Biomedical Ethics, Misc

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)

Federated learning (FL) is a machine learning (ML) approach that allows multiple devices or institutions to collaboratively train an ML model without sharing their local data with a third-party. It has recently received significant attention as a promising way to overcome longstanding ethical obstacles to training medical ML models with patient health data. This paper examines the promise of FL in healthcare from an ethical perspective. It argues that medical FL generates a new variety of opacity – federation opacity, wherein (...) stakeholders cannot access, analyze, or curate the data on which a model has been trained – which (a) presents distinctive ethical challenges concerning institutional fairness and accountability in medical ML; and (b) makes FL models especially vulnerable to data poisoning attacks. It then identifies several key claims about the expected benefits of FL in healthcare and argues that they may be either exaggerated, misleading, or incomplete – often due to the problem of federation opacity. (shrink)

En este trabajo se comparan dos representaciones en competencia sobre el origen de la bioética para llamar la atención sobre un posible cambio de marco teórico dentro de la disciplina. Por un lado, una representación parroquiana del origen de la bioética, centrada en problemas tecnológicos locales, y fundamentada en tradiciones culturales particulares. Por otro lado, una representación universal y pluralista, que enfrenta problemas de justicia y salud globales y que intenta buscar el fundamento normativo del discurso de la bioética en (...) los derechos humanos. Luego de compararlas, desarrollo algunas razones para mostrar por qué las relaciones entre bioética y derechos humanos están sólidamente justificadas. Por último, planteo dos observaciones críticas que deberían tenerse en cuenta al pensar la relación entre bioética y derechos humanos. (shrink)

En este trabajo se comparan dos representaciones en competencia sobre el origen de la bioética para llamar la atención sobre un posible cambio de marco teórico dentro de la disciplina. Por un lado, una representación parroquiana del origen de la bioética, centrada en problemas tecnológicos locales, y fundamentada en tradiciones culturales particulares. Por otro lado, una representación universal y pluralista, que enfrenta problemas de justicia y salud globales y que intenta buscar el fundamento normativo del discurso de la bioética en (...) los derechos humanos. Luego de compararlas, desarrollo algunas razones para mostrar por qué las relaciones entre bioética y derechos humanos están sólidamente justificadas. Por último, planteo dos observaciones críticas que deberían tenerse en cuenta al pensar la relación entre bioética y derechos humanos. (shrink)

Rapidly advancing technologies in the field of extracorporeal cardiopulmonary resuscitation (ECPR) have presented a new challenge in accurate neuroprognostication following cardiac arrest. Determination of brain state informs the prognostic picture and allows providers to begin effective communication regarding likelihood of meaningful neurological recovery as defined by patients or family members. The evolving role of sedation during ECPR and its impacts on ethical tension in decision-making is reviewed. Work surrounding the advancing field of neuroprognostication after cardiac arrest and hypothermia is summarized (...) and implications of premature withdrawal of life-sustaining treatments are discussed. Advances that improve predictive value for neurological recovery are utilized in affirming and discussing the implications for end-of-life wishes of individuals in the setting of intensive resuscitative therapies. (shrink)

Researchers and Institutional Review Board members often disagree about the permissibility of some parts or all of the former’s proposed research. At least sometimes, this disagreement is reasonable. This is often because there are competing values and no clear solution as to how to balance these values. Arguably, given that there are multiple reasonable ways in which these values might be balanced, IRBs are subject to an asymmetric public justification requirement. This requirement implies that IRBs should defer to researchers when (...) the disagreement is reasonable. After briefly defending this claim, this paper examines its implications with respect to three questions that IRBs face. We argue that IRBs should not impose a strict limit on payments to participants, that they should take a more expansive view of what types of research are authorized by broad consent forms, and there should be no hard cap on risks participants might choose to undergo. (shrink)

Hematopoietic stem cell transplantation is a widely accepted practice in the United Kingdom (UK). The relatively liberal UK law permits donation both within families and from strangers, and even allows the creation of “saviour siblings” who are brought into being with the specific intent of having them donate stem cells to save other members of their family. This chapter describes the regulation of HSCT in the UK and highlights some ethical issues related to discrimination against some categories of potential donors, (...) the accuracy of the information provided to potential donors, and the controversy concerning saviour siblings. (shrink)

Artificial intelligence (AI)-enabled remote patient monitoring (RPM) is promoted as a solution to rising pressures in health care, including personnel shortages and the growing burden associated with population aging and chronic disease management. Yet, the ethical implications of deploying adaptive systems in routine care remain underexamined at the level of specific, situated use cases. This article examines the ethical risks of MonitAir, an AI-enabled RPM system for chronic obstructive pulmonary disease (COPD) in a Swedish health care setting. Drawing on the (...) Three Domains, Six Levels (3D6L) framework, we identify epistemic, normative and traceability-related risks across six levels of abstraction. The article offers, to our knowledge, the first operationalization of the 3D6L as an analytic tool for screening ethical risks. We argue that screening AI-enabled health care technology with 3D6L clarifies how ethical risks manifest across levels, from individual patients and patient–clinician relationships to organizational and sectoral contexts. In addition, the framework’s minimal normativity allows alignment with context-sensitive principles and guidelines. Through this analysis, we identify ethical risks related to data bias, intelligibility of outputs, uneven access and blurred responsibility, including redistributive and role-shifting effects. While MonitAir may support earlier detection of exacerbations, its implementation in Swedish COPD care may also reproduce and amplify existing health disparities or overburden patients without sufficient support. We demonstrate how structured ethical screening makes visible concerns typically overlooked by the optimization discourse in digital health. Finally, we argue that open-ended evaluation of ethical risks of AI-enabled DHT provides a valuable early phase that complements ethical assessment, without collapsing into checklist compliance. (shrink)

Drugs given to reduce suffering in palliative care often cause adverse consciousness diminishment. The causing of this consciousness diminishment is often justified appealing to the Doctrine of Double Effect. This justification relies on consciousness diminishment being unintended and a side effect in such cases. Arima (2025) argues that in many of these cases, consciousness diminishment is actually intended and not a side effect at all. If that is so, in those cases the use of drugs that cause consciousness diminishment cannot (...) be justified by appeal to the Doctrine of Double Effect alone. Here I aim to challenge two points that play a central role bolstering Arima’s conclusion. The first I call the ‘instrumental rationality’ point: if something is causally necessary to bring about an intended end, that causally necessary thing must likewise be intended. The second I call the ‘dissimilarity’ point: consciousness diminishment in this context is unlike a side effect insofar as side effects do not contribute causally to the intended aims of an intervention. I challenge both of these points by appealing to recent work on defining medical side effects. I conclude that Arima is likely right that the number of instances where the Doctrine of Double Effect justifies consciousness diminishment in palliative care is less than commonly thought, though it is not as rare as Arima’s argument leads one to believe. (shrink)

This chapter explores the significance of the changed legal test for dishonesty arising from (Ivey v. Genting Casinos (UK) Ltd. t/a Crockfords (2017) for the professional regulation of doctors. This is an important topic because dishonesty is a key consideration in tribunals’ assessment of doctors’ fitness to practise. The chapter assesses the extent to which the reasons for the Supreme Court’s adoption of the Ivey test in the criminal law apply to Medical Practitioner Tribunals (MPT), given their different functions and (...) the different functions of dishonesty within them. It concludes that while an objective test based on the standards of ordinary people is preferable to a subjective test for the MPT, the justification and application of such a standard is less straightforward than in the criminal law. (shrink)

AI technology has shown tremendous results in medical areas such as cancer detection. With the advent of generative AI and large language models, there is great potential for AI-based therapy, so-called “automated therapy.” While a lot has been said in the psychological literature about automated therapy, detailed ethical analyses relevant to the ethics of automated therapy literature have been relatively sparse in philosophy. The failure to address ethical concerns related to automated therapy is surprising since therapy is arguably a very (...) sensitive aspect of medical care, and integrating AI technology into this domain raises substantive ethical queries that require careful analysis. This paper will contribute to the urgent need to address ethical concerns by analyzing the ethical impact of automated therapy through the lens of its effects on human dignity. (shrink)

Some medical interventions have the potential to interfere with patients’ future healthcare decision-making. We identify two types of such influences: affecting whether a patient has decision-making capacity in the first place; and influencing which treatment option a patient ends up selecting. Using the example of deep brain stimulation, we argue that one should utilise this effect to obtain more authentic treatment preferences. In patients with implanted deep brain stimulators who do not meet the capacity threshold, the device state should be (...) reverted as there is a chance that doing so has a positive effect on their capacity. In patients who are already deemed decision-competent, the same approach can reveal on/off-discrepancies in the selection of treatment choices. We propose five cross-checking strategies to deal with such discrepancies and call for a revision of current procedures for obtaining consent following any interventions whose psychotropic influences can be reversed within clinically reasonable time frames. (shrink)

Since 2022, genetically modified pig organs have been transplanted into both deceased and living human subjects, and first-in-human clinical trials began in 2025. Yet, little is known about the experience of performing such procedures. The first kidney xenotransplant studies involved human brain-dead recipients, with graft function ranging from hours to months. Interviews were conducted with one of the first surgeons with experience in performing a pig-to-human kidney xenotransplant and analysed using interpretative phenomenological analysis. Following analysis, four personal experiential themes were (...) identified: Desiring a more equitable patient future; Being changed by bonding with the family; Crossing a boundary without feeling the difference and Everything changed when the pig kidney turned pink. As the first exploration of a surgeon’s lived experience of xenotransplantation, the study highlights how motivations, uncertainties and ethical commitments influence engagement with emerging biotechnologies. While uncertainties remain, the findings provide insight into how a surgeon interprets and navigates the conceptual and emotional terrain of crossing into first-in-human xenotransplantation. (shrink)

Respect for patient dignity is recognized as an ethical commitment in healthcare, yet the concept often remains too abstract to guide clinical practice. This challenge is salient in mental health contexts, where patients may experience diminished autonomy, stigma, or institutional constraints. This paper develops a conceptual and normative analysis of dignity in mental health care by distinguishing between two conceptions: dignity as inherent worth and dignity-as-standing. Drawing on philosophical analysis, empirical literature, and global policy frameworks, the paper evaluates each conception’s (...) practical implications for care. We argue that while dignity as inherent worth understands dignity as an intrinsic, non-natural value grounding human rights, it often remains too vague to guide clinical decision-making and may risk excluding patients with diminished autonomy. By contrast, dignity-as-standing conceives dignity not as a metaphysical value but as the elevated moral standing of persons that calls for treatment befitting their rank as members of the moral community. This conception offers a more action-guiding and inclusive framework for care, especially for patients with mental illness, disabilities, dementia, or advanced age. On this basis, we identify strategies for operationalizing dignity in practice, including recognizing autonomy as a continuum, implementing supported decision-making, respecting value-based refusals, and embedding relational, structural, and culturally responsive supports in care. The dignity-as-standing framework offers a practical and ethically coherent foundation for respecting patients’ dignity in mental health care, enabling clinicians and institutions to translate the ideal of dignity into concrete practices across diverse clinical and cultural contexts. (shrink)

Philip Reed (forthcoming) has offered several interesting objections to my recent JME paper, “Expressivist concerns for assisted dying on request.” In this brief reply, I address those objections.

Rapid advancements in artificial intelligence (AI) pose novel ethical and practical challenges for scholarly publishing. Although AI-related policies are emerging in many disciplines, little is known about the extent and clarity of AI guidance in bioethics and health humanities journals. A search of publicly available journal lists from the American Society for Bioethics and Humanities, Health Humanities Consortium, and Association for Medical Humanities was supplemented with Google Scholar’s top 20 bioethics journals ranked by h5-index. This yielded 54 unique journals, of (...) which 50 remained after excluding those without a functional website or recent publications. AI policies were reviewed at the journal and publisher levels were assessed via website review, and editors were contacted for clarification when required. Data extraction was conducted by one author and independently verified by two additional researchers to ensure accuracy. Of the 50 journals analyzed, only 8 (16%) had a clear AI policy, while 27 (54%) were published by a publisher with an identifiable AI policy. Publisher AI policy statements were favorable to considering AI-assisted manuscripts. Five (10%) of the 8 journals with a clear AI policy explicitly prohibited AI-generated text in submissions. The remaining 15 (30%) journals did not have a publicly available AI policy. Ten of these 15 journals confirmed an absence of any formal AI policy, and seven indicated that discussion to develop guidelines was ongoing. The adoption of AI policies in bioethics and health humanities journals is currently inconsistent. Some journals explicitly ban AI-generated text, whereas others permit AI-assisted writing, with publisher policies being favorable to considering AI-assisted manuscripts. The lack of standardized AI guidelines underscores the need for further discussion to ensure the ethical and responsible integration of AI in academic publishing. (shrink)

Machine-learning algorithms are transforming healthcare diagnostics and prognostics. However, they sometimes underperform for groups underrepresented in their training data. Vandersluis and Savulescu have suggested selectively deploying these algorithms for populations well represented in the training data, while excluding underrepresented groups until improvements are made to the algorithms. In this paper, I explore one long-term risk of such selective deployment for certain small underrepresented groups, such as those with rare diseases. The risk in question is the potential long-term decline in the (...) human expertise critical for such small groups, which, because they are excluded from effective care by the algorithm, would still rely on non-algorithmic, human expertise even in the long run. I then discuss how to best preserve human expertise and maintain long-term access to quality care for excluded groups and contend that such expertise preservation is essential for ethical deployment of algorithmic processes in healthcare. (shrink)

Public debates over the morality of new or emerging technologies tend to devolve into false dichotomies of optimism versus pessimism. Playing God with Emerging Technologies: How to Avoid the Traps of Techno-Optimism and Techno-Pessimism provides a conceptual apparatus for engaging in such debates in a critical manner through the constructive lens of “playing God” arguments. Moti Mizrahi sketches a conceptual framework consisting of an argumentation scheme for “playing God” arguments along with Critical Questions. This framework can be used to analyze (...) and evaluate “playing God” arguments as they are made in debates over the ethical development and deployment of new and emerging technologies, such as solar geoengineering, Artificial Intelligence (AI), autonomous vehicles, autonomous weapons, and more. Mizrahi argues that “playing God” arguments allow us to assume an intermediate, critical attitude between the extremes of hype and panic as well as to approach the governance of new or emerging technologies in ways that might help to increase our control over, improve our understanding of, and prevent our misuse or abuse of such technologies. (shrink)

When two people need a kidney transplant, but only one kidney is available, we need to decide who gets it. If one of the potential recipients needs the kidney because of their own voluntary behavior, but the other is not at all responsible for needing a kidney, then we need to decide whether this fault should be a consideration in favor of the other patient getting the kidney. While there has been considerable philosophical debate on this issue, there is far (...) less research into the views of the public. To explore opinions on these issues, we first asked survey participants to ascribe or deny responsibility for the risky behavior for kidney disease, and for being deprived of a kidney in cases of drinking alcohol, drug abuse, smoking and unhealthy eating when the patient did or did not stop the risky behavior after being diagnosed with kidney disease. Next, we asked participants who should get the kidney when the patient who engaged in risky behavior did or did not know, or have easy access to, the information that the behavior was risky. We found that participants generally ascribed responsibility on the basis of knowledge but allocated the kidney on the basis of access to information. These findings have important implications for moral theories as well as medical policies. (shrink)

. In the evolving landscape of healthcare, the efficient processing of biomedical signals is critical for real-time diagnosis and personalized treatment. Conventional cloud-based AI systems for biomedical signal processing face challenges such as high latency, bandwidth consumption, and data privacy concerns. Edge computing, which brings data processing closer to the source, has emerged as a potential solution to these limitations. However, optimizing AI models for edge devices, which often have limited computational resources, remains a challenge. This paper proposes an innovative (...) approach to optimize AI models for biomedical signal processing by leveraging reinforcement learning (RL) techniques within edge computing environments. Reinforcement learning offers the potential to dynamically adapt model parameters based on real-time feedback from the edge devices, optimizing the trade-offs between model accuracy, resource utilization, and processing speed. The proposed system is designed to operate with high efficiency on edge devices, enabling faster signal processing while ensuring energy efficiency and maintaining diagnostic accuracy. A detailed review of existing literature highlights the benefits and challenges of edge computing in biomedical applications, the role of reinforcement learning in dynamic optimization, and the limitations of traditional AI models in constrained environments. The proposed system methodology integrates RL for model optimization, focusing on edge devices' unique constraints in terms of power, memory, and processing capacity. Simulation results demonstrate the improved efficiency and accuracy of biomedical signal processing with optimized AI models in edge computing setups, showing significant improvements in real-time diagnostic applications. (shrink)

Reprint of an article that first appeared in Theoretical Medicine and Bioethics (2017).

Biobanking-the storage of human biological samples, including tissue, blood, urine, and genetic data-raises many ethical, legal, and social issues, including confidentiality and privacy. Pediatric biobanking is more complicated, with difficulties arising because children lack capacity to consent and acquire this capacity upon maturity when the research is still ongoing. Yet given the limited availability of pediatric samples, the translational nature of biobanking presents a unique opportunity to share samples and produce clinically necessary information about pediatric development and diseases. Guidance on (...) navigating these legal and ethical difficulties is needed for those involved in pediatric biobanking-including researchers, participants, and families, and those involved in biobank governance. This paper seeks to map the current regulatory framework governing pediatric biobanking to determine what guidance is currently offered. Regulatory mapping of current international and national guidelines on pediatric biobanking addressing the ethical, legal, and social nuances of pediatric biobanking was undertaken. This paper finds that international guidelines around biobanking are mostly for adults, and even when pediatric-specific, documents are non-binding, inconsistent, or only limited guidance is offered on a range of important issues specific to pediatric biobanks. Conclusion: This paper shows a need for consistent, comprehensive, and clear regulation on pediatric biobanking so that research can more quickly, efficiently, and ethically be translated to useful information and treatment in pediatric care. What is Known: • Pediatric biobanking presents new opportunities to conduct valuable translational research to benefit pediatric populations. However, the storage of pediatric biological samples raises many ethical, legal and social issues-in part because child participants may be considered to lack capacity to consent but can acquire this capacity upon maturity when the research is still ongoing. Pediatric biobanks must grapple with issues of consent, confidentiality and privacy, and long-term participation regarding child participants. What is New: • Regulatory guidance on these ethical, legal, and social issues is needed for researchers, participants, and families and those involved in biobank governance. This paper identifies nationally specific and international guidance on biobanking and summarizes the guidance provided in relation to these pediatric specific issues. It finds that most guidance is non-binding and inconsistent between guidance documents and may offer only limited guidance to stakeholders. A need for consistent, comprehensive, and clear regulation on pediatric biobanking is needed at an international level to enable research. (shrink)

This issue of The Journal of Medicine and Philosophy is unified by a theme of what contributes to and detracts from patient well-being. I highlight this unifying thread through five of this issue’s contributions, dividing them according to whether they are predominantly about what diminishes or enhances the well-being of patients. Three of them are more directly relevant to whether certain actions diminish well-being, and two of them touch more closely on what promotes well-being. Although these papers are generally focused (...) on what is good or detrimental for patients, their insights are also relevant to the nature of human flourishing. (shrink)

Applied behavior analysis (ABA) has featured an increasing concern for understanding and considering the cultural diversity of the populations behavior analysts serve in recent years. As an expression of that concern, the new BACB’s Ethics Code for Behavior Analysts is more explicit and comprehensive in its inclusion of ethical obligations concerning cultural diversity. The purpose of this paper is to offer a discussion on the limitations of both our capacity and willingness to know and overcome our ignorance about our own (...) and other cultures. We examine different ways in which our ignorance of other cultures plays out even in willful compliance with the BACB ethics code. We suggest part of the problem is that the BACB ethics code seems to operate under the assumption that practitioners are always aware or can be aware of what they do not know and their biases. In contrast, we offer a reflection on a more complex picture of our understanding of ourselves and other cultures where we cannot assume people are aware of what they ignore and of their biases. Ethically, we find that in some cases these blindspots are accounted for by the BACB ethics code and should be foreseen and addressed by the behavior analyst (BA). But in other cases, when a person is not aware of what they ignore, understanding the connection between cultural diversity ignorance and professional behavior requires a different approach. Our analysis suggests an attitude of being thoughtfully diligent and humble while learning about cultural diversity issues and examining the areas where we might be ignorant and not aware of our ignorance. We argue that BAs’ obligations to respect the dignity of clients and their families and to provide effective treatment call for this attitude of diligence and humility that goes beyond mere compliance. (shrink)

In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for (...) the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues. (shrink)

This paper introduces three new criteria that a theory of personal identity ought to satisfy: (1) material holism, (2) narrative unity, and (3) narrative integrity. Material holism guards against the undesirable consequence of positing the person as part and existentially distinct from the organismal whole, of which it is dependent and interconnected. Narrative unity ensures that continuity between the beginning, middle, and end of a human life is sufficiently accounted for. Narrative integrity secures fidelity and congruence between each part and (...) the whole, the whole to each part. Jeff McMahan’s Embodied Mind Account (EM) fails to satisfy each of these. On McMahan’s account, human persons and human organisms are distinct entities, human persons come into existence after its human organism, and human persons may go out of existence before their human organism. Moreover, fetuses, infants, the congenitally severely cognitively impaired, those with severe dementia, and the comatose are non-persons. A theory of personal identity that incorporates holism and narrative can provide a better explanation of human existence, life and death, and the identity paradox of dicephalic twins. If accepted, EM must either be rejected or ameliorated, and the new criteria ought to be incorporated in contemporary research of personal identity. (shrink)

In this paper, we address the moral justification problem concerning the use of age as a criterion for the allocation of scarce life-saving medical resources. We present and discuss four justifications that stand out in philosophical literature: efficiency, sufficiency, egalitarian, and prioritarian. We aim to demonstrate that all these justifications are unsatisfactory since they entail counterintuitive implications in cases involving fetuses and newborns. We then suggest another justification for the relevance of age based on the Time-Relative Interest Account of the (...) harm of death. Finally, we evaluate an objection that could limit the scope of the defended justification, leading us to draw a distinction between justification of harm and strict justification of harm. (shrink)

Healthism and ableism intertwine through an imperative of normalcy and the ensuing devaluing of those who fail to meet societally dominant norms and expectations around “normal” health. This paper tracks the effect of that imperative of normalcy through current research into gut microbiome therapies, using therapies targeting fatness and autism as examples. The complexity of the gut microbiome ought to encourage us to rethink our conception of ourselves and our embeddedness in the world; instead, the microbiome is transformed into one (...) more tool for controlling unruly bodies and minds. (shrink)

The Covid-19 pandemic raises the need for an ethical framework that addresses the unique ethical challenges and questions arising from airborne infectious diseases. For example, are we ever ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein proposes pathways to answers grounded in ethical norms and the moral principles of non-harm, beneficence and respect for personal autonomy. REF is a personal ethics wherein your ethical duty to increase your respiratory hygiene efforts—such (...) as by donning a mask—is proportional to your estimation of an increase in the likelihood that your respiratory effluent poses a risk of harmful infection to others. REF includes illustrated decision models that instantiate a framework of proportionality between levels of risk, ethical duty and mitigation that shapes risk mitigation across domains. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...) decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

RD, a 32-year-old male, was admitted to the hospital with hypoxic COVID pneumonia–a potentially life-threatening condition characterized by dangerously low levels of oxygen in the body- during one of the pandemic’s surges. While RD’s age gave the clinical team hope for his prognosis, his ability to recover was complicated by his being unvaccinated and having multiple comorbidities, including diabetes and obesity. His condition worsened to the point that he required extracorporeal membrane oxygenation (ECMO), a machine that maintains the functioning of (...) a person’s heart and lungs. -/- Given its scarcity–only 264 of the over 6,000 hospitals in the United States offer ECMO, according to the Extracorporeal Life Support Organization–as well as its high cost and the inadequate supply of staff required to maintain it, ECMO primarily serves as a bridge to support critically ill patients until they can receive an organ transplant or implanted medical device. For RD, ECMO was started to support him until he could be evaluated for, and possibly receive, a bilateral lung transplant. Despite its intended use as a treatment of last resort, some patients can remain on ECMO for weeks or months. And some are awake, alert, and capable of medical decision-making. -/- RD was one such patient. However, the transplant evaluation committee ruled out RD’s candidacy for bilateral lung transplantation, based on his poor potential for recovery and a lack of family and friends to provide post-transplant support. This determination raised the prospect of continued ECMO treatment being a bridge to nowhere. But RD was comfortable on ECMO and wanted to remain in the ICU. The ICU intensivist contacted the ethics consult service with questions about whether continued ECMO support was medically and ethically inappropriate. (shrink)

I introduce a new distinction between two types of paternalism, which I call ‘internal’ and ‘external’ paternalism. The distinction pertains to the question of whether the paternalized subject’s current evaluative judgments are mistaken relative to a standard of correctness that is internal to her evaluative point of view—which includes her ‘true’ or ‘ideal’ self—as opposed to one that is wholly external. I argue that this distinction has important implications for (a) the distinction between weak and strong paternalism; (b) the distinction (...) between soft and hard paternalism; and (c) medical practice, where internal paternalism can, and probably often does, occur. (shrink)

My question in the chapter is this: could (and should) the role of the physician be construed as that of a friend to the patient? I begin by briefly discussing the “friendship model” of the physician-patient relationship—according to which physicians and patients could, and perhaps should, be friends—as well as its history and limitations. Given these limitations, I focus on the more one-sided idea that the physician could, and perhaps should, be a friend to the patient (a “physician-qua-friend model” of (...) the physician-patient relationship). I show that given recent developments in our understanding of the physician-patient relationship, this idea is far from asinine. I then make the case that the most plausible conception of the physician-qua-friend model incorporates the following components: (a) a common goal, that is, one that physician and patient share; (b) certain forms of equality between physician and patient; (c) an ideal of a caring physician. Finally, I show how the model can be instantiated in a certain type of physician-patient interaction, namely, in physician-assisted dying. (shrink)

Arguments that claim opponents of abortion are inconsistent in some manner are becoming increasingly prevalent both in academic and public discourse. For example, it is common to claim that they spend considerable time and resources to oppose induced abortion, but show little concern regarding the far greater numbers of naturally occurring intrauterine deaths (miscarriages). Critics argue that if abortion opponents took their beliefs about the value of embryos and fetuses seriously, they would invest more time and resources combating these naturally (...) occurring deaths than those caused by induced abortion. The implication is that abortion opponents do not take their beliefs about embryos and fetuses seriously—and so why should anyone else? These “inconsistency arguments”, as we have called them, have considerable intuitive appeal: showing that someone is living inconsistently or holding beliefs that seem prima facie inconsistent seems to many to undermine those beliefs. However, upon closer examination, these arguments become less convincing. In short, we show that the inconsistency arguments we are aware of are severely flawed, and so, if critics wish to continue their criticism, they should abandon inconsistency arguments in favor of other styles of argument. We will proceed in four stages. First, we describe the basic form of inconsistency arguments against abortion opponents. Second, we outline specific instances of the inconsistency argument that have been advanced. Third, we outline specific responses to these arguments, noting ways in which responses also conform to set patterns. Finally, we assess the debate and suggest how it might progress in productive ways. (shrink)

Bioethics, Volume 36, Issue 1, Page 63-70, January 2022.

Artificial Intelligence (AI) contributes to common goods and common harms in our everyday lives. In light of the Collingridge dilemma, information about both the actual and potential harm of AI is explored and myths about AI are dispelled. Catholic health care is then presented as being in a unique position to exert its influence to model the use of AI systems that minimizes the risk of harm and promotes human flourishing and the common good.

Background: Adequate immunity to COVID-19 apparently cannot be attained in Germany by voluntary vaccination alone, and therefore the introduction of mandatory COVID-19 vaccination is still under consideration. We present findings on the potential acceptance of such a requirement by the German population, and we report on the reasons given for accepting or rejecting it and how these reasons vary according to population subgroup. -/- Methods: We used representative data from the Socio-Economic Panel for the period January to December 2021. We (...) linked the respondents’ answers concerning mandatory COVID-19 vaccination to information about their sociodemographic characteristics, state of health, political attitudes, and degree of confidence in the judicial and political systems. We analyzed these data using univariate, bivariate, and multivariate statistical methods. -/- Results: Just over half of the respondents (50.44% [49.08%; 51.79%]) favored mandatory COVID-19 vaccination. Among the supporters, the reason most frequently given (95.22% [94.45; 96.00]) was that, without such a requirement, not enough people would be vaccinated. Among the opponents of mandatory COVID-19 vaccination (49.56% [48.21%; 50.92%]), by far the most common reason given for opposing it was a desire to uphold individual freedom (91.36% [90.31%; 92.40%]). Persons supporting mandatory COVID-19 vaccination, on average, older than those who opposed it; they less commonly had an education beyond secondary school, were less healthy, tended to have no children, had centrist political views, and expressed more confidence in the political system. The largest difference between the two groups was that about 90% of supporters of mandatory COVID-19 vaccination were themselves vaccinated, compared to only about 62% of opponents. -/- Conclusion: The lack of consensus on this issue among politicians and physicians in Germany is reflected in a similar lack of consensus in the German population as a whole. A discussion of the appropriate understanding of individual freedom would be the most promising way to widen the acceptance of mandatory COVID-19 vaccination. A commonly expressed conception of freedom that permits the deliberate endangerment of other people’s health seems morally questionable. -/- DOI: 10.3238/arztebl.m2022.0174. (shrink)

Blumenthal-Barby et al. (2022) are right. Philosophers should pay greater attention to bioethics and bioethicists should pay greater attention to insights from philosophy. This commentary extends t...

In Vayena’s article, ‘direct-to-consumer (DTC) genomics on the scales of autonomy’, she claims that there may be a strong autonomy-based argument for permitting DTC genomic services. In this response, I point out how the diminishment of one’s genetic privacy can cause a relevant autonomy-related harm which must be balanced against the autonomy-related gains DTC services provide. By drawing on conceptual connections between privacy and the Razian conception of autonomy, I show that DTC genetic testing may decrease the range of valuable (...) options individuals possess, which impacts the extent to which would-be consumers can exercise their autonomy. (shrink)

Pro-life advocates commonly argue that fetuses have the moral status of persons, and an accompanying right to life, a view most pro-choice advocates deny. A difficulty for this pro-life position has been Judith Jarvis Thomson’s violinist analogy, in which she argues that even if the fetus is a person, abortion is often permissible because a pregnant woman is not obliged to continue to offer her body as life support. Here, we outline the moral theories underlying public health ethics, and examine (...) the COVID-19 pandemic as an example of public health considerations overriding individual rights. We argue that if fetuses are regarded as persons, then abortion is of such prevalence in society that it also constitutes a significant public health crisis. We show that on public health considerations, we are justified in overriding individual rights to bodily autonomy by prohibiting abortion. We conclude that in a society that values public health, abortion can only be tolerated if fetuses are not regarded as persons. (shrink)

Brian Earp’s and Julian Savulescu’s provocatively titled “Love Drugs: The Chemical Future of Relationships” is a philosophically rigorous, scientifically informed, and yet wholly accessible study o...

Double Effect Donation claims it is permissible for a person meeting brain death criteria to donate vital organs, even though such a person may be alive. The reason this act is permissible is that it does not aim at one’s own death but rather at saving the lives of others, and because saving the lives of others constitutes a proportionately serious reason for engaging in a behavior in which one foresees one’s death as the outcome. Double Effect Donation, we argue, (...) opens a novel position in debates surrounding brain death and organ donation, and does so without compromising the sacredness and fundamental equality of human life. (shrink)

I support Abram Brummett’s contention that there is a need for secular clinical ethics to acknowledge that various positions typically advocated for by ethicists, concerning bedside decision-making and broader policy-making, rely upon metaphysical commitments that are not often explicit. I further note that calls for “neutrality” in debates concerning conscientious refusals to provide legal health care services—such as elective abortion or medical aid-in-dying—may exhibit biases against specific metaphysical claims regarding, for instance, the ontological and moral status of fetuses or the (...) valuing of the phenomena of life, suffering, and dying/death, as constitutive of medicine’s internal morality as a profession. I conclude that there is an operative distinction between metaphysical views founded essentially upon religious tenets and those founded upon rationally defensible premises. (shrink)

While different positions on the permissibility of organ markets enjoy support, there is widespread agreement that some benefits to living organ donors are acceptable and do not raise the same moral concerns associated with organ markets, such as exploitation and commodification. We argue on the basis of two distinctions that some benefit packages offered to donors can defensibly surpass conventional reimbursement while stopping short of controversial cash payouts. The first distinction is between benefits that defray the costs of donating an (...) organ and benefits that incentivize donation by offer- ing something in excess of defraying. The second distinction is between benefits that compensate donors and benefits that are non-compensating. We argue that non-compensating benefits are innocent of moral concerns typically associated with controversial cash payouts, and thus may be a morally promising avenue for increasing rates of kidney donation to address the tragic results of undersupply. (shrink)

Bioethical work on solidarity has yielded an array of divergent conceptions. But what do these accounts add to normative bioethics? What is solidarity’s distinctive social normative role? Prainsack and Buyx suggest that solidarity be understood as the ‘putty’ of justice. I argue here that the putty metaphor is deeply insightful and—when spelled out in detail—successfully explicates solidarity’s social normative function. Unfortunately, Prainsack and Buyx’s own account cannot play this role. I propose instead that the putty metaphor supports a conception of (...) solidarity as equity. This proposal enables us to answer whether and when we should act in solidarity, and with whom, while also capturing the putty metaphor and hence answering a basic question: what is solidarity for? (shrink)

The monograph includes works of specialists and scientists - active members of the bioethical movement In Ukraine, and regular participants in national congresses on bioethics in Kyiv for the last 20 years. Over the years, bioethics has become widely used our lives It is evidenced, in particular, by the list of topics that are presented in the collective monographs, namely: philosophical and philosophical aspects of bioethics and dissemination bioethical norms and rules in various spheres of human activity. Most articles include (...) both theoretical aspects of bioethics and examples of practical application of bioethical principles. The book is intended for scientists, doctors, philosophers, jurists, teachers and students of higher educational institutions, as well as a wide range of readers who are interested in bioethical issues. (shrink)