Bioethics最新文献

The term slow code refers to an intentional reduction in the pace or intensity of resuscitative efforts during a medical emergency. This can be understood as an intermediate level between full code (full resuscitation efforts) and no code (no resuscitation efforts) and serves as a symbolic gesture when intervention is considered medically futile. While some previous research acknowledges the slow code as an integral part of clinical practice, many ethicists have condemned the practice as dishonest and causing unnecessary pain for the patient. As the public's views on this issue have been largely absent from the discussion to date, two vignette experiments were performed to investigate their perceptions. The findings indicate that laypersons believe that slow codes are commonplace and often prefer them over a no code. While a full code was perceived as the standard approach and rated most ethical and least punishable, the present results do not support the widespread assumption that laypersons generally oppose slow codes, and this finding should inform ethical discussion and clinical practice.

Current clinical research lacks diversity in those that participate. This lack of diversity is concerning given its importance for successful drug development. The frequency and severity of many diseases, along with the pharmacological properties of therapies, can display significant differences based on patient diversity. A clinical trial population that is more reflective of these differences will help researchers better understand the therapeutic profile of the treatment and provide generalizable knowledge to the medical community. The advent of decentralized clinical trial designs is meant to help address this lack of diversity by using portable digital health technologies and virtual interactions to enhance clinical trial access and broaden participation. By leveraging these technologies, trial conduct can occur at locations other than traditional research sites. This shift in trial location may help address some of the logistical, educational, engagement, and trust barriers that have historically prevented enrollment of diverse populations. However, these types of trials still have limitations. Ethical concerns around justice, equity, and diversity will still exist with decentralized clinical trials, which could be mediated using clinical research vehicles. When utilized, this modality may enhance the scientific design and conduct of clinical trials and better follow these ethical principles. These enhancements and improved ethical direction could be accomplished through increasing community involvement, improving health literacy, supporting more diverse trial sites, creating community-based research footholds, fostering connections with researchers, limiting technical challenges, and preventing data security issues.

Opponents of legalised assisted dying often assert that palliative care is worse in countries where assisted dying has been legalised, and imply that legalised assisted dying makes palliative care worse. This study considers five versions of this claim: that it is difficulty to access expert palliative care in countries where assisted dying has been legalised, that those countries rank low in their quality of end-of-life care; that legalising assisted dying doesn't expand patient choice in respect of palliative care; that growth in palliative care services has stalled in countries where assisted dying has been legalised; and that legalised assisted dying impedes the growth of palliative care or causes it to decline. In each case, it concludes that neither argumentation nor evidence supports these claims.

In 1975, The New England Journal of Medicine published James Rachels' article 'Active and Passive Euthanasia'. The argumentative method that Rachels introduced, the Bare Difference Argument (also known as the Contrast Strategy), became one of the most widely used tools in ethical reasoning. The argument, however, fails to show active euthanasia being morally permissible. It fails because Rachels takes the intuitions from the case where letting die is morally impermissible and applies the intuitions to cases where letting die is morally permissible. While it is possible to create thought-experiments that are more analogous to euthanasia, in this respect, than Rachels' cases, they too are disanalogous to euthanasia with some of the relevant features. Creating the perfect analogy, however, would be a mistake too. Such a case would be too analogous; people would simply be divided on what kind of moral intuitions they would have. The problem thus highlights a methodological limit in philosophical bioethics and raises questions related to the roles of philosophical ethicists in the context of assisted dying.

Emerging evidence that intrauterine exposures to environmental stressors can ‘programme’ epigenetic modifications in offspring, leading to long-lasting health risks, has generated debate about whether prospective mothers have a specific ‘epigenetic’ moral responsibility. However, to date, proposals for maternal epigenetic responsibility have failed to grapple adequately with the uncertainty of scientific evidence, and specifically, whether the causal basis for intrauterine epigenetic effects is sufficiently established to ground claims of moral responsibility. Causality is widely considered a necessary condition for the attribution of moral responsibility. In this paper, we show that much foetal programming science in humans has yet to establish a causal epigenetic connection between intrauterine exposures and subsequent offspring health impacts. This research struggles to establish that the relationship between such exposures and offspring health risks is in fact causal, neither has it been able to evince the causal significance of exposures during pregnancy to such outcomes. We argue that these two challenges to establishing causality in foetal programming research seriously undercut the idea that prospective mothers may have a moral responsibility to ensure the epigenetics of their offspring.

With the continued expansion and commercialisation of fertility treatments, the selection and matching of donors have become more sophisticated and technologised. As part of this landscape, new form of genetic screening: ‘expanded carrier screening’ (ECS) is being offered as a technique to avoid the risk of donors passing on genetic conditions to future offspring. Allowing donors to be tested for hundreds of genetic conditions simultaneously, ECS marks a considerable departure from traditional ‘family history’ models of screening, which rely on an individual's knowledge of family health. There is growing evidence of a drive towards the use of ECS within the fertility sector, and a growing number of clinics are offering it for a fee, as part of an egg or sperm donation cycle or as an add-on to IVF treatment. In this article, we use methods of critical reflection to synthesise data from two studies to explore how ECS is being used to avoid genetic risk in IVF treatment using donor gametes. We suggest that ECS is a new form of repro-genetic selection—a selective reproductive technology—with specific and important implications for donors, recipients and clinicians and with the potential to reconfigure the scope and application of gamete donation. We examine these implications and conclude that the existing policy blind spot relating to this development in fertility treatment practice needs to be urgently addressed.

The past two decades have seen growing calls for the “tobacco endgame.” Its advocates are united by their commitment to two ideas. First, tobacco-related harms represent a catastrophic health emergency, and second, current tobacco-control approaches are an inadequate response to the scale of that emergency. To endgame advocates, tobacco policy should have more ambitious goals than merely “controlling” tobacco. Instead, it should aim to bring about a smoke-free world. While a range of different policies are included under the umbrella of the “tobacco endgame,” the most radical proposal is for a complete ban on tobacco. Its advocates argue that in addition to improving global public health, an effective ban on tobacco would also promote overall autonomy and would have important egalitarian benefits. This article critically examines these arguments for a tobacco ban. I argue that they rely on idealizing assumptions about the likely effects of a ban. Because an effective ban would require robust enforcement to control the illegal market in tobacco, it would be more likely to undermine autonomy and equality than it would be to promote them. By relying on idealizing assumptions and ignoring the likely consequences of a tobacco ban, advocates of a ban obscure, rather than clarify, both the policy debate and the ethical stakes. I conclude by considering the ways that idealizing assumptions should—and should not—play a role in debates about ethical issues in public policy.

There is a well-established asymmetry in our judgments of performance enhancing drugs (PEDs) in sports and in other competitive activities. When an athlete is found using such drugs, it is a scandal that prompts public outrage, fan disappointment, and even loss of title. It seems that we judge enhanced results cannot be genuinely attributed to athletes. There is no similar reaction to use of PEDs in art, science, music, literature, business, and other human endeavors. The question I tackle in this paper is whether this disanalogy is justified: Is there some underlying difference in virtue of which PEDs should be thus stigmatized in sports but not elsewhere? I survey a couple of potential justifications that I find lacking. I then consider the difference in our judgments of the participation of superman-like characters in sports (which we censure) and in other activities (which we endorse). I argue that the fact that the athlete is human is relevant to the value of sports—and by extension, the status of the effort involved—while this fact plays no significant role with regard to the value of other activities and that this difference in the value of activities ultimately justifies our differing judgments here. I then return to my initial question and examine whether similar appeal to what is human can justify the varying judgments of the use of PEDs. I argue that it can but only under certain assumptions. I conclude by discussing wider implication of my suggestion.

All over the world, many companies are including oocyte cryopreservation for nonmedical reasons, also popularly known as nonmedical egg freezing (NMEF), within their employee benefits packages. However, it is important to ask whether companies are ethically justified in offering NMEF as a benefit for their employees. The inclusion of NMEF within companies' employee benefits packages could be ethically justified in two ways. On the one hand, company-sponsored NMEF can serve as a strategy to mitigate or eliminate gender inequalities in the workplace, such as female underrepresentation in positions of authority and leadership and the so-called work/motherhood conflict. On the other hand, company-sponsored NMEF can be a means to expand women's reproductive autonomy by making egg freezing accessible to those women who are not able to afford it otherwise. This article calls into question these ethical justifications. We argue that by offering NMEF as an employee benefit, companies maintain current workplace inequalities and impose an option for women with multiple risks and externalities. Therefore, companies' offering of NMEF benefits cannot be ethically justified. Furthermore, we argue that companies that offer NMEF benefits incur fiduciary responsibilities related to the physiological, emotional, psychological, and financial costs of the use of company-sponsored NMEF.