Biomedical Ethics

Ongoing and anticipated COVID-19 human challenge studies in the UK may advance our understanding of COVID-19 and facilitate the licensure of safe, effective, and easily deployable next-generation COVID-19 vaccines and boosters. We argue that international volunteer recruitment for COVID-19 human challenge trials can help promote diversity in these trials and ensure a sufficient number of eligible volunteers, both of which will increase the benefits of challenge research. We explore the ethical ramifications of dealing with unfair background conditions of global vaccine (...) injustice to expand medical research, and conclude that international recruitment for COVID-19 human challenge trials can be conducted ethically provided that several robust protections are in place for volunteers. (shrink)

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and institutional-system activity; and (...) two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

In this article, an account of the architecture of the cognitive contamination system is offered, according to which the contamination system can generate contamination representations in circumstances that do not satisfy the norms of contamination, including in cases of mere visual contact with disgusting objects. It is argued that this architecture is important for explaining the content, logic, distribution, and persistence of maternal impression beliefs—according to which foetal defects are caused by the pregnant mother’s experiences and actions—which in turn provide (...) important evidence of the architecture of the cognitive contamination system. (shrink)

In this paper, we argue that promoting patient values is a legitimate goal of medicine. Our view offers a justification for certain current practices, including birth control and living organ donation, that are widely accepted but do not fit neatly within the most common extant accounts of the goals of medicine. Moreover, we argue that recognising value promotion as a goal of medicine will expand the scope of medical practice by including some procedures that are sometimes rejected as being outside (...) the scope of acceptable medical practice, such as certain forms of physician-assisted death. We then rebut some common and possible objections to this view. Our aim is not to argue that other accounts are mistaken—except when they argue for a single goal that does not include patient values—but rather to show that value promotion should play a more central role in discussions about the goals of medicine. (shrink)

In “Informed Consent: What Must be Disclosed and What Must be Understood?”, we reject a dogma at the heart of research ethics. We demonstrate that the constitutive claim...

The 14-day rule restricts the culturing of human embryos in vitro for the purposes of scientific research for no longer than 14 days. Since researchers recently developed the capability to exceed the 14-day limit, pressure to modify the rule has started to build. Sophia McCully argues that the limit should be extended to 28 days, listing numerous potential benefits of doing so. We contend that McCully has not engaged with the main reasons why the Warnock Committee set such a limit, (...) and these still remain valid. As a result, her case for an extension of the 14-day rule is not persuasive. (shrink)

In the face of the increasing substitution of free speech for academic freedom, I argue for the distinctiveness and irreplaceability of the latter. Academic freedom has evolved alongside universities in order to support the important social purpose universities serve. Having limned this evolution, I compare academic freedom and free speech. This comparison reveals freedom of expression to be an individual freedom, and academic freedom to be a group-differentiated freedom with a social purpose. I argue that the social purpose of academic (...) freedom behooves an inclusive approach to group differentiation. (shrink)

Braun explores the use of digital twin technology in medicine with a particular emphasis on the question of how such simulations can represent a person.1 In defining some first conditions for ethically justifiable forms of representation of digital twins, he argues that digital twins do not threaten an embodied person, as long as that person retains control over their simulated representation via dynamic consent, and ideally with the option to choose both form and usage of the simulation. His thoughtful elaboration (...) provides insight into the challenges inherent in interactions between a person and their digital twin, emphasising the modes of control required to respect personal modes of freedom. This individual-centric approach to the question of representation leaves out the important ethical consideration of ensuring that all, not merely some, can be represented. Braun describes dynamic consent as a necessary mode of control, arguing that where a person is unable to give consent, ‘such simulations threaten to become illegitimate representations. They would then shift the kind of interaction from representation to illegitimate forms of prediction or surveillance and thereby could lead to infringements to individual modes of freedom.’ Consequently, the implementation of digital twin technology in healthcare would seem to exclude the most vulnerable members of society from participation in and benefiting from medical innovation, …. (shrink)

This academic paper on Ethical issues of using umbilical cord blood stem cell therapy of John Stuart Mill perspective aim to investigate the new approaches in the treatment of diseases by using umbilical cord blood stem cells. And also to study ethical issues from the use of umbilical cord blood stem cells in the treatment of diseases considered by Mill’s utilitarianism. 21st century, the medical industry was interested in organ transplantation from stem cells especially stem cells from the umbilical cord (...) to treat chronic and degenerative organ diseases, blood cancer and organ transplantation which successful and widespread throughout the world. Thailand has about 900 new children with Leukemia every year. About 50 percent are leukemia which needs to be treated correctly and urgently. In general Standardized chemotherapy but if the cancer patient has a bad prognosis Or have recurrent cancer Patients need to be treated with bone marrow transplants or stem cells to have a chance to heal. According to Mill’s Utilitarianism, the ethical concepts that determine what is the basic criterion used to determine whether it should or should not concern with the popular benefit that the criterion used is the amount of happiness that results from actions. Treating the disease using stem cells will make the patient recover from the disease, healthier and happier in life. As Mill said "The correctness of an action depends on the tendency that the action will lead to happiness. (shrink)

Zu Beginn der Pandemie im Frühjahr 2020, und nach einem weitreichenden Lockdown, ruhten große Erwartungen auf Corona-Warn-Apps, um einen erneuten Lockdown zu verhindern. Diese Erwartungen haben sich nicht erfüllt; stattdessen wurden in Deutschland als Reaktion auf erneute Wellen von COVID-19 weitere Kontaktbeschränkungen verordnet. Wie hätte die digitale Kontaktverfolgung wirksamer gestaltet werden können? Wir argumentieren, dass es ein Spannungsfeld zwischen der Datensparsamkeit und einer wirksamen Bekämpfung der Pandemie besteht. Im Gegensatz zur deutschen Corona-Warn-App wäre eine Variante der App, in der pseudonymisierte (...) Kennungen zentral gespeichert werden, in der Lage gewesen, die Effektivität der Kontaktverfolgung entscheidend zu erhöhen. Schließlich argumentieren wir, dass das Spannungsfeld zwischen Datensparsamkeit und einer wirksamen Pandemiebekämpfung sich jedoch nicht in einen Wertekonflikt übersetzt, weil zentrale Systeme uns trotz ihrer erhöhten Wirksamkeit nicht vor deutlich gravierendere Probleme beim Datenschutz stellen als dezentrale Systeme. Zentrale Möglichkeiten der digitalen Kontaktverfolgung wären daher ethisch gerechtfertigt, um auf weitere Wellen von COVID-19 oder auf zukünftige Epidemien effektiv zu reagieren. (shrink)

Fears of black-box algorithms are multiplying. Black-box algorithms are said to prevent accountability, make it harder to detect bias and so on. Some fears concern the epistemology of black-box algorithms in medicine and the ethical implications of that epistemology. In ‘Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI,’ Juan Durán and Karin Jongsma seek to allay such fears. While we find some of their arguments compelling, we still see reasons for (...) fear. (shrink)

As COVID-19 spread, clinicians warned of mental illness epidemics within the coronavirus pandemic. Funding for digital mental health is surging and researchers are calling for widespread adoption to address the mental health sequalae of COVID-19. -/- We consider whether these technologies improve mental health outcomes and whether they exacerbate existing health inequalities laid bare by the pandemic. We argue the evidence for efficacy is weak and the likelihood of increasing inequalities is high. -/- First, we review recent trends in digital (...) mental health. Next, we turn to the clinical literature to show that many technologies proposed as a response to COVID-19 are unlikely to improve outcomes. Then, we argue that even evidence-based technologies run the risk of increasing health disparities. We conclude by suggesting that policymakers should not allocate limited resources to the development of many digital mental health tools and should focus instead on evidence-based solutions to address mental health inequalities. (shrink)

The COVID-19 pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation pools and that triage protocols should be (...) immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

Les émotions ont souvent été considérées comme une menace pour la moralité et la rationalité ; dans la tradition romantique, les passions étaient placées au centre de l'individualité humaine et de la vie morale. Cette ambivalence a conduit à une ambiguïté entre les termes des émotions pour les vices et les vertus. Spinoza déclare que les systèmes éthiques fondés sur l'auto-préservation tiennent également compte des éléments sociaux et culturels. Spinoza nous dit que le bonheur est le pouvoir d'être libéré de (...) la tyrannie des émotions négatives. Le bonheur n'est pas une récompense pour la vertu : c'est la vertu elle-même. Les sentiments sont nécessaires étant une expression mentale des émotions. À ce niveau, il est possible pour les émotions, à travers les sentiments, de prendre soin de son soi. DOI: 10.13140/RG.2.2.29121.07527. (shrink)

An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people’s choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further (...) conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums. (shrink)

In recent decades, phenomenology has been utilized not only as a conceptual framework from which to understand medical encounters in healthcare settings, but also to guide medical professionals in providing care. In the realm of physical therapy, phenomenology has been touted as a philosophically-based avenue to aid in helping to understand what it means to be a patient. The works of Edmund Husserl and Martin Heidegger have been utilized as paths to approach phenomenologically-informed care in physical therapy. However, to our (...) knowledge, no significant connection has been made in regard to the work of Hans-Georg Gadamer’s phenomenology and hermeneutics in the realm of physical therapy. The authors aim to close that gap by showing the ways in which Gadamer’s philosophy can help physical therapists provide phenomenologically-informed patient care. They begin by outlining some of the touchpoints between phenomenology and healthcare and then introduce Gadamer as a figure who deserves attention in the question of how to apply phenomenology to healthcare settings. Upon analyzing Gadamer’s account of what it means to experience an altered body, they outline Gadamer’s understanding of tact, practical knowledge, and good sense in order to show how to understand at a conceptual level what it means to empathize with patients on the path to building therapeutic alliance, that is, a cooperative working relationship. They then look closely at Gadamer’s hermeneutics and particularly his comments on how to cultivate a fusion of horizons in order to attempt to help guide physical therapists in theoretically understanding how to empathize with their patients. Ultimately, they argue that physical therapists who practice phenomenologically-informed care, which they call “hermeneutical healing,” are positioned well to form strong working relationships with their patients. (shrink)

Using Ursula K. Le Guin’s The Left Hand of Darkness as an inspirational backdrop, a novel whose story unfolds on a genderless planet that nevertheless relies on reproductive sex for the sake of generativity, this paper tackles the sex/gender debate, its entanglements with procreation, and its consequences for transgender pregnancies. More specifically, I analyze three issues that pose barriers to thinking about a more inclusive reproductive ethics: state-sanctioned sterilization, non-reproductive futurism, and access to assisted reproductive technology.

This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA’s obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the (...) public about the health risks and benefits of products it regulates, it also has other roles (and attendant responsibilities) that inform when and how it should disseminate information. In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices. In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence. (shrink)

Draft of forthcoming article in the Journal of Medical Ethics where I discuss ethical tension between LGBT testimony and testimonial trust of medical professionals.

Some placebo-controlled trials can continue ethically after a candidate vaccine is found to be safe and efficacious.

The paper presents an analysis of the ethics of abortion and infanticide. The work considers two main approaches: the argument of J.J. Thomson on the right to use his body and the absence of responsibilities regarding the fetus, and the argument about the difference in the moral status of the fetus and the adult, which are used both in the argumentation of supporters and opponents of abortion. The paper shows the fallacy of the first approach, and also, in order for (...) the second approach to remain internally consistent, we must agree that infanticide is permissible. (shrink)

In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...) consider how nations ought to distribute a scarce life-saving resource across healthcare regions in a public health emergency, particularly in view of regional differences in projected need and existing capacity. We call this the regional triage question. Using the case study of ventilators in the COVID-19 pandemic, we show how the moral frameworks that we might adopt in response to individual triage decisions do not translate straightforwardly to this regional-level triage question. Having outlined what we take to be a plausible egalitarian approach to the regional triage question, we go on to propose a novel way of operationalising the ‘save the most lives’ principle in this context. We claim that the latter principle ought to take some precedence in the regional triage question, but also note important limitations to the extent of the influence that it should have in regional allocation decisions. (shrink)

This paper explores some ways in which artificial intelligence (AI) could be used to improve human moral judgments in bioethics by avoiding some of the most common sources of error in moral judgment, including ignorance, confusion, and bias. It surveys three existing proposals for building human morality into AI: Top-down, bottom-up, and hybrid approaches. Then it proposes a multi-step, hybrid method, using the example of kidney allocations for transplants as a test case. The paper concludes with brief remarks about how (...) to handle several complications, respond to some objections, and extend this novel method to other important moral issues in bioethics and beyond. (shrink)

Over the last few decades, multiple studies have examined the understanding of participants in clinical research. They show variable and often poor understanding of key elements of disclosure, such as expected risks and the experimental nature of treatments. Did the participants in these studies give valid consent? According to the standard view of informed consent they did not. The standard view holds that the recipient of consent has a duty to disclose certain information to the profferer of consent because valid (...) consent requires that information to be understood. The contents of the understanding and disclosure requirements are therefore conceptually linked. In this paper, we argue that the standard view is mistaken. The disclosure and understanding requirements have distinct grounds tied to two different ways in which a token of consent can be rendered invalid. Analysis of these grounds allows us to derive the contents of the two requirements. It also implies that it is sometimes permissible to enroll willing participants who have not understood everything that they ought to be told about their clinical trials. (shrink)

At the beginning of the COVID-19 pandemic, high hopes were put on digital contact tracing, using mobile phone apps to record and immediately notify contacts when a user reports as infected. Such apps can now be downloaded in many countries, but as second waves of COVID-19 are raging, these apps are playing a less important role than anticipated. We argue that this is because most countries have opted for app configurations that cannot provide a means of rapidly informing users of (...) likely infections while avoiding too many false positive reports. Mathematical modelling suggests that differently configured apps have the potential to do this. These require, however, that some pseudonymised data be stored on a central server, which privacy advocates have cautioned against. We contend that their influential arguments are subject to two fallacies. First, they have tended to one-sidedly focus on the risks that centralised data storage entails for privacy, while paying insufficient attention to the fact that inefficient contact tracing involves ethical risks too. Second, while the envisioned system does entail risks of breaches, such risks are also present in decentralised systems, which have been falsely presented as ‘privacy preserving by design’. When these points are understood, it becomes clear that we must rethink our approach to digital contact tracing in our fight against COVID-19. (shrink)

Human embryo models formed from stem cells—known as embryoids—allow scientists to study the elusive first stages of human development without having to experiment on actual human embryos. But clear ethical guidelines for research involving embryoids are still lacking. Previously, a handful of researchers put forward new recommendations for embryoids, which they hope will be included in the next set of International Society for Stem Cell Research guidelines. Although these recommendations are an improvement over the default approach, they are nonetheless unworkable, (...) because they rely on a poorly conceived notion of an embryoid’s ‘potential’ to trigger stringent research regulations. (shrink)

Human neural organoid research is advancing rapidly. As Greely notes in the target article, this progress presents an “onrushing ethical dilemma.” We can’t rule out the possibility that suff...

Codes of ethics currently offer no guidance to scientists acting in capacity of expert. Yet communicating their expertise is one of the most important activities of scientists. Here I argue that expert communication has a specifically ethical dimension, and that experts must face a fundamental trade-off between "actionability" and "transparency" when communicating. Some recommendations for expert communication are suggested.

Although neurological disease and mental illness can cause terrible human suffering, strategies for researching their causes and cures are not obvious. Invasive brain research on actual human being...

Henry Shevlin’s paper—“How could we know when a robot was a moral patient?” – argues that we should recognize robots and artificial intelligence (AI) as psychological moral patients if they are cognitively equivalent to other beings that we already recognize as psychological moral patients (i.e., humans and, at least some, animals). In defending this cognitive equivalence strategy, Shevlin draws inspiration from the “behavioral equivalence” strategy that I have defended in previous work but argues that it is flawed in crucial respects. (...) Unfortunately—and I guess this is hardly surprising—I cannot bring myself to agree that the cognitive equivalence strategy is the superior one. In this article, I try to explain why in three steps. First, I clarify the nature of the question that I take both myself and Shevlin to be answering. Second, I clear up some potential confusions about the behavioral equivalence strategy, addressing some other recent criticisms of it. Third, I will explain why I still favor the behavioral equivalence strategy over the cognitive equivalence one. (shrink)

The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of defenders of conscientious objection—being expected to participate in (...) the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected. (shrink)

This addendum expands upon the arguments made in the author’s 2020 essay, “Legal Personhood for Artificial Intelligence: Citizenship as the Exception to the Rule”, in an effort to display the significance human augmentation technologies will have on (feasibly) inadvertently providing legal protections to artificial intelligence systems (AIS)—a topic only briefly addressed in that work. It will also further discuss the impacts popular media have on imprinting notions of computerised behaviour and its subsequent consequences on the attribution of legal protections to (...) AIS and on speculative technological advancement that would aid the sophistication of AIS. (shrink)

This paper explores the role of moral uncertainty in explaining the morally disruptive character of new technologies. We argue that existing accounts of technomoral change do not fully explain its disruptiveness. This explanatory gap can be bridged by examining the epistemic dimensions of technomoral change, focusing on moral uncertainty and inquiry. To develop this account, we examine three historical cases: the introduction of the early pregnancy test, the contraception pill, and brain death. The resulting account highlights what we call “differential (...) disruption” and provides a resource for fields such as technology assessment, ethics of technology, and responsible innovation. (shrink)

At this stage of the COVID-19 pandemic, two policy aims are imperative: avoiding the need for a general lockdown of the population, with all its economic, social and health costs, and preventing the healthcare system from being overwhelmed by the unchecked spread of infection. Achieving these two aims requires the consideration of unpalatable measures. Julian Savulescu and James Cameron argue that mandatory isolation of the elderly is justified under these circumstances, as they are at increased risk of becoming severely ill (...) from COVID-19, and are thus likely to put disproportionate strain on limited healthcare resources. However, their arguments for this strategy are contingent on the lack of viable alternatives. We suggest that there is a possible alternative: a mandatory, centralised contact-tracing app. We argue that this strategy is ethically preferable to the selective isolation of the elderly, because it does not target members of a certain group, relying instead on the movements of each individual, and because it avoids the extended isolation of certain members of the society. Although this type of contact-tracing app has its drawbacks, we contend that this measure warrants serious consideration. (shrink)

Peer commentary on Char, Abràmoff & Feudtner (2020) target article: "Identifying Ethical Considerations for Machine Learning Healthcare Applications" .

In this commentary, I will consider the implications of the argument made by Christopher Stratman (2020) in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, that virtually everything we already know about unintended pregnancies, abortion and adoption does not (...) prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion then there is unlikely to be any radical transformation of the practice of abortion. Second, abortion is already associated with stigma and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the fetus to the human subject of the artificial womb—the gestateling. Therefore, creating a new category of killing—gestaticide—and this would only reorient the debate rather than end it. (shrink)

Debates about obesity in bioethics tend to unfold in predictable epicycles between individual choices and behaviours and the oppressive socio-economic structures constraining them. Here, we argue that recent work from two cutting-edge research programmes in microbiology and social psychology can advance this conceptual stalemate in the literature. We begin in section 1 by discussing two promising lines of obesity research involving the human microbiome and relationship partners. Then, in section 2, we show how this research has made viable novel strategies (...) for fighting obesity, including microbial therapies and dyad-level interventions. Finally, in section 3, we consider objections to our account and conclude by arguing that attention to the most immediate features of our biological and social environment offers a middle ground solution, while also raising important new issues for bioethicists. (shrink)

PANDEMIA Y ÉTICA es una introducción clara y provocativa a los temas éticos del COVID-19, apropiada para estudiantes de nivel universitario, académicos y diseñadores de políticas públicas, así como para el público general. Es también una contribución original a la literatura emergente acerca de este importante tema. El autor ha lanzado este libro con acceso abierto para pueda ser descargado y leído en forma gratuita por todas las personas interesadas en estas cuestiones. Algunas de las características principales de este libro (...) son: - Una clara organización de los temas éticos planteados por la pandemia. - Una exploración de las múltiples y complejas interrelaciones entre estos temas. - Un argumento conciso a favor de un confinamiento continuado hasta que desarrollemos una vacuna. - Una formulación original del Profundo Problema Ético de la Pandemia, así como un Argumento Revolucionario acerca de cómo deberíamos cambiar a la sociedad después de la pandemia. - Referencias a, e interacciones con, muchos de los mejores escritos sobre la pandemia hasta ahora (tanto en medios de comunicación populares como en revistas especializadas). (shrink)

This paper argues that assessing personal responsibility in healthcare settings for the allocation of medical resources would be too privacy-invasive to be morally justifiable. In addition to being an inappropriate and moralizing intrusion into the private lives of patients, it would put patients’ sensitive data at risk, making data subjects vulnerable to a variety of privacy-related harms. Even though we allow privacy-invasive investigations to take place in legal trials, the justice and healthcare systems are not analogous. The duty of doctors (...) and healthcare professionals is to help patients as best they can—not to judge them. Patients should not be forced into giving up any more personal information than what is strictly necessary to receive an adequate treatment, and their medical data should only be used for appropriate purposes. Medical ethics codes should reflect these data rights. When a doctor asks personal questions that are irrelevant to diagnose or treat a patient, the appropriate response from the patient is: ‘none of your business’. (shrink)

The aim of this commentary is to critically examine Matti Häyry’s article ‘Just Better Utilitarianism’, where he argues that liberal utilitarianism can offer a basis for moral and political choices in bioethics and thus could be helpful in decision-making. This commentary, while generally sympathetic to Häyry’s perspective, argues that Häyry should expand on who belongs to our moral community because, to solve practical ethical issues, we need to determine who (and what) deserves our moral consideration. Challenging Häyry’s principle of actual (...) or prospective existence, this commentary suggests that – at least sometimes – the quality of life of those who will never come into existence matters. In a similar vein, this commentary aims to show that determining how to treat mindless humans such as fetuses might pose difficulties for liberal utilitarianism unless the issue of the boundaries of the moral community is addressed. (shrink)

This paper addresses global bioethical challenges entailed in emerging viral diseases, focussing on their socio-cultural dimension and seeing them as symptomatic of the current era of globalisation. Emerging viral threats exemplify the extent to which humans evolved into a global species, with a pervasive and irreversible impact on the planetary ecosystem. To effectively address these disruptive threats, an attitude of preparedness seems called for, not only on the viroscientific, but also on bioethical, regulatory and governance levels. This paper analyses the (...) global bioethical challenges of emerging viral threats from a dialectical materialist perspective, focussing on three collisions: the collision of expanding networks of globalisation with local husbandry practices; the collision of global networks of mobility with disrupted ecosystems; and the collision of viroscience as a globalised research field with existing regulatory frameworks. These collisions emerge in a force field defined by the simultaneity of the non-simultaneous. Evidence-based health policies invoke discontent as they reflect the normative logic of a globalised knowledge regime. The development of a global bioethics or macro-ethics requires us to envision these collisions not primarily as issues of benefits and risks, but first and foremost as normative tensions closely entangled with broader socio-economic and socio-cultural developments. (shrink)

The rapid development of artificial womb technologies means that we must consider if and when it is permissible to kill the human subject of ectogestation—recently termed a ‘gestateling’ by Elizabeth Chloe Romanis—prior to ‘birth’. We describe the act of deliberately killing the gestateling as gestaticide, and argue that there are good reasons to maintain that gestaticide is morally equivalent to infanticide, which we consider to be morally impermissible. First, we argue that gestaticide is harder to justify than abortion, primarily because (...) the gestateling is completely independent of its biological parents. Second, we argue that gestaticide is morally equivalent to infanticide. To demonstrate this, we explain that gestatelings are born in a straightforward sense, which entails that killing them is infanticide. However, to strengthen our overall claim, we also show that if gestatelings are not considered to have been born, killing them is still equivalent to killing neonates with congenital anomalies and disabilities, which again is infanticide. We conclude by considering how our discussion of gestaticide has implications for the permissibility of withdrawing life-sustaining treatment from gestatelings. (shrink)

When widespread use of sex‐selective abortion and sex selection through assisted reproduction lead to severe harms to third parties and perpetuate discrimination, should these practices be banned? In this paper I focus on India and show why a common argument for a ban on sex selection fails even in these circumstances. I set aside a common objection to the argument, namely that women have a right to procreative autonomy that trumps the state's interest in protecting other parties from harm, and (...) argue against the ban on consequentialist grounds. I perform a pairwise comparative analysis of sex selection and its plausible alternatives and argue that that the ban fails to improve the state of affairs relative to a scenario without a ban. The ban makes the situation worse, especially for mothers and their daughters. India should therefore repeal its ban on sex selection. (shrink)

. . Tom Beauchamp and David DeGrazia's principles do improve upon the 3Rs which don’t mention the need for benefits from animal experimentation, the need to compare these benefits to animal harms, and provide no hard limits on experimentation. -/- However, they present their principles as “useful” for people engaged in animal research and as a “philosophically sound” (p. 4) framework for a new ethic for animal research. Regrettably, I have doubts about both these overall claims and so am pessimistic (...) about the book. (shrink)

Following the Introduction, the second section of this essay lays out Tom Cavanaugh’s helpful and convincing account of the enduring significance of the Hippocratic Oath in terms of how it responds to the problem of iatrogenic harm. The third section discusses something underemphasized in Cavanaugh’s account, namely, the key role of the virtue of piety within the Oath and the profession it establishes, and argues that this virtue should be regarded as integral to an authentic Hippocratic ethic. The fourth and (...) final section briefly examines the connection between medicine and philosophy, focusing on how both should be seen as wisdom-seeking ways of life, and shows the relevance of this for regarding the virtue of piety as the key virtue of medical practice. (shrink)

Volume 20, Issue 8, August 2020, Page 65-66.

Volume 20, Issue 8, August 2020, Page W8-W11.

Este documento ofrece una propuesta desde la perspectiva de la bioética para la elaboración de un protocolo de triaje en el contexto de la pandemia de COVID-19. Dicha propuesta incluye recomendaciones sobre las normas procedimentales y normas sustantivas que deben regir la asignación y reasignación de recursos terapéuticos en condiciones de escasez extrema.

The goals and tasks of neuroethics formulated by Farahany and Ramos (2020) link epistemological and methodological issues with ethical and social values. The authors refer simultaneously to the social significance and scientific reliability of the BRAIN Initiative. They openly argue that neuroethics should not only examine neuroscientific research in terms of “a rigorous, reproducible, and representative neuroscience research process” as well as “explore the unique nature of the study of the human brain through accurate and representative models of its function (...) and dysfunction”, but also its responsibilities or social consequences. In our commentary, we would like to concentrate on problem selection, which is shortly noticed by Farahany and Ramos, and by BRAIN Initiative’s Neuroethics Report itself. The document raises an important issue related to problem selection, which is strengthening or perpetuating existing prejudices and biases by choosing a research subject: “scientists are prompted to consider how the questions they choose to study in the laboratory might amplify existing biases.” This leads to several further problems: what constitutes bias?; how biases may be embedded in the selection of research programs?; is it possible to conduct completely unbiased research?; who should be a gatekeeper in the case of research that may amplify biases? We try to notice possible answers to these questions in the context of the research on differences (e.g., cognitive, medical, behavioral) between human populations. (shrink)