Biomedical Ethics

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...

The idea that agent-regret is an important phenomenon in healthcare seems clear. Enck and Condley (2025) do an excellent job giving examples where clinician agent-regret seems understandable. Nonetheless, they focus almost exclusively on the importance of preserving clinician agency in these cases which, while likewise important, fails to fully capture their significance. Cases such as Dr. C’s and Nurse M’s are ones where there are clearly victims even if there are no wrongdoers; this is likely part of why Dr. C (...) and Nurse M feel alienated from colleagues who insist they have nothing to feel badly about, having acted in line with professional guidelines. Addressing the ongoing concerns of those victims may be helpful for all parties involved, including perhaps alleviating some of the clinicians’ agent-regret. But regardless of its effects, recognizing the parties impacted by Dr. C’s and Nurse M’s actions is an important part of properly understanding and taking responsibility for those actions. (shrink)

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)

While the ethical significance of caregivers in neurological research has increasingly been recognized, the role of caregivers in brain- computer interface (BCI) research has received relatively less attention. Objectives: This report investigates the extent to which caregivers are mentioned in publications describing implantable BCI (iBCI) research for individuals with motor dysfunction, communication impairment, and blindness. Methods: The scoping review was conducted in June 2024 using the PubMed and Web of Science bibliographic databases. The articles were systematically searched using query terms (...) for caregivers, family members, and guardians, and the results were quantitatively and qualitatively analyzed. Results: Our search yielded 315 unique studies, 78 of which were included in this scoping review. Thirty-four (43.6%) of the 78 articles mentioned the study participant’s caregivers. We sorted these into 5 categories: Twenty-two (64.7%) of the 34 articles thanked caregivers in the acknowledgement section, 6 (17.6%) articles described the caregiver’s role with regard to the consent process, 12 (35.3%) described the caregiver’s role in the technical maintenance and upkeep of the BCI system or in other procedural aspects of the study, 9 (26.5%) discussed how the BCI enhanced participant communication and goal-directed behavior with the help of a caregiver, and 3 (8.8%) articles included general comments that did not fit into the other categories but still related to the importance of caregivers in the lives of the research participants. Discussion: Caregivers were mentioned in less than half of BCI studies in this review. The studies that offered more robust discussions of caregivers provide valuable insight into the integral role that caregivers play in supporting the study participants and the research process. Attention to the role of caregivers in successful BCI research studies can help guide the responsible development of future BCI study protocols. (shrink)

While the ethical significance of caregivers in neurological research has increasingly been recognized, the role of caregivers in brain- computer interface (BCI) research has received relatively less attention. Objectives: This report investigates the extent to which caregivers are mentioned in publications describing implantable BCI (iBCI) research for individuals with motor dysfunction, communication impairment, and blindness. Methods: The scoping review was conducted in June 2024 using the PubMed and Web of Science bibliographic databases. The articles were systematically searched using query terms (...) for caregivers, family members, and guardians, and the results were quantitatively and qualitatively analyzed. Results: Our search yielded 315 unique studies, 78 of which were included in this scoping review. Thirty-four (43.6%) of the 78 articles mentioned the study participant’s caregivers. We sorted these into 5 categories: Twenty-two (64.7%) of the 34 articles thanked caregivers in the acknowledgement section, 6 (17.6%) articles described the caregiver’s role with regard to the consent process, 12 (35.3%) described the caregiver’s role in the technical maintenance and upkeep of the BCI system or in other procedural aspects of the study, 9 (26.5%) discussed how the BCI enhanced participant communication and goal-directed behavior with the help of a caregiver, and 3 (8.8%) articles included general comments that did not fit into the other categories but still related to the importance of caregivers in the lives of the research participants. Discussion: Caregivers were mentioned in less than half of BCI studies in this review. The studies that offered more robust discussions of caregivers provide valuable insight into the integral role that caregivers play in supporting the study participants and the research process. Attention to the role of caregivers in successful BCI research studies can help guide the responsible development of future BCI study protocols. (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)

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)

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)

Artificial intelligence (AI) systems have demonstrated impressive performance across a variety of clinical tasks. However, notoriously, sometimes these systems are “black boxes.” The initial response in the literature was a demand for “explainable AI.” However, recently, several authors have suggested that making AI more explainable or “interpretable” is likely to be at the cost of the accuracy of these systems and that prioritizing interpretability in medical AI may constitute a “lethal prejudice.” In this paper, we defend the value of interpretability (...) in the context of the use of AI in medicine. Clinicians may prefer interpretable systems over more accurate black boxes, which in turn is sufficient to give designers of AI reason to prefer more interpretable systems in order to ensure that AI is adopted and its benefits realized. Moreover, clinicians may be justified in this preference. Achieving the downstream benefits from AI is critically dependent on how the outputs of these systems are interpreted by physicians and patients. A preference for the use of highly accurate black box AI systems, over less accurate but more interpretable systems, may itself constitute a form of lethal prejudice that may diminish the benefits of AI to—and perhaps even harm—patients. (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)

By now a consensus has emerged that people, when subjected to high-stakes decisions through automated decision systems, have a moral right to have these decisions explained to them. However, furnishing such explanations can be costly. So the right to an explanation creates what we call the cost problem: providing subjects of automated decisions with appropriate explanations of the grounds of these decisions can be costly for the companies and organisations that use these automated decision systems. In this paper, we explore (...) whether large language models could prove significant in overcoming the cost problem. We provide an initial case for believing that they can but only with serious ethical costs. (shrink)

The recent developments of medical AI systems (MAIS) open up questions as to whether and to what extent MAIS can be modeled to include empathetic understanding, as well as what impact MAIS’ lack of empathetic understanding would have on its ability to perform the necessary critical analyses for reaching a diagnosis and recommending medical treatment. In this paper, we argue that current medical AI systems’ ability to empathize with patients is severely limited due to its lack of first-person experiences with (...) human interests and that efforts to correct for this deficit – by having MAIS interpret patients’ medical and non-medical interests – will encounter significant obstacles. Finally, we demonstrate how MAIS’ lack of empathy is likely to hinder its performance in crucial aspects of the processes through which useful medical diagnoses are reached and through which appropriate treatment recommendations for patients are determined. (shrink)

Bioethicists’ views diverge public opinion on various ethical issues, particularly in healthcare. For instance, bioethicists generally oppose payment for organs and advocate for preventing death at any age, whereas the public is more supportive of organ payment and prioritizing younger patients. I offer four arguments on how best to view this divergence. (a) Bioethicists’ specialized training, objectivity, and reliance on research often lead to views that differ from those of the public, which may be less informed and more influenced by (...) biases. (b) Further, divergence between expert and public opinion is a normal and sometimes necessary aspect of bioethics. Divergence can lead to more informed and progressive ethical practices. (c) While public input is valuable, achieving meaningful engagement is difficult due to varying values, risk perceptions, and socioeconomic circumstances. Effective bioethics would balance expert knowledge with public input, aiming for policies that are both scientifically sound and democratically legitimate. (d) Maintaining public trust in bioethics does not require full alignment with public opinion. Instead, bioethicists should focus on educating the public and incorporating informed public perspectives into their analysis and recommendations. (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)

Sacrificial dilemmas such as the trolley problem play an important role in experimental philosophy (x-phi). But it is increasingly argued that, since we are not likely to encounter runaway trolleys in our daily life, the usefulness of such thought experiments for understanding moral judgments in more ecologically valid contexts may be limited. However, similar sacrificial dilemmas are experienced in real life by animal research decision makers. As part of their job, they must make decisions about the suffering, and often the (...) death, of many non-human animals. For this reason, a context-specific investigation of so-called “3R dilemmas” (i.e., dilemmas where there is a conflict between the principles of replacement, reduction, and refinement of the use of animals in research) is essential to improve the situation of both non-human animals and human stakeholders. An approach well suited for such investigation is experimental philosophical bioethics (“bioxphi”), which draws on methods similar to x-phi to probe more realistic, practical scenarios with an eye to informing normative debates and ethical policy. In this article, we argue for a need to investigate 3R dilemmas among professional decision-makers using the tools of bioxphi. In a first step, we define 3R dilemmas and discuss previous investigations of professionals’ attitudes in such cases. In a second step, we show how bioxphi is a promising method to investigate the whys and hows of professional decision-making in 3R dilemmas. In a last step, we provide a bioxphi template for 3R dilemmas, give recommendations on its use, explore the normative relevance of data collected by such means, and discuss important limitations. (shrink)

Jennifer Hawkins (2024) offers two cases that challenge traditional accounts of decision-making capacity, according to which respect for a medical decision turns on an individual’s cognitive capacities at the time the decision is made (Hawkins 2024; Appelbaum and Grisso 1988). In each of her described cases (involving anorexia nervosa and grief, respectively), a patient makes a decision that—although instrumentally rational at the time—does not reflect the patient’s longer-term values due to being in a particular psychological state. Importantly, this state does (...) not impair the patient’s cognition, but rather predisposes them to make a decision that conflicts with their own broader values, beliefs, or desires. (shrink)

In this paper, we report the results from an experimental reproductive ethics study exploring questions about reproduction and parenthood. The main finding in our study is that, while we may assume that everyone understands these concepts and their relationship in the same way, this assumption may be unwarranted. For example, we may assume that if ‘x is y’s father’, it follows that ‘y is x’s child’. However, the participants in our study did not necessarily agree that it does follow. This (...) means, at the very least, that we need to make sure all parties in a debate have the same relationships in mind when talking about reproduction and parenthood. Moreover, it gives us reason to explore more carefully the conditions which support or undermine the connections between these concepts. This cannot come from purely theoretical reasoning, nor from empirical research alone, but from the alliance between the two. (shrink)

Volume 24, Issue 8, August 2024, Page 60-62.

The practice of force-feeding dangerously malnourished patients with anorexia nervosa (AN) raises a puzzle for clinical ethics. Force-feeding AN patients may seem justified to save their lives and to help them recover from a debilitating pathological condition. Yet clinical ethics seems committed to a robust anti-paternalism principle, on which it is normally wrong to force treatment on decisionally capacitated patients for their own good. And some AN patients do retain decisional capacity, at least by standard criteria. Thus, routinely force-feeding AN (...) patients seems to constitute an unjustifiable exception to a well-established principle of clinical decision-making. Call this the moral puzzle of AN. I examine three attempts to solve the puzzle and argue that, individually or taken together, they cannot justify force-feeding those AN patients for whom this intervention would be potentially effective at enabling recovery. I conclude that no such justification is currently available. A solution to the moral puzzle of AN may come from a reevaluation of the anti-paternalism principle, a deeper clinical understanding of the psychology of AN, or even a novel reconceptualization of decisional capacity. (shrink)

In transplant medicine, the use of normothermic regional perfusion (NRP) in donation after circulatory determination of death raises ethical difficulties. NRP is objectionable because it restores the donor's circulation, thus invalidating a death declaration based on the permanent cessation of circulation. NRP's defenders respond with arguments that are tortuous and factually inaccurate and depend on introducing extraneous concepts into the law. However, results comparable to NRP's—more and higher‐quality organs and more efficient allocation—can be achieved by removing organs from deceased donors (...) and using normothermic machine perfusion (NMP) to support the organs outside the body, without jeopardizing confidence in transplantation's legal and ethical foundations. Given the controversy that NRP generates and the convoluted justifications made for it, we recommend a prudential approach we call “ethical parsimony,” which holds that, in the choice between competing means of achieving a result, the ethically simpler one is to be preferred. This approach makes clear that policy‐makers should favor NMP over NRP. (shrink)

Whether anorexic patients should be able to refuse treatment when this potentially has a fatal outcome is a vexed topic. A recent proposal for a new category of ‘terminal anorexia’ suggests criteria when a move to palliative care or even physician assisted suicide might be justified. I argue that this proposed diagnosis presents a false sense of certainty of the illness trajectory by conceptualizing anorexia in analogy with physical disorders and stressing the effects of starvation. Furthermore, this conceptualization is in (...) conflict with the claim that individuals who meet the diagnostic criteria for terminal anorexia have decision making capacity. It should therefore be rejected. (shrink)

Psychedelic-assisted therapy (PAT) is currently undergoing a resurgence of clinical interest for several mental health ailments. We propose that philosophers can play a significant role in PAT in both the preparation and integration phases of PAT. Philosophers can aid in the former phase by offering philosophical preparatory insights and in the latter phase by providing the conceptual language to articulate the complex philosophical aspects of a psychedelic experience.

Illness and injury are often accompanied by experiences of bodily objectification. Medical treatments intended to restore the structure or function of the body may amplify these experiences of objectification by recasting the patient’s body as a biomedical object—something to be examined, measured, and manipulated. In this article, we contribute to the phenomenology of embodiment in illness and medicine by reexamining the results of a qualitative study of the experiences of nurses and patients isolated in an intensive care unit during the (...) first wave of COVID-19. Drawing upon the phenomenological concept of embodiment—as developed in the work of Edmund Husserl, Maurice Merleau-Ponty, Jean-Paul Sartre, and Emmanuel Levinas—we reconsider how bodily objectification manifests in complex clinical encounters. We show that, in these settings, objectification is not simply the unilateral act of a clinician objectifying a patient. Rather, both clinicians and patients reported a variety of objectifying experiences influenced by their interactions, the immediate context of the intensive care milieu, and the broader atmosphere of a global pandemic. In light of these findings, we argue that bodily objectification in illness and medicine can often be more complicated than typically presented in the phenomenological literature. (shrink)