会导致同一个孩子晚出生,而是会产生完全不同的孩子;因此,未来的父母不能通过选择出生时间来伤害/造福他们的孩子。然而,我们认为,对于接受试管婴儿过程的准父母来说,情况就不同了。由于胚胎可以在植入前无限期冷冻和储存,父母可以选择孩子的出生时间。因为某些生育时间可能更有利于健康,这就引入了生育时间的利弊可能性。本文通过概述其理论假设和检查试管婴儿准父母可能在短期、中期和长期延迟植入的道德原因来探讨这一新概念。
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引用次数: 0
Global Health Solidarity: A Multidimensional Framework 全球卫生团结:多层面框架。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-10-27 DOI: 10.1111/bioe.70042
Yijie Wang

Solidarity has emerged as a vital concept in bioethics. In recent years, the concept of solidarity has transcended domestic boundaries, with its rhetorical power being leveraged across diverse global health contexts. However, despite its prominence in bioethics and its rhetorical use in global health, health solidarity remains largely confined to domestic contexts. This paper fills this gap by exploring the possibility of extending health solidarity on a global level. Rather than pursuing a singular, unitary concept, I propose to conceptualize global health solidarity (GHS) with a multidimensional framework that encompasses four essential modes: prudential, moral, sociopolitical, and institutional. The prudential mode provides a compelling foundation for GHS through self-interested motivations, emphasizing global health interdependence. The moral mode frames GHS as morally right or good, grounded in relational personhood, functioning either as a duty or a virtue. The sociopolitical mode conceptualizes GHS as a politically significant, prosocial phenomenon in pursuing liberation and confronting injustices, enabling project-based collaboration beyond identity boundaries. The institutional mode formalizes GHS through established structures, shaping global bioethics frameworks and health governance systems. Recognizing these diverse sources, contexts, and practices of solidarity, the multidimensional framework offers a comprehensive conceptual map for understanding and operationalizing GHS. It provides both analytical clarity and practical guidance for navigating solidarity-based practices in global health contexts. When compared with established frameworks, such as global health justice, global health governance, global health activism, and global health security, GHS provides distinct added value and deserves a more fundamental place in the current global health discourse.

团结已成为生命伦理学中的一个重要概念。近年来,团结的概念已经超越了国内界限,其修辞力量在不同的全球卫生背景下得到利用。然而,尽管卫生团结在生物伦理学中占有突出地位,并在全球卫生中使用修辞手法,但它在很大程度上仍局限于国内背景。本文通过探讨在全球范围内扩大卫生团结的可能性来填补这一空白。与其追求单一、单一的概念,我建议将全球卫生团结(GHS)概念化为一个多维框架,其中包括四种基本模式:审慎、道德、社会政治和制度。审慎模式通过自私自利的动机,强调全球卫生的相互依存,为全球统一制度提供了令人信服的基础。道德模式将GHS定义为道德上的正确或良好,以人际关系人格为基础,作为一种责任或美德发挥作用。社会政治模式将GHS概念化为追求解放和对抗不公正的政治意义,亲社会现象,使基于项目的合作超越身份界限。体制模式通过既定结构,形成全球生物伦理框架和卫生治理体系,使全球统一制度正规化。认识到这些不同的来源、背景和团结实践,多维框架为理解和实施全球统一制度提供了一个全面的概念图。它为在全球卫生背景下开展基于团结的做法提供了清晰的分析和实用指导。与全球卫生正义、全球卫生治理、全球卫生行动主义和全球卫生安全等现有框架相比,全球卫生统一体系提供了独特的附加价值,在当前的全球卫生话语中应占有更重要的地位。
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引用次数: 0
Love (Drugs), Happiness, and Morality 爱情(毒品)、幸福和道德。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-10-27 DOI: 10.1111/bioe.70043
Vojin Rakić

Various authors, including myself, have argued that happiness and morality operate in a circularly supportive relationship. In this paper, love will be added to this relationship. The new triple correlation will be explored through the following lens: not only do love and happiness reinforce moral action, but they appear to be in a triple circularly supportive relationship. Moral behavior is frequently grounded in love; love encourages prosocial behavior; prosocial behavior increases happiness; happiness, in turn, enhances the inclination of most people to act morally most of the time. Argued from the opposite direction: happiness tends to encourage prosocial behavior in most people most of the time; prosocial behavior is conducive to the development of loving relationships; love induces us to behave morally toward the people we love. The argument presented here will also propose that this triple circular reinforcement can be significantly deepened and sustained through a careful use of love-enhancing substances, aided by guided meditation—particularly in the case of the psychedelic psilocybin. It will be concluded that humans will be motivated to use love drugs because they tend to increase their happiness. Consequently, a voluntary use of love drugs is a more effective means of moral (bio-)enhancement than is the prevention of “ultimate harm” that is based on compulsory moral enhancement.

包括我在内的许多作者都认为,幸福和道德在一种循环支持的关系中运作。在本文中,将爱添加到这种关系中。新的三重相关性将通过以下镜头进行探索:爱和幸福不仅会加强道德行为,而且它们似乎处于三重循环支持关系中。道德行为常常以爱为基础;爱鼓励亲社会行为;亲社会行为增加幸福感;幸福,反过来,增强了大多数人的倾向,使他们在大多数时候都合乎道德。从相反的方向争论:在大多数时候,幸福倾向于鼓励大多数人的亲社会行为;亲社会行为有利于恋爱关系的发展;爱促使我们以道德的方式对待我们所爱的人。这里提出的论点还将提出,通过谨慎使用增强爱情的物质,在有指导的冥想的帮助下,特别是在迷幻药裸盖菇素的情况下,这种三重循环强化可以显着加深和维持。结论是,人类会被激励使用爱情药物,因为它们倾向于增加他们的幸福感。因此,自愿使用爱情药物是一种更有效的道德(生物)增强手段,而不是预防基于强制性道德增强的“最终伤害”。
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引用次数: 0
Defending Irreversibility and Brain Death in the Ethics of Heart Donation After Circulatory Death 在循环死亡后心脏捐献伦理中捍卫不可逆性和脑死亡。
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-10-27 DOI: 10.1111/bioe.70044
Calixto Machado

Heart donation after circulatory determination of death (DCDD) expands the donor pool but requires careful ethical grounding, particularly regarding the determination of death. This article affirms the legitimacy of brain death as a medically and ethically valid form of death, emphasizing that the irreversible cessation of brain function remains the foundational criterion. Building upon the framework proposed by Bernat and Dalle Ave, the essay promotes the concept of Donation after Brain Circulation Determination of Death (DBCDD), which ensures death is defined by the permanent cessation of brain circulation, leading inevitably to the loss of all brain function. It argues for the necessity of safeguards in DCDD protocols, including strict verification of systemic circulatory arrest and clear exclusion of cerebral reperfusion. Rather than undermining the legitimacy of DCDD, these standards uphold the integrity of brain-based death determination, reinforce the dead donor rule, and safeguard public trust. This approach unifies death determination under the brain criterion across all clinical pathways.

循环确定死亡(DCDD)后的心脏捐赠扩大了供体池,但需要仔细的道德基础,特别是在确定死亡方面。这篇文章肯定了脑死亡作为一种医学上和伦理上有效的死亡形式的合法性,强调脑功能不可逆转的停止仍然是基本标准。在Bernat和Dalle Ave提出的框架基础上,本文推广了脑循环后捐赠确定死亡(DBCDD)的概念,该概念确保死亡被定义为脑循环永久停止,不可避免地导致所有脑功能的丧失。它认为在DCDD方案中有必要采取保障措施,包括严格验证全身循环骤停和明确排除脑再灌注。这些标准不但没有削弱脑死亡决定的合法性,反而维护了脑死亡确定的完整性,加强了死亡捐赠者规则,维护了公众的信任。这种方法统一了所有临床途径中大脑标准下的死亡判定。
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引用次数: 0
Non-Emergent Oncologic Surgery Cancellation During the COVID-19 Pandemic: A Risk–Benefit Analysis COVID-19大流行期间非紧急肿瘤手术取消:风险-收益分析
IF 2.1 2区 哲学 Q2 ETHICS Pub Date : 2025-10-22 DOI: 10.1111/bioe.70039
Samantha R. Scott, Megan Applewhite, Wayne Shelton

The COVID-19 pandemic was a devastating worldwide event with great consequences on medical and surgical care that has not been fully evaluated. The pandemic caused an imbalance between rapidly increasing patient needs and limited hospital resources such as staff, personal protective equipment (PPE), and open beds. As a result, surgeons in the United States were encouraged or required to postpone “non-emergent” operations, including some cancer surgeries, in March of 2020. Resource allocation during the pandemic focused on the needs of the community to accommodate potential surges, and cancer patients needing “non-emergent” operations had operations delayed. This paper is an ethical analysis based on the review of the literature covering a range of topics from known harms due to certain operation delays, to COVID-19 caseloads, to triage ethics. The key surgery types examined were cancer surgeries for a wide range of organ systems. Many mandates for suspension of surgical care came from the national level without consideration of the local COVID-19 caseload, which was variable. It could be argued that the physical and mental harm sustained by patients whose disease progressed as a result of surgery delay outweighed the benefits of preserving resources, particularly in the regions with low COVID volumes. This paper uses the principles of medical ethics within a public health framework to examine the ethical issues surrounding the cancellation of oncologic surgeries and makes recommendations for times of future resource strain.

2019冠状病毒病大流行是一场毁灭性的全球事件,对医疗和外科护理造成了巨大影响,但尚未得到充分评估。大流行造成了快速增长的患者需求与有限的医院资源(如工作人员、个人防护装备和开放床位)之间的不平衡。因此,美国的外科医生被鼓励或要求在2020年3月推迟“非紧急”手术,包括一些癌症手术。大流行期间的资源分配侧重于社区的需求,以适应潜在的激增,需要“非紧急”手术的癌症患者的手术被推迟。本文是一篇基于文献综述的伦理分析,涵盖了一系列主题,从某些手术延误造成的已知危害,到COVID-19病例量,再到分诊伦理。研究的主要手术类型是针对多种器官系统的癌症手术。许多暂停手术治疗的命令来自国家层面,没有考虑到当地的COVID-19病例量,这是可变的。可以说,由于手术延误而导致疾病恶化的患者所遭受的身心伤害超过了保留资源的好处,特别是在新冠肺炎病例较少的地区。本文利用公共卫生框架内的医学伦理原则来研究围绕取消肿瘤手术的伦理问题,并为未来资源紧张的时候提出建议。
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引用次数: 0
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