Bioethics最新文献

This paper develops a vision for The Ecological Genome Project: an aspirational, global endeavour to connect human genomic sciences with the ethos of ecological sciences. The Project's goal is to strengthen interdisciplinary networks that relate to diverse initiatives using genomic technologies, with respect to shared ethical frameworks and governance structures. To this end, this paper proposes a practical definition of ecogenomics to align various methodologies and values in a single environmental field using principles used to safeguard all forms of life in their habitats. We achieve this by using a One Health approach as a pretext for disparate disciplines to collaborate and also a lens to view the Ethical, Legal and Social Implications (ELSI) inherent in ecological systems.

Molecular HIV surveillance, involving the collection and analysis of HIV genome sequences, has become an integral part of public health programmes in high-income countries. By employing phylogenetic analysis, molecular HIV surveillance can identify individuals and their positions within networks of HIV transmission. While the primary aim of molecular surveillance is to yield public health benefits, such as linking people to care and reducing transmission, it also poses risks and potential infringements on individual privacy and liberty. This paper examines the ethical implications of using phylogenetics to identify individuals involved in multiple transmission events in high-income countries. Although public health responses tailored to such individuals can significantly reduce further transmission, these individuals often face multiple intersecting vulnerabilities and bear the greatest risks associated with molecular surveillance. We analyze the risks related to privacy, stigma, mistrust, criminalization, and liberty infringements, alongside the benefits of preventing further transmission and increasing healthcare engagement for people living with HIV. We conclude by outlining plausible and ethically acceptable policy options for molecular surveillance practice.

The 2024 version of the Declaration of Helsinki [1] provoked a flurry of commentaries from the international research community on a host of different issues [2-6]. These included the broadened scope of the revised Declaration, its emphasis on integrity, the inclusion of the notion of meaningful engagement, the importance of ethical research in public health emergencies, research ethics committees’ (RECs) independence and the importance of providing them with adequate resources. It should also be noted that, with regard to some very controversial issues such as placebo control and post-trial benefits, the Declaration is not vastly different from its 2013 version [4]. However, some significant changes have arguably not been sufficiently considered in the published commentaries. Here, I will focus on paragraphs 19 and 20 of DoH 2024 that refer to vulnerability and suggest that these changes usher in a welcome paradigm shift regarding the concept of vulnerability.

The importance of certain changes to language in the revised version of the DoH has been noted. For example, the term “research subject” was replaced by “participant” [3, 6]. Thus far, no scholarship has addressed the linguistic dimension surrounding the Declaration's revision of the notion of vulnerability. Yet in paragraph 19, there is indeed a crucial change in language related to this concept. A new description of vulnerabilities is introduced: individuals, groups, and communities are in a “situation of more vulnerability.” In other words, the 2024 DoH leaves behind the essentialist conception of vulnerability–that individuals and groups are particularly vulnerable (Paragraph 19 (DoH 2013)). Note that the term “vulnerable populations” has been avoided, as now different situations may render these groups or communities more vulnerable. Furthermore, this is dynamic and contextual and may change.

This addition of a more dynamic conception of vulnerability has important consequences for research ethics. Perhaps most significantly, it means not labeling a priori with a categorical or essential property or following a predetermined list of people already considered vulnerable. However, some commentators fail to appreciate this difference and still use the previous terminology from 2013 [5, 7] as the 2024 version still maintains that factors may be fixed. But the 2024 DoH expands and refers to “a situation of more vulnerability as research participants, due to factors that may be fixed or contextual and dynamic,”¹ thus introducing a different way of thinking about the concept that captures the various ways in which vulnerabilities are expressed. This non-essentialist vision avoids stereotyping and labeling individuals, groups, and communities as vulnerable. As when a label is applied, it fixes the content and is quite difficult to remove; but if we think there are circumstances or characteristics that a

Artificial womb (AW) prototypes are currently being developed with the aim of improving the medical care of extremely premature infants. Despite the seemingly imminent reality of partial ectogenesis (i.e., gestation partially outside a human womb), there is persisting debate about the moral status of the fetus transferred in an AW—henceforth, the “developing entity.” For some, AWs are simply another neonatal intensive cares’ technology. Thus, developing entities in AWs should deserve the same protections as newborns in incubators. Others consider that AWs are fundamentally different technologies than incubators. Therefore, they believe that developing entities in AWs are new moral entities. These differences in perception generate disagreement about how developing entities in AWs should be treated and how decisions about them should be made. We argue that developing entities in AWs should be considered patients by transposing Chervenak and McCullough's “The fetus as a patient” proposition to the context of partial ectogenesis. As pregnant persons will have to consent to transfer their fetuses in AWs, and this technology will ultimately present itself as a beneficial medical intervention for viable developing entities in AWs, these latter would be patients, even if they are not legally and morally recognized as person. Thus, the moral obligations of beneficence and non-maleficence owed by physicians to their patients would apply to entities in AWs, ethically guiding their treatment and decision-making toward them.

I analyse two classic pro-choice thought experiments in the Anglo-American philosophical literature in Thomson's Violinist Case and Tooley's Kitten Serum Case, in light of two prominent African normative theories. Though each of these cases is designed to generate pro-choice intuitions, I suggest they do not do so nearly as clearly when African normative theories are in view. Furthermore, even where they might yield a pro-choice verdict, they do so for very different reasons. That African ethics, which is often labelled communitarian, differs from what one typically finds in the Anglo-American normative tradition is hardly a new insight. However, that these differences might undermine the universality of pro-choice thought experiments about abortion in Anglo-American bioethics has yet to receive significant attention.

This paper examines the ways in which public health measures taken to contain the spread of COVID-19 impacted the freedom of those affected, understanding freedom as non-domination. It argues that, in the absence of effective vaccines, individuals who carry a virus with the profile of COVID-19 have the capacity to impose high risks of severe illness and death on other people. But formal and informal rules can help control this capacity, supporting the freedom of people in certain respects. With regard to governmental enforcement of public health measures such as lockdowns, it argues that—depending on the form they take—they can be consistent with the enjoyment of freedom as non-domination of the population. Still, for this to be the case, some demanding conditions must be met. First, the government must continue to operate under a number of suitable checks. Second, the relevant policies must protect the basic interests of all members of the population. The paper also responds to criticisms of this account of freedom, stressing the connection between the secure enjoyment of basic liberties and the enforcement of formal and informal rules.

Do bioethicists have an obligation to speak out against such atrocities as Hamas' terrorism and Israel's war crimes? I will argue that they do have such an obligation, but not because they are bioethicists or even ethicists. Before driving home this conclusion, I will highlight some crucial facts in applying criteria for ethical engagement in warfare. Although I maintain that Hamas' terrorist attack of October 7 involved crimes against humanity that deserve condemnation, here I will focus on Israel's subsequent conduct, the ethical significance of which has been insufficiently appreciated among those who embrace a highly prevalent double standard_.