Biomedical Ethics

This review critically appropriates Stephanie Gray Connors’ On IVF through a Lonerganian method of inquiry: beginning from attentive experience, moving through intelligent understanding, reasonable judgment, and culminating in responsible evaluation. Connors’ work is praised for its empathetic attention to the existential pain of infertility, its clear articulation of the moral structure distinguishing ends from means, and its systematic unfolding of the layers of harm intrinsic to in vitro fertilization. Ascending from the immediate drama of suffering to the broader metaphysical horizon, (...) Connors situates human procreation within a theology of giftedness rather than technological production. Her advocacy for Restorative Reproductive Medicine exemplifies an ethics that collaborates with natural finality rather than subverting it. Furthermore, her pastoral call to repentance and healing reveals an understanding of moral failure not as condemnation, but as an opportunity for conversion and renewed fidelity to the dignity of life. Connors' inquiry thus fulfills, in the domain of bioethics, the transcendental precepts of authentic moral reflection: be attentive, be intelligent, be reasonable, and be responsible. In doing so, On IVF emerges not merely as a critique of a contemporary practice, but as a summons to a more reverent participation in the mystery of human life. (shrink)

Despite its prevalence today, the practice of purely performative resuscitation (PPR)—paradigmatically, the “slow code”—has attracted more critics in bioethics than defenders. The most common criticism of the slow code is that it's fundamentally deceptive or harmful, while the most common justification offered is that it may benefit the patient's loved ones, by symbolically honoring the patient or the care team's relationship with the family. I argue that critics and defenders of the slow code each have a point. Advocates of the (...) slow code are right that not all PPR is wrongly deceptive or harmful to the patient or his family and that the symbolic aspect of medicine is itself morally significant. But the critics are also correct: slow codes are prima facie wrong. I argue that pursuing a slow code amounts to treating the patient as a tool for others' benefit—hence, treating him as an object—and that this instrumentalizing quality constitutes one core prima facie wrong of the practice. I also build a case for the idea that the slow code may not always be all‐things‐considered wrong, specifying certain limited conditions under which acts of PPR might ultimately be permissible. Thus, the symbolic dimension of medical treatment is indeed morally important, both in morally favorable and in morally problematic respects—namely, in its symbolic denial of the patient's humanity. (shrink)

COVID-19 has forced policy-makers to impose measures affecting citizens' fundamental rights without public consultation. This study examines citizens’ perceptions of such measures in four countries, focusing on how moral foundations and socio-demographic factors shape differing views. A survey was conducted in April-October 2021 in The Netherlands (NL), Italy (IT), Indonesia (ID) and Kenya (KE), with questions on citizens’ agreement with containment measures, plus the Moral Foundation Theory questionnaire. Univariable and multivariable multinomial logistic regression analysis was performed to examine associations between (...) agreement levels and moral foundations/socio-demographic factors. Agreement with the government approach was at 47% in NL, 21% in IT, 58% in ID and 26% in KE. Most participants agreed with a full lockdown in NL (61·3%), IT (58·8%) and ID (82·5%) but not in KE (36·1%). Being religious increased the probability of agreeing with most containment measures. The moral foundations of care, fairness, and sanctity-purity were positively associated with the likelihood of agreeing with all measures but restricting hospital visits. Containment measures were perceived differently based on country, morals, and background. More focus is needed on the potential influence of socio-cultural contexts and overlooked dynamics when designing and communicating these measures. (shrink)

Contemporary Bioethics: Themes and Dilemmas by Željko Kaluđerović is a thought-provoking exploration of the ethical challenges posed by modern science and technology. ​ From genetic modifications and human cloning to the rights of non-human living beings and the impact of globalization, the book tackles pressing issues that shape our future. With a blend of philosophical insight and practical analysis, Kaluđerović invites readers to reflect on the moral complexities of scientific advancements and their implications for humanity, society, and the environment. ​ (...) Perfect for scholars, students, and anyone interested in the intersection of ethics and innovation, this book offers a compelling guide to navigating the dilemmas of our rapidly changing world. (shrink)

Barnes et al. (2025) emphasize the need for current biobanking consent models to more deeply engage participants who want to determine how their data are used. We appreciate their desire to provide par- ticipants with real-time updates on the status of their data and make the process more accessible. We addi- tionally agree with the goal of making biobanking data more private and secure. However, despite agreeing with the authors on these broader aims, we identify deep moral difficulties with their (...) article on two levels. On one level, we worry that the authors have not engaged deeply enough with some of the constituent parts of their proposal. On a different level, rather than critically examining the use of novel technological methods for managing biobank- ing data, the article instead reads as an effort by the authors to “sell” the underlying technology under the guise of an ethics paper. (shrink)

In this article, I explore the ethical dimensions of same-sex reproduction achieved through epigenome editing—an innovative and transformative technique. For the first time, I analyse the potential normativity of this disruptive approach for reproductive purposes, focusing on its implications for lesbian couples seeking genetically related offspring. Epigenome editing offers a compelling solution to the complex ethical challenges posed by traditional gene editing, as it sidesteps genome modifications and potential long-term genetic consequences. The focus of this article is to systematically analyse (...) the bioethical issues related to the use of epigenome editing for same-sex reproduction. I critically assess the ethical acceptability of epigenome editing with reproductive purposes from multiple angles, considering harm perspectives, the comparison of ethical issues related to gene and epigenome editing, and feminist theories. This analysis reveals that epigenome editing emerges as an ethically acceptable means for lesbian couples to have genetically related children. Moreover, the experiments of a reproductive use of epigenome editing discussed in this article transcend bioethics, shedding light on the broader societal implications of same-sex reproduction. It challenges established notions of biological reproduction and prompts a reevaluation of how we define the human embryo, while poses some issues in the context of gender self-identification and family structures. In a world that increasingly values inclusivity and diversity, this article aims to reveal a progressive pathway for reproductive medicine and bioethics, as well as underscores the need for further philosophical research in this emerging and fertile domain. (shrink)

An important argument against prohibiting organ sales is that it removes the best option available to individuals in dire circumstances. However, this line of reasoning fails to recognise that selling a kidney on a regulated market is only the best option in a very narrow comparison, where a regulated organ market is compared with banning organ sales. Once we acknowledge this narrowness, selling a kidney is not the best option. This paves the way for a distributive justice-based critique of the (...) ‘best option’ argument for organ markets, which illuminates that organ markets should be compared with a broader set of alternatives. If providing the option of selling a kidney is not the best option, but rather the best option we are willing to provide, and one which means that many people will remain in poverty and unjust circumstances, then this reflects poorly on those societies willing to offer only this option and not a better one. (shrink)

In this article, I explore the ethical dimensions of same-sex reproduction achieved through epigenome editing—an innovative and transformative technique. For the first time, I analyse the potential normativity of this disruptive approach for reproductive purposes, focusing on its implications for lesbian couples seeking genetically related offspring. Epigenome editing offers a compelling solution to the complex ethical challenges posed by traditional gene editing, as it sidesteps genome modifications and potential long-term genetic consequences. The focus of this article is to systematically analyse (...) the bioethical issues related to the use of epigenome editing for same-sex reproduction. I critically assess the ethical acceptability of epigenome editing with reproductive purposes from multiple angles, considering harm perspectives, the comparison of ethical issues related to gene and epigenome editing, and feminist theories. This analysis reveals that epigenome editing emerges as an ethically acceptable means for lesbian couples to have genetically related children. Moreover, the experiments of a reproductive use of epigenome editing discussed in this article transcend bioethics, shedding light on the broader societal implications of same-sex reproduction. It challenges established notions of biological reproduction and prompts a reevaluation of how we define the human embryo, while poses some issues in the context of gender self-identification and family structures. In a world that increasingly values inclusivity and diversity, this article aims to reveal a progressive pathway for reproductive medicine and bioethics, as well as underscores the need for further philosophical research in this emerging and fertile domain. (shrink)

It is plausible that in the future synthetic DNA (synDNA) technology could enable the creation of non-viable embryos for research, potentially bypassing ethical objections to embryo experimentation. This article explores how the technology might work, the ethical concerns it might mitigate, and the challenges that remain.

Abstract: In 1990, Congress established the Ryan White HIV/AIDS Program (RWHP). The program has since expanded to cover numerous treatments and support services. It’s hard to overstate how transformative RWHP has been, but hundreds of thousands of other people had died from the same condition White had, so why did politicians wait to enact serious AIDS healthcare? Bluntly, White’s AIDS education activism was sympathetic because he embodied a “moral innocence,” a quality the public did not usually extend to gay men, (...) intravenous drug users, or others who suffered from HIV/AIDS. I ask two questions about this delayed political support. First, are there any moral problems with appealing to moral innocence, even if it secures public support and medical care, by hierarchically ranking lives as more or less sympathetic? Second, can we reduce or eliminate these problems, or are they a necessary cost to getting the public to care about marginalized communities? (shrink)

Medicalization occurs when a phenomenon comes to be subject to medical study, diagnosis, treatment, or prevention. Whether a phenomenon ought to be medicalized should be decided on a case-by-case basis. Recent moves to remove “bereavement exclusions” from psychiatric diagnostic manuals and to introduce grief-specific medical disorders have elicited criticisms from skeptics about grief’s medicalization, but these criticisms can largely be blunted. This article first clarifies the nature of disputes about medicalization, highlighting how these disputes do not concern whether a condition (...) such as grief is clinically significant or whether it can generate illness, but whether the condition itself is rightfully categorized as potentially pathological. It then offers a stronger, philosophically grounded case against the medicalization of grief, resting on how medicalizing grief is likely to detrimentally alter the moral and political meanings attached to grief. Specifically, medicalizing grief will “normativize” a medical vocabulary for evaluating grief that may impede authentic engagement with grief, validate a suspect “time slice” model of human well-being that overlooks how grief can benefit a person’s life as a whole, and impede desirable sympathy or solidarity with grieving persons. (shrink)

This chapter aims to make analytical political philosophy part of existing discussions about the role of numbers in the workings of political institutions that already cut across many other disciplines in the humanities and social sciences. To do that, it will first explore the prominent ‘capability approach’ to justice, which is characterised by scepticism towards excessive precision in law- and policy-making. Given the close link between precision and quantification, the loudest voice from political philosophy will therefore turn out to be (...) one of warning against the use of numbers in political decision-making. However, the chapter will also discuss powerful objections to the capability approach that, building on the work of John Rawls, stress the importance of public justification and, in turn, simplifying devices in political decision-making. Those objections will be used to demonstrate that quantification can play functions that are very important from a normative perspective. To further support its claim that under certain circumstances, numerical tools might well be the best way of making political decisions, the chapter will use as a case study the National Institute for Health and Care Excellence, an administrative body in charge of appraising health technology for use in the British National Health Service. (shrink)

The structural scarcity of healthcare resources has deeply challenged their fair distribution, prompting the need for allocation criteria. Long under the spotlight of the bioethical debate with an extraordinary peak during the recent COVID-19 pandemic, micro-allocation of healthcare has been extensively discussed in the literature with regard to issues of substantive and formal justice. This paper addresses a relatively underdiscussed question within the field of formal justice: who should define micro-allocation criteria in healthcare? To explore this issue, we first establish (...) formal requirements that must be met for allocation criteria to be considered fair and legitimate. Then, we introduce three possible answers to the research question: the attending physician, the team of physicians, and the team of experts. We discuss and then reject all of them, arguing that the task of defining allocation criteria should be assigned to a political representative, supported by a cross-disciplinary team of experts. This proposal is based on the need to take democracy seriously as a tool for making substantive allocative decisions in light of the inevitable disagreement on such matters within a community. To support this claim, we present two key arguments—the democracy argument and the consistency argument. We also pre-emptively respond to two significant critiques: the too-specificity of the decision critique and the catastrophic outcomes critique. In conclusion, we argue that our proposal offers the fairest and most legitimate decision-making process for healthcare micro-allocation. (shrink)

The structural scarcity of healthcare resources raises im- portant bioethical issues regarding their allocation, such as who should make such decisions. This paper evaluates whether or not physicians should be responsible for deciding how to allocate healthcare resources in the micro-allocation context. Addressing this issue is essential for determining the moral or legal responsibility of physicians when allocating scarce healthcare resources in both ordinary and emer- gency conditions. The paper is structured as follows: First, I discuss the perspective of the (...) physician as a double agent, balancing their duty to their patient with that towards other patients and society. This perspective aims to justify bedside rationing by physicians. After discussing some critical issues with this conception, I propose a critique based of the prin- ciple of justice. I then define the necessary requirements for a fair and legitimate allocation choice in healthcare and argue that the specificity of such a choice makes it morally problematic to attribute a direct decision-making role to the treating physician when rationing healthcare resources in the micro-allocation context. This leads to a rejection of the conception of the physician as a double agent and bedside rationing, although I observe that this does not preclude the physician from some involvement in the process of defining allocation criteria and methods. (shrink)

This paper explores the issue of racial bias in artificial intelligence (AI) through the lens of the bioethical principle of justice, with a focus on Joy Buolamwini’s “Coded Bias” and the work of the “Algorithmic Justice League.” AI technologies, particularly facial recognition systems, have been shown to disproportionately misidentify individuals from marginalised racial groups, raising profound ethical concerns about fairness and equity. The bioethical principle of justice stresses the importance of equal treatment and the protection of vulnerable populations. Through qualitative (...) research, including content analysis of Buolamwini’s works and case studies of AI bias, this paper assesses the efforts of the Algorithmic Justice League to combat racial bias in AI. It emphasises their advocacy for the development of fair, equitable algorithms and calls for systemic reform in AI development to ensure justice for marginalised communities. (shrink)

Questo contributo propone una riflessione sul tema dell’expertise bioetica. In primo luogo, si definirà questo tipo di expertise come una competenza metodologica. Questa scelta è motivata dalla necessità di rispondere alla critica secondo cui non potrebbe esistere l’expertise in ambito bioetico. In secondo luogo, si sosterrà che definire tale exper- tise in termini metodologici non basta per esaurire la riflessione sul tema; verranno dunque accennate alcune questioni da affrontare per una definizione completa in questo ambito.

Newborn screening is a publicly funded test aimed at identifying genetic diseases in healthy infants where early diagnosis can lead to timely and effective clinical intervention. Recently, there has been growing interest in applying genomic sequencing, in particular Whole Genome Sequencing and Whole Exome Sequencing, to this screening, significantly increasing the number of identifiable conditions. Considering the promises of this approach and the specificity of genomic data, some have suggested that newborn sequencing could serve the interests of not only screened (...) newborns but also their parents, relatives, and even society. Determining which interests should legitimately be considered in genomic newborn sequencing is crucial for defining which genes to include in the gene panel of neonatal genomic screening. Stemming from a bioethical perspective, this paper discusses which interests should be considered in newborn sequencing, what the implications are for gene panel definition, and what conflicts between interests might emerge. Specifically, the newborn clinical interest, the reproductive interest, the family clinical interest, personal utility, and social utility will be considered. (shrink)

Lee argues that pronatalist policies in countries suffering from declining birth rates, such as South Korea, are ethically flawed.1 The ‘soft’ pronatalist policies Lee describes aim at persuading citizens to reproduce. For Lee, coercive pronatalist policies are so obviously unacceptable as not to merit consideration. However, we suggest that this is an issue that requires further analysis. When ethicists regard certain possibilities as not worth debating, we miss opportunities to examine the basis for our convictions. In short, it behoves us (...) now and again to challenge our convictions, especially if they seem inconsistent in relation to other views we hold. By comparing coercive pronatalism with enforced military conscription, we can notice some inconsistencies. South Korea—which Lee discusses in her paper—enforces military service, as do Austria, Switzerland, Ukraine and Finland to name a few. Many countries that do not currently conscript citizens retain the right to do so during wartime. Conscription is an example of coercive state intervention which, even if not widely endorsed, rarely generates outrage or even attention from ethicists.2 For those who accept that coercive conscription could in principle be justified, it is not easy to show why coercive pronatalism must be rejected without argument. Indeed, many of those who are alarmed about declining birth rates …. (shrink)

In a recent paper, I argued that an externalist understanding of mental disorder from the philosophy of psychiatry presents an ethical challenge to the practice of medical assistance in dying (MAiD) for psychiatric illness, because it highlights the ways in which the suffering associated with psychiatric illness is sustained by features of the external environment wherein the person is embedded, including social barriers and injustices. In a response to my paper, Harry Hudson argues that addressing social inequality lacks relevance to (...) the immediate permissibility of psychiatric MAiD and that the issue of psychiatric MAiD should be informed by ‘pragmatic politics’ rather than by ‘obfuscatory philosophy’. Herein, I contend that Hudson’s response misconstrues my position and ascribes to me views I neither express nor endorse. My paper does not claim that psychiatric MAiD should be denied to people who are presently in intolerable distress. Rather, it suggests that the provision of psychiatric MAiD comes along with social responsibilities of the state to attend to the barriers and injustices that sustain and exacerbate psychiatric illness, as well as ethical responsibilities of clinicians to consider a wider range of presently available psychological and social interventions which may have been neglected under a traditional internalist approach. (shrink)

The growing demand for uterus transplantation (UTx) invites continued philosophical evaluation of the function of UTx (and what constitutes its ‘success’), as well as the recipient eligibility for UTx. Currently, UTx caters to partnered, cisgender women of childbearing age looking to get pregnant and give birth to a biogenetically related child. The medical justification for this—the treatment of uterine infertility—explains the primacy of this practice. However, this dominant conceptualization of UTx does not necessarily capture the diverse needs for which both (...) cis‐ and transgender women might take interest in UTx that are not strictly procreative, such as bodily integrity and gender identity reasons. In this paper, I argue that non‐procreative motivations for uterus acquisition ought to be taken seriously as a matter of non‐discrimination and consistency. (shrink)

In “Voluntary Acts and Responsible Agents,” Bernard Williams sketches what it means to be a mature agent. This mature agent tries to make sense of their own life, which is a life that is shared wit...

In this article, I explore concerns that have been raised regarding the relation between love and uptake of reproductive technologies, embryo selection and enhancement. Objections to (certain) uses of these technologies in terms of fractures in love, either parental or between partners, come from a variety of directions, from the conservative to the liberal. I examine two claims: (1) that the separation of procreation from sex and intimacy is a threat to love, and (2) that intervention on the traits of (...) one’s future offspring betrays inadequate parental love. I will place these concerns in a broader context of (a) technologically facilitated threats to – or aids towards maintaining – love and (b) irreversible changes to parent-child relationships that arise at the moment a prospective parent acts on the choice to select or shape the essence of their future child. (shrink)

Conscious but incapacitated patients need protection from both undertreatment and overtreatment, for they are exceptionally vulnerable, and dependent on others to act in their interests. In the United States, the law prioritizes autonomy over best interests in decision making. Yet U.S. courts, using both substituted judgment and best interests decision making standards, frequently prohibit the withdrawal of life-sustaining treatment from conscious but incapacitated patients, such as those in the minimally conscious state, even when ostensibly seeking to determine what patients would (...) have wanted. In the United Kingdom, under the Mental Capacity Act of 2005, courts decide on the best interests of incapacitated patients by, in part, taking into account the past wishes and values of the patient. This paper examines and compares those ethicolegal approaches to decision making on behalf of conscious but incapacitated patients. We argue for a limited interpretation of best interests such that the standard is properly used only when the preferences of a conscious, but incapacitated patient are unknown and unknowable. When patient preferences and values are known or can be reasonably inferred, using a holistic, all-things-considered substituted judgment standard respects patient autonomy. (shrink)

In this paper, we take a data-driven approach to analyse intellectual trends over the first five decades of theJournal of Medical Ethics(JME). Our data set, comprising all texts published in theJMEsince 1975, reveals not only the most distinctive topics of theJMEin comparison to other key journals with similar profiles but also diachronic fluctuations in the prominence of certain topics. Overall, the distribution of topics shifted gradually, with each editorial period at theJMEshowing continuity with its immediate predecessor. However, a significant drift (...) in topic distribution is evident over the 50 years, with some editorial periods being more ‘disruptive’ than others. These disruptions were influenced by external events (eg,Public health emergencies), broader trends in bioethics (eg, the recent growth of topics such asRace,PrivacyandVaccination) or editors’ preferences (eg,Ethics education). Additionally, our data provides insights into editorials where editors outlined their visions for the journal or reflected retrospectively on their past editorship. (shrink)

This correspondence piece responds to commentaries on the authors' survey of U.S. bioethicists. The authors address two key questions: the definition of a bioethicist and how bioethics should evolve. They identify four distinct roles bioethicists occupy: researchers, pedagogues, consultants, and advocates/activists. The article examines various aspects of inclusiveness in bioethics - demographic, viewpoint, methodological, and topical - while acknowledging inherent tensions and trade-offs between them. For example, including religiously or geographically diverse voices may conflict with other inclusivity goals. The authors (...) argue that while demographic inclusiveness is crucial, other forms of inclusiveness require careful consideration of trade-offs and empirical research to assess their impacts. They emphasize the need for systematic research on bioethicists' beliefs and reasoning, particularly regarding complex issues like disability and racial health disparities. The piece concludes by calling for continued dialogue and better funding for empirical research on ethical perspectives across different groups. (shrink)

Julia Knopes’s (2025) article aims to explain how models of disability apply in the lives and experiences of people with lived mental health conditions who serve as peer support providers. However,...

The use of psychedelics has recently gained increased interest among bioethicists, as the articles published in this journal attest. Some of the recent scholarship suggests that psychedelic experie...

Self-tracking-technologies can serve as a prominent example of how digital technologies put to test established practices, institutions, and structures of medicine and healthcare. While proponents emphasize the potentials, e.g., for individualized healthcare and new research data, opponents stress the risk that these technologies will reinforce gender-related inequalities. -/- While this has been made clear from—often intersectional—feminist perspectives since the introduction of such technologies, we aim to provide a queer-feminist perspective on self-tracking applications in healthcare by analyzing three concrete cases. In (...) this way, we want to show why such a perspective is helpful in assessing self-tracking technologies and how such a perspective might contribute to a queering of healthcare. -/- After a short introduction to self-tracking in healthcare and the corresponding risks of reproducing gender-related inequalities, we introduce queer bioethics as a methodology to examine structural discrimination and marginalization in bioethical research. We apply this framework in the analysis of three exemplary self-tracking applications from the areas of nutrition/fitness, reproductive health, and mental health. In the subsequent discussion of these results against the backdrop of already existing queer-sensitive technologies, we identify an equal access, a subversive design, an inclusive database, and a diversity-sensitive and discriminatory-critical definition of purposes as well as individualized usage possibilities as first possible starting points for a queering of self-tracking applications. Finally, we draw conclusions, how such a critical perspective on self-tracking applications might also contribute to a queering of the healthcare system at a structural level. (shrink)

In the following paper I develop an account of Gilles Deleuze’s ethics through his work on Spinoza, which he contrasts with morality, to argue that an ethical response to the COVID-19 pandemic should resist the moralizing of the New Normal and instead have an immanent focus on what is happening to us. In the first part of the paper I detail the novel approach to ethics as ethology that Deleuze works out most explicitly in Spinoza: Practical Philosophy. In the second (...) part I show exactly how Deleuze contrasts ethics from morality and moral thinking before showing the relation of ethics to morality in relation to the New Normal and contrast the Deleuzian ethical perspective from other ethical philosophical accounts that I claim are indicative a moral approach to the New Normal. I conclude by arguing that the prevalence of the New Normal amidst COVID-19 represents a triumph of what Spinoza calls the sad passions and suggest Deleuze’s ethics might be a way to reject those sad passions. (shrink)

Some of the most difficult consultations for an ethics consultant to resolve are those in which the patient is ready to leave the acute-care setting, but the patient or family refuses the plan, or the plan is impeded by deficiencies in the healthcare system. Either way, the patient is “stuck” in the hospital and the ethics consultant is called to help get the patient “unstuck.” These encounters, which we call “complex discharges,” are beset with tensions between the interests of the (...) institution and the interests of the patient as well as tensions within the ethics consultant whose commitments are shaped both by the values of the organization and the values of their own profession. The clinical ethics literature on this topic is limited and provides little guidance. What is needed is guidance for consultants operating at the bedside and for those participating at a higher organizational level. To fill this gap, we offer guidance for facilitating a fair process designed to resolve the conflict without resorting to coercive legal measures. We reflect on three cases to argue that the approach of the consultant is generally one of mediation in these types of disputes. For patients who lack decision making capacity and lack a surrogate decision maker, we recommend the creation of a complex discharge committee within the organization so that ethics consultants can properly discharge their duties to assist patients who are unable to advocate for themselves through a fair and transparent process. (shrink)

This article is concerned with "all-or-nothing" approaches to female genital cosmetic surgeries, those that overemphasize either women's autonomy to defend total accessibility or the oppressive social context affecting women to defend the total banning of the procedures. By contrast, the author takes both phenomena into consideration. The author argues identifying patterns of false consciousness and weighing those against harm done to a patient provides a moral basis for a doctor to possibly deny their consent at face value. This also requires (...) a shift in understanding the doctor–patient relationship as a first step toward a feminist model for women's healthcare. (shrink)

How important is it, morally speaking, that banning the sale of organs removes the best option available to would-be organ sellers? According to a widespread argument called the best option argument, this is very important. In a recent article I criticised such reasoning, drawing on considerations of distributive justice. Luke Semrau has argued that I have misunderstood the best option argument. In this article, I respond to Semrau’s criticism and elaborate on my original argument.

This article discusses the role and validity of arguments of culture in biomedical ethics. It is often maintained that any fundamental bioethical consensus is ruled out by the existence of incommensurable value axioms rooted in the different traditions, above all with regard to diverging conceptions of the human being. For example, it is argued that the <Christian>Western culture leads to more restrictive and the <Confucian> Chinese culture to more permissive stances with regard to consumptive embryo research. However, what a <culture> (...) says has always been a matter of interpretation and debate. Confucianism, too, offers more than just one option to answer crucial bioethical questions. There is no established cultural position that would absolve one from a responsible decision. Rather than exerting a one-sided impact on ethics, culture can also be reshaped and changed in view of ethical challenges. (shrink)

Jennifer Blumenthal-Barby (2024) has called for bioethics to end talk about personhood, asserting that such talk has the tendency to confuse and offend. It will be argued that this has only limited application for (largely) private settings. However, in other settings, theorizing about personhood leaves a gap in which there is the risk that the offending concept will get uptake elsewhere, and so the problem Blumenthal-Barby nominates may not be completely avoided. In response to this risk, an argument is presented (...) in support of the idea that the role of philosophers and bioethicists, far from ending talk of personhood, ought to be to clarify the concept, and to do so in nuanced ways, given its application for specific kinds of impairments. The case of dementia is used to illustrate this in the context of person-centered care. Ironically, given the stigma attached to dementia, far from the need to end talk of personhood, bioethicists are needed to rescue the concept and clarify its role. (shrink)

Researchers and practitioners are increasingly using machine‐generated synthetic data as a tool for advancing health science and practice, by expanding access to health data while—potentially—mitigating privacy and related ethical concerns around data sharing. While using synthetic data in this way holds promise, we argue that it also raises significant ethical, legal, and policy concerns, including persistent privacy and security problems, accuracy and reliability issues, worries about fairness and bias, and new regulatory challenges. The virtue of synthetic data is often understood (...) to be its detachment from the data subjects whose measurement data is used to generate it. However, we argue that addressing the ethical issues synthetic data raises might require bringing data subjects back into the picture, finding ways that researchers and data subjects can be more meaningfully engaged in the construction and evaluation of datasets and in the creation of institutional safeguards that promote responsible use. (shrink)

The following abstracts were selected by AJOB-Neuroscience judges as the best submitted to the International Neuroethics Society 2024 Annual Meeting based on merit, novelty, relevance, and contribution to the field of neuroethics. The scores were tallied and the top abstracts appear in alphabetical order by first author surname.

The global inequality in the distribution of vaccines is unjust. As countries scrambled to ensure enough vaccines, the world’s poorest were left to fend for themselves, and the generosity meant to mitigate this through COVAX was not sufficiently forthcoming. In light of this, I proposed a vaccine tax, which obligates those willing and able to pay to protect their own population to contribute to protecting those residing in the world’s low-income countries. Petrovic has offered an important critique of this proposal, (...) questioning both the fairness and the efficiency of the tax. However, when properly specified, the vaccine tax is not vulnerable to these critiques. (shrink)

An increasing vaccine hesitancy among parents, which has resulted in insufficient rates of immunization, provides reason to reconsider childhood vaccination practices. Studies suggest that parents' decision-making process concerning whether to vaccinate their child is highly influenced by cognitive biases. These biases can be utilized to increase vaccination uptake via changes in the choice context. This article considers childhood vaccination programmes, which involve children being vaccinated in school or daycare unless their parents actively ‘opt out’. We suggest that such programmes reconcile (...) parents' decisional authority and vaccination duties. First, opt-out childhood vaccination based in schools or daycare centres are not disrespectful of parental authority. Second, the programme aligns the default setting with a moral obligation to vaccinate one's child that most parents have. (shrink)

Traditional medical Artificial Intelligence models, approved for clinical use, restrict themselves to single-modal data e.g. images only, limiting their applicability in the complex, multimodal environment of medical diagnosis and treatment. Multimodal Transformer Models in healthcare can effectively process and interpret diverse data forms such as text, images, and structured data. They have demonstrated impressive performance on standard benchmarks like USLME question banks and continue to improve with scale. However, the adoption of these advanced AI models is not without challenges. While (...) multimodal deep learning models like Transformers offer promising advancements in healthcare, their integration requires careful consideration of the accompanying ethical and environmental challenges. (shrink)

In addressing the question of what mental health is we might proceed as if there is a single phenomenon – mental health – denoted by a single overarching concept. The task, then, is to provide an informative analysis of this concept which applies to all and only instances of mental health, and which illuminates what it is to be mentally healthy. In contrast, mental health pluralism is the idea that there are multiple mental health phenomena denoted by multiple concepts of (...) mental health. Analysis and illumination of mental health may still be possible, but there isn’t a single phenomenon or concept to be analysed in addressing the question of what mental health is. The question of pluralism has been overlooked in the philosophy of mental health. The discussion to follow is an attempt to get us to take mental health pluralism seriously. To that end, in this essay I have three primary goals: (1) to give a precise account of what mental health pluralism is, (2) to show that the question of pluralism should not be neglected in debate about what mental health is, and (3) to argue for mental health pluralism. I also draw out some implications of this discussion for philosophy, science, and psychotherapy. (shrink)

According to the sufficiency theory of justice in health, justice requires that people have equal access to adequate health. In this article, I lay out the structure of this view and I assess its distributive implications for setting priority (i) between health needs across persons and (ii) between health care spending and other societal goods. I argue, first, that according to the sufficiency theory, deficiency in health cannot be completely offset by providing other societal goods. And, second, that it can (...) prevent the medicalization of societies by stressing that improvements beyond the level of adequate health have relatively little weight, if any, from the standpoint of justice. (shrink)

State militaries have strong interests in developing enhanced warfighters: taking otherwise healthy service personnel (soldiers, marines, pilots, etc.) and pushing their biological, physiological, and cognitive capacities beyond their individual statistical or baseline norm. However, the ethical and regulatory challenges of justifying research into these kinds of interventions to demonstrate the efficacy and safety of enhancements in the military has not been well explored. In this paper, we offer, in the context of the US Common Rule and Institutional Review Board framework, (...) potential justifications for justifying research into enhancing warfighters on the grounds of (1) individual and group risk reduction, (2) protection of third parties such as civilians, and (3) military effectiveness. (shrink)

We recently suggested that there are both pragmatic and normative reasons to classify pregnancy as a disease. Several scholars argued against our claims. In this response, we defend the disease view of pregnancy against their criticism. We claim that the dysfunctional account of disease that some of our critics rely on has some counterintuitive results. Furthermore, we claim that our critics assume what needs to be argued that the primary function of our sexual organs is to reproduce. Since only a (...) small percentage of sexual intercourse leads to pregnancy, it is far from obvious that reproduction is the primary biological function of our sexual organs. We also claim that while taking pregnancy itself as a reference class could avoid the conclusion that pregnancy is a disease, the strategy is problematic since it renders the Boorsean approach to disease and health circular and effectively deprives it of any utility in determining whether a particular phenomenon is a disease or not. (shrink)

An AI-based “patient preference predictor” (PPP) is a proposed method for guiding healthcare decisions for patients who lack decision-making capacity. The proposal is to use correlations between sociodemographic data and known healthcare preferences to construct a model that predicts the unknown preferences of a particular patient. In this paper, I highlight a distinction that has been largely overlooked so far in debates about the PPP–that between algorithmic prediction and decision-making–and argue that much of the recent philosophical disagreement stems from this (...) oversight. I show how three prominent objections to the PPP only challenge its use as the sole determinant of a choice, and actually support its use as a source of evidence about patient preferences to inform human decision-making. The upshot is that we should adopt the evidential conception of the PPP and shift our evaluation of this technology towards the ethics of algorithmic prediction, rather than decision-making. (shrink)

This paper critically interrogates the anti-fat beliefs that are employed in environmental bioethics, particularly in response to climate change. Fat bodies have been associated with climate change because they are presumed to consume more resources and produce more greenhouse gas emissions. In this paper, we argue that such interpretations employ mistaken assumptions to justify placing disproportionate blame on already oppressed individuals, reinforcing weight stigma, which increases the vulnerability of fat people to a range of harms and disproportionately affects communities of (...) color. For these reasons, conceiving fat bodies as harmful to the environment is both misguided and unjust. (shrink)

Background: Exposomics, the study of the exposome, is flourishing, but the field is not well defined. The term “exposome” refers to all environmental influences and associated biological responses throughout the lifespan. However, this definition is very similar to that of the term “environment”—the external elements and conditions that surround and affect the life and development of an organism. Consequently, the exposome seems to be nothing more than a synonym for the environment, and exposomics a synonym for environmental research. As a (...) result, some have rebranded their “standard” environmental health research with the neologistic exposome term, whereas others ignore or seek to abandon the seemingly redundant concept of the exposome. -/- Objectives: We argue that exposomics needs to sharpen its mission focus to counteract this apparent redundancy. Exposomics should be defined as a research program in environmental health aimed at enabling a comprehensive and discovery-driven approach to identifying environmental determinants of human health. Similar to the aim of the Human Genome Project, exposomics aims to analyze the complete complexity of exposures and their corresponding biological responses. Exposomics’ primary premise is that the existence of undiscovered, potentially interconnected, nongenetic (environmental) risk factors for health necessitates a comprehensive discovery-driven analysis approach. -/- Discussion: We argue that exposomics researchers should adopt our reconceptualization of exposomics and focus on the productiveness and integrity of their research program: its purpose and principles. We suggest that exposomics researchers should coordinate the writing of reviews that assess the program’s productiveness and integrity, as well as provide a platform for exposomics researchers to define their vision for the field. (shrink)

In 1975, The New England Journal of Medicine published James Rachels' article 'Active and Passive Euthanasia'. The argumentative method that Rachels introduced, the Bare Difference Argument (also known as the Contrast Strategy), became one of the most widely used tools in ethical reasoning. The argument, however, fails to show active euthanasia being morally permissible. It fails because Rachels takes the intuitions from the case where letting die is morally impermissible and applies the intuitions to cases where letting die is morally (...) permissible. While it is possible to create thought-experiments that are more analogous to euthanasia, in this respect, than Rachels' cases, they too are disanalogous to euthanasia with some of the relevant features. Creating the perfect analogy, however, would be a mistake too. Such a case would be too analogous; people would simply be divided on what kind of moral intuitions they would have. The problem thus highlights a methodological limit in philosophical bioethics and raises questions related to the roles of philosophical ethicists in the context of assisted dying. (shrink)