Bioethics最新文献

This paper presents an Ethics Framework for MAiD (Medical Assistance in Dying) to support the integration of evidence-informed, values-based, inclusive and transparent ethical decision-making into everyday MAiD practice. As with other areas of clinical practice, ethical decision-making is an intrinsic part of MAiD. While clinicians connected to academic medical centers or large hospitals may have access to the expertise of an ethicist, those working independently, or in community-based, rural or remote settings may wrestle with ethical issues alone. Without a process to guide ethical reflection and analysis, clinicians navigating complex MAiD cases risk moral distress and uncertainty, and may inadvertently make decisions that are biased, narrow or ill-informed. The proposed Ethics Framework for MAiD includes a description of core values and principles relevant to the delivery of MAiD and a process guide to support the application of values and principles to cases. Use of the framework is illustrated through a simplified complex MAiD case. This Ethics Framework for MAiD is applicable to both clinical patient cases and organizational ethics issues, and adaptable to any jurisdiction and any legal or practice context. It may also be used by ethicists when conducting formal ethics case consultations involving MAiD. The goal of the paper is to empower MAiD assessors, providers, health professionals, program managers and ethicists to address ethical issues arising in everyday practice through the introduction of a pragmatic ethics framework specifically tailored to assisted dying.

Since the beginning of the Israel-Hamas war in 2023, the healthcare infrastructure within Gaza has been dismantled. While international humanitarian law mandates distinction between lawful targets (combatants and military objectives) and non-lawful targets (civilians and civilian objects), and acknowledging the inherent complexities of applying this principle in conflicts involving non-state actors like Hamas operating within civilian areas, numerous reports indicate that Israel's actions have resulted in significant and foreseeable consequences for the Gazan civilian population. Due to these substantial and foreseeable harms, which have led to a long-term humanitarian crisis, we argue that the Israeli government bears a moral responsibility to help mitigate the long-term humanitarian crisis, which, at a minimum, requires helping to rebuild the healthcare infrastructure to its status quo ante bellum.

A minority of countries around the world have taken steps to legalize the practice of physician-assisted suicide and/or euthanasia (PAS/E). Proponents frame PAS/E as a means to enhance patient autonomy, reduce suffering, alleviate the burden of illness, and respect patient dignity. Critics of PAS/E, on the other hand, assert that it reflects a distortion of autonomy, mistakes the source of patient suffering, and dangerously affirms to people that their dignity and worth are contingent on not requiring burdensome caregiving. This has the potential to create uncertainty for how clinicians and institutions should provide ethical guidance to patients on morally controversial matters such as PAS/E. Although ethicists have a duty to explain the range of ethical arguments, they also have an obligation to reinforce ethical boundaries and provide decisive guidance when an intervention is irreconcilable with the practice of medicine. In their clinical role, ethicists can explain why PAS/E is not a healing act and why it violates the principles of beneficence and nonmaleficence. This article outlines three roles for clinical ethicists to provide education, consultation, and develop policies designed to respond to patient suffering in a manner that preserves the integrity of medicine.

Critics of affective moral enhancement generally contend that moral improvement can only be properly achieved through interventions that engage a person's rational faculties. Therefore, they view attempts to achieve moral improvement by targeting emotions as futile at best and detrimental to moral agency at worst. In this paper, I argue that even if we accept the view that genuine moral improvement requires the engagement of rational faculties, we need not reject all forms of affective moral enhancement. My argument premises on the view that certain types of affect are highly informative. Affective moral enhancement that aims to elicit these affective states grants enhancement recipients access to vital moral knowledge they may not be able to attain otherwise. I then introduce the distinction between two types of affect—emotions and moods—and argue that the concerns regarding affective moral enhancement only apply to interventions that aim to achieve moral improvement via direct mood modulation.

There is mounting global interest in the revolutionary potential of AI tools. However, its use in healthcare carries certain risks. Some argue that opaque (‘black box’) AI systems in particular undermine patients' informed consent. While interpretable models offer an alternative, this approach may be impossible with generative AI and large language models (LLMs). Thus, we propose that AI tools should be evaluated for clinical use based on their implementation risk, rather than interpretability. We introduce a practical decision algorithm for the clinical implementation of black-box AI by evaluating its risk of implementation. Applied to the case of an LLM for surgical informed consent, we assess a system's implementation risk by evaluating: (1) technical robustness, (2) implementation feasibility and (3) analysis of harms and benefits. Accordingly, the system is categorised as minimal-risk (standard use), moderate-risk (innovative use) or high-risk (experimental use). Recommendations for implementation are proportional to risk, requiring more oversight for higher-risk categories. The algorithm also considers the system's cost-effectiveness and patients' informed consent.

This study examines the violence inflicted upon Palestinians in Israeli prisons during the initial phase of the "Iron Swords" war, which commenced following a Hamas attack on Israeli civilians on October 7, 2023. It investigates how wartime circumstances can intensify the use of torture and ill-treatment within prisons, with a particular focus on the impact on detainees who were not implicated in activities connected to the attack. Utilizing the case files of Palestinian security prisoners who lodged complaints of mistreatment with Israeli NGOs, the study uses descriptive analysis to categorize and quantify diverse forms of reported violence that could potentially constitute torture. The study's findings reveal a concerning pattern: all 19 subjects reported experiencing violence from prison staff, with 18 of these cases involving physical violence. Multiple claims referenced more than one instance of violence, and eleven claims additionally reported violence against other detainees. The claims of violence spanned seven different prisons, underscoring the systemic nature of the issue. Reported methods of violence encompassed beatings, forced positioning in painful postures, threats, and humiliation, sometimes with sexual undertones, among other forms of abuse. Seven subjects had visible bruises and wounds, two suffered broken limbs, and one sustained a fractured tooth. These findings suggest a correlation between war, a decline in ethical standards, and the abuse of prisoners. By bringing these issues to light, the study advocates for evaluating prison practices and a commitment to upholding human rights standards, even during violent conflict and war.

This paper argues that philosophical practice can complement existing medical ethics structures by offering a publicly accessible space for discourse and negotiation of basic concepts that are relevant to ethical decision making. The potential of collaboration becomes particularly evident by the example of assisted dying: it raises a wide range of philosophical questions which, however, tend to remain unarticulated where there is urgency for action and focus on ethical dilemma. In this paper, we first provide an analysis of the neglect of profound questions in ethics consultation and why these need to be considered and negotiated within a broader socio-philosophical framework and place. These reflections are grounded in conceptual approaches informed by Immanuel Kant, Charles Taylor, and the tradition of Hellenistic philosophy as interpreted by Pierre Hadot. These frameworks are not presented as final answers, but as productive starting points and historically significant philosophical thought figures for engaging with the complex philosophical dimensions of assisted suicide. Then, we draw upon insights from an ongoing research project on philosophical practice in palliative care and hospice work. Interim results indicate that people experience a need for a kind of dialogue that gives such philosophical considerations a space and a person who is capable of facilitating it. Synthesizing theoretical-philosophical and empirical insights, the paper provides an outlook for fruitful collaboration amongst medical ethics structures and philosophical practice.