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  1. Double effect donation or bodily respect? A 'third way' response to Camosy and Vukov.Anthony McCarthy & Helen Watt - forthcoming - The Linacre Quarterly.
    Is it possible to donate unpaired vital organs, foreseeing but not intending one's own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on 'double effect donation.' Where we disagree with these authors is that we see double effect donation not as a morally praiseworthy act akin to martyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...)
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  2. Predicting and Preferring.Nathaniel Sharadin - forthcoming - Inquiry: An Interdisciplinary Journal of Philosophy.
    The use of machine learning, or “artificial intelligence” (AI) in medicine is widespread and growing. In this paper, I focus on a specific proposed clinical application of AI: using models to predict incapacitated patients’ treatment preferences. Drawing on results from machine learning, I argue this proposal faces a special moral problem. Machine learning researchers owe us assurance on this front before experimental research can proceed. In my conclusion I connect this concern to broader issues in AI safety.
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  3. Personalized Patient Preference Predictors Are Neither Technically Feasible nor Ethically Desirable.Nathaniel Sharadin - 2024 - American Journal of Bioethics 24 (7):62-65.
    Except in extraordinary circumstances, patients' clinical care should reflect their preferences. Incapacitated patients cannot report their preferences. This is a problem. Extant solutions to the problem are inadequate: surrogates are unreliable, and advance directives are uncommon. In response, some authors have suggested developing algorithmic "patient preference predictors" (PPPs) to inform care for incapacitated patients. In a recent paper, Earp et al. propose a new twist on PPPs. Earp et al. suggest we personalize PPPs using modern machine learning (ML) techniques. In (...)
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  4. Resolving the Ethical Quagmire of the Persistent Vegetative State.Ognjen Arandjelović - 2023 - Journal of Evaluation in Clinical Practice.
    A patient is diagnosed with the persistent vegetative state (PVS) when they show no evidence of the awareness of the self or the environment for an extended period of time. The chance of recovery of any mental function or the ability to interact in a meaningful way is low. Though rare, the condition, considering its nature as a state outwith the realm of the conscious, coupled with the trauma experienced by the patient's kin as well as health care staff confronted (...)
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  5. Default Positions in Clinical Ethics.Parker Crutchfield, Tyler Gibb & Michael Redinger - 2023 - Journal of Clinical Ethics 34 (3):258-269.
    Default positions, predetermined starting points that aid in complex decision-making, are common in clinical medicine. In this article, we identify and critically examine common default positions in clinical ethics practice. Whether default positions ought to be held is an important normative question, but here we are primarily interested in the descriptive, rather than normative, properties of default positions. We argue that default positions in clinical ethics function to protect and promote important values in medicine—respect for persons, utility, and justice. Further, (...)
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  6. Should the family have a role in deceased organ donation decision-making? A systematic review of public knowledge and attitudes towards organ procurement policies in Europe.Alberto Molina-Pérez, Janet Delgado, Mihaela Frunza, Myfanwy Morgan, Gurch Randhawa, Jeantine Reiger-Van de Wijdeven, Silke Schicktanz, Eline Schiks, Sabine Wöhlke & David Rodríguez-Arias - 2022 - Transplantation Reviews 36 (1).
    Goal: To assess public knowledge and attitudes towards the family’s role in deceased organ donation in Europe. -/- Methods: A systematic search was conducted in CINHAL, MEDLINE, PAIS Index, Scopus, PsycINFO, and Web of Science on December 15th, 2017. Eligibility criteria were socio-empirical studies conducted in Europe from 2008 to 2017 addressing either knowledge or attitudes by the public towards the consent system, including the involvement of the family in the decision-making process, for post-mortem organ retrieval. Screening and data collection (...)
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  7. Vices in autonomous paternalism: The case of advance directives and persons living with dementia 1.Sungwoo Um - 2022 - Bioethics 36 (5):511-518.
    Advance directives are intended to extend patient autonomy by enabling patients to prospectively direct the care of their future incapacitated selves. There has been much discussion about issues such as whether the future incompetent self is identical to the agent who issues the advance directives or whether advance directives can legitimately secure patient autonomy. However, there is another important question to ask: to what extent and in what conditions is it ethically appropriate for one to limit the liberty or agency (...)
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  8. Personal Identity, Possible Worlds, and Medical Ethics.Nils-Frederic Wagner - 2022 - Medicine, Health Care and Philosophy: A European Journal (3):429-437.
    Thought experiments that concoct bizarre possible world modalities are standard fare in debates on personal identity. Appealing to intuitions raised by such evocations is often taken to settle differences between conflicting theoretical views that, albeit, have practical implications for ethical controversies of personal identity in health care. Employing thought experiments that way is inadequate, I argue, since personhood is intrinsically linked to constraining facts about the actual world. I defend a moderate modal skepticism according to which intuiting across conceptually incongruent (...)
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  9. Reasons for endorsing or rejecting ‘self-binding directives’ in bipolar disorder: a qualitative study of survey responses from UK service users.Tania Gergel, Preety Das, Lucy Stephenson, Gareth Owen, Larry Rifkin, John Dawson, Alex Ruck Keene & Guy Hindley - 2021 - The Lancet Psychiatry 8.
    Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and human (...)
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  10. Further Reflections: Surrogate Decisionmaking When Significant Mental Capacities are Retained.Jennifer Hawkins - 2021 - Cambridge Quarterly of Healthcare Ethics 30 (1):192-198.
    Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients by appealing (...)
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  11. European and comparative law study regarding family’s legal role in deceased organ procurement.Marina Morla-González, Clara Moya-Guillem, Janet Delgado & Alberto Molina-Pérez - 2021 - Revista General de Derecho Público Comparado 29.
    Several European countries are approving legislative reforms moving to a presumed consent system in order to increase organ donation rates. Nevertheless, irrespective of the consent system in force, family's decisional capacity probably causes a greater impact on such rates. In this contribution we have developed a systematic methodology in order to analyse and compare European organ procurement laws, and we clarify the weight given by each European law to relatives' decisional capacity over individual's preferences (expressed or not while alive) regarding (...)
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  12. Advance Directives and Transformative Experience: Resilience in the Face of Change.Govind C. Persad - 2020 - American Journal of Bioethics 20 (8):69-71.
    In this commentary, I critique three aspects of Emily Walsh's proposal to reduce the moral and legal weight of advance directives: (1) the ambiguity of its initial thesis, (2) its views about the ethics and legality of clinical practice, and (3) its interpretation and application of Ronald Dworkin’s account of advance directives and L.A. Paul's view on transformative experience. I also consider what Walsh’s proposal would mean for people facing the prospect of dementia. I conclude that our reasons to honor (...)
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  13. Epistemic burdens and the incentives of surrogate decision-makers.Parker Crutchfield & Scott Scheall - 2019 - Medicine, Health Care and Philosophy 22 (4):613-621.
    We aim to establish the following claim: other factors held constant, the relative weights of the epistemic burdens of competing treatment options serve to determine the options that patient surrogates pursue. Simply put, surrogates confront an incentive, ceteris paribus, to pursue treatment options with respect to which their knowledge is most adequate to the requirements of the case. Regardless of what the patient would choose, options that require more knowledge than the surrogate possesses (or is likely to learn) will either (...)
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  14. Consent’s dominion: Dementia and prior consent to sexual relations.Samuel Director - 2019 - Bioethics 33 (9):1065-1071.
    In this paper, I answer the following question: suppose that two individuals, C and D, have been in a long-term committed relationship, and D now has dementia, while C is competent; if D agrees to have sex with C, is it permissible for C to have sex with D? Ultimately, I defend the view that, under certain conditions, D can give valid consent to sex with C, rendering sex between them permissible. Specifically, I argue there is compelling reason to endorse (...)
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  15. Authority without identity: defending advance directives via posthumous rights over one’s body.Govind Persad - 2019 - Journal of Medical Ethics 45 (4):249-256.
    This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual’s rights over that body can support (...)
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  16. No One Who Loves Anyone.Alison Reiheld - 2019 - Journal of Medical Humanities 40 (3):451-453.
    In this bioethical poem, the narrator reflects on the experience of their father's degenerative illness, and decisions that must be made about whether to continue life support technologies such as ventilation and nutrition/hydration. What is it that is owed to family and patient at the end of life? What must no one who loves anyone ever do to the one they love?
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  17. Should Aggregate Patient Preference Data Be Used to Make Decisions on Behalf of Unrepresented Patients?Nathaniel Sharadin - 2019 - AMA Journal of Ethics 21 (7):566-574.
    Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple reasonable models” (...)
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  18. Why letting die instead of killing? Choosing active euthanasia on moral grounds.Evangelos Protopapadakis - 2018 - Proceedings of the XXIII World Congress of Philosophy.
    Ever since the debate concerning euthanasia was ignited, the distinction between active and passive euthanasia – or, letting die and killing – has been marked as one of its key issues. In this paper I will argue that a) the borderline between act and omission is an altogether blurry one, and it gets even vaguer when it comes to euthanasia, b) there is no morally significant difference between active and passive euthanasia, and c) if there is any, it seems to (...)
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  19. What’s Good for Them? Best Interests and Severe Disorders of Consciousness.Jennifer Hawkins - 2016 - In Walter Sinnott-Armstrong (ed.), Finding Consciousness: The Neuroscience, Ethics, and Law of Severe Brain Damage. Oxford University Press USA. pp. 180-206.
    I consider the current best interests of patients who were once thought to be either completely unaware (to be in PVS) or only minimally aware (MCS), but who, because of advanced fMRI studies, we now suspect have much more “going on” inside their minds, despite no ability to communicate with the world. My goal in this chapter is twofold: (1) to set out and defend a framework that I think should always guide thinking about the best interests of highly cognitively (...)
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  20. Animals, advance directives, and prudence: Should we let the cheerfully demented die?David Limbaugh - 2016 - Ethics, Medicine and Public Health 2 (4):481-489.
    A high level of confidence in the identity of individuals is required to let them die as ordered by an advance directive. Thus, if we are animalists, then we should lack the confidence required to apply lethal advance directives to the cheerfully demented, or so I argue. In short, there is consensus among animalists that the best way to avoid serious objections to their account is to adopt an ontology that denies the existence of brains, hands, tables, chairs, iced-tea, and (...)
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  21. Autonomy and the Moral Authority of Advance Directives.Eric Vogelstein - 2016 - Journal of Medicine and Philosophy 41 (5):500-520.
    Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based. The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is “yes.” I argue that a patient’s autonomy is not (...)
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  22. Fluctuating capacity and advanced decision making – self-binding directives and self-determination’.Tania Gergel & Gareth Owen - 2015 - International Journal of Law and Psychiatry 105 (40):92-101.
    For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and efforts (...)
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  23. Medicine & Well-Being.Daniel Groll - 2015 - In Guy Fletcher (ed.), The Routledge Handbook of Philosophy of Well-Being. New York,: Routledge.
    The connections between medicine and well-being are myriad. This paper focuses on the place of well-being in clinical medicine. It is here that different views of well-being, and their connection to concepts like “autonomy” and “authenticity”, both illuminate and are illuminated by looking closely at the kinds of interactions that routinely take place between clinicians, patients, and family members. -/- In the first part of the paper, I explore the place of well-being in a paradigmatic clinical encounter, one where a (...)
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  24. Autonomia revisitada: considerações a propósito do testamento vital.Marta Dias Barcelos - 2014 - In António Barbosa & Jorge Marques da Silva (eds.), Confluências bioéticas. Publicações da Universidade de Lisboa. pp. 91-100.
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  25. Well-Being, Time, and Dementia.Jennifer Hawkins - 2014 - Ethics 124 (3):507-542.
    Philosophers concerned with what would be good for a person sometimes consider a person’s past desires. Indeed, some theorists have argued by appeal to past desires that it is in the best interests of certain dementia patients to die. I reject this conclusion. I consider three different ways one might appeal to a person’s past desires in arguing for conclusions about the good of such patients, finding flaws with each. Of the views I reject, the most interesting one is the (...)
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  26. Should the Late Stage Demented be Punished for Past Crimes?Annette Dufner - 2013 - Criminal Law and Philosophy 7 (1):137-150.
    The paper investigates whether it is plausible to hold the late stage demented criminally responsible for past actions. The concern is based on the fact that policy makers in the United States and in Britain are starting to wonder what to do with prison inmates in the later stages of dementia who do not remember their crimes anymore. The problem has to be expected to become more urgent as the population ages and the number of dementia patients increases. This paper (...)
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  27. Der mutmaßliche Wille im deutschen Transplantationsgesetz.Christoph Schmidt-Petri - 2012 - In M. G. Weiss & H. Greif (eds.), Ethics-Society-Politics. ALWS.
    This paper discusses (in German) an idea enshrined in the recent (2012) revision of the German transplantation law. The law allows family members to make claims about what the deceased would have wanted to happen to his/her organs/tissue even though he/she never has voiced any relevant opinions. I argue that this is illegitimate.
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  28. The Impact of Personal Identity on Advance Directives.Nada Gligorov & Christine Vitrano - 2011 - Journal of Value Inquiry 45 (2):147-158.
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  29. Conflicting preferences and advance directives.Sandra Woien - 2007 - American Journal of Bioethics 7 (4):64-65.
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  30. Advance directives, autonomy and unintended death.Jim Stone - 1994 - Bioethics 8 (3):223–246.
    Advance directives typically have two defects. First, most advance directives fail to enable people to effectively avoid unwanted medical intervention. Second, most of them have the potential of ending your life in ways you never intended, years before you had to die.
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