In recognition of the important ethical issues posed by qualitative research in health care, the authors present key questions to aid ethical review. The purpose is to assist lay and professional members of research ethics committees in their assessment of applications involving qualitative research methods and to inform researchers intending to submit such applications for ethical approval. For the benefit of those less familiar with this type of research, the authors include an overview of different types of qualitative research, together (...) with an explanation of terms commonly used by qualitative researchers. (shrink)

The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert’s) suggests that there is no reform of morality , but (...) of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured. (shrink)

While bioethics as a field has concerned itself with methodological issues since the early years, there has been no systematic examination of how ethics is incorporated into research on the Ethical, Legal and Social Implications of the Human Genome Project. Yet ELSI research may bear a particular burden of investigating and substantiating its methods given public funding, an explicitly cross-disciplinary approach, and the perceived significance of adequate responsiveness to advances in genomics. We undertook a qualitative content analysis of a sample (...) of ELSI publications appearing between 2003 and 2008 with the aim of better understanding the methods, aims, and approaches to ethics that ELSI researchers employ. We found that the aims of ethics within ELSI are largely prescriptive and address multiple groups. We also found that the bioethics methods used in the ELSI literature are both diverse between publications and multiple within publications, but are usually not themselves discussed or employed as suggested by bioethics method proponents. Ethics in ELSI is also sometimes undistinguished from related inquiries. (shrink)

The aim of this study was to investigate the experiences of persons with severe functional disabilities who receive personal assistance in their homes, the focus being on their daily life in relation to the ethical principles represented in the Swedish Disability Act: autonomy, integrity, influence and participation. Qualitative interviews were performed with 26 persons and thereafter subjected to qualitative latent content analysis. The experiences of personal assistance were very much in accordance with the said principles, the most important factor being (...) that one is met with understanding. The participants described situations in which their integrity was violated in that they were not treated as competent adults. This indicates the importance of future efforts in nursing to support personal assistants with ethical knowledge and supervision so that they can empower people with disabilities and thereby enable them to maintain their self-esteem and dignity. (shrink)

In recent years, debates about euthanasia and assisted suicide have increased to the point that now, many people defend the recognition of the right to die, the right for people to decide upon the end of their life. Consistently, advocates fight to legalise practices such as euthanasia to guarantee patients’ possibility to die when they request it. In this paper, I review two of the strongest arguments invoked by proponents of physician-assisted suicide: the argument for compassion and the argument for (...) dignity. The focus of this paper is to propose a review of these arguments through the lens of virtue ethics to inform the debate on physician-assisted suicide and question the relevance of such arguments for the legalisation of that right that would greatly ease the possibilities to end the life of a patient asking for it. (shrink)

Discussion of the ethics of memory modification technologies has often focused on questions about the limits of their permissibility. In the current paper, I focus primarily on a different issue: when is it rational to prefer MMTs to alternative interventions? My conclusion is that these conditions are rare. The reason stems from considerations of autonomy. When compared with other interventions, MMTs do a particularly poor job at promoting the autonomy of their users. If this conclusion is true, moreover, it provides (...) a fresh perspective on debates about the permissibility of MMTs. On the one hand, for those who would limit the use of MMTs to a narrow range of circumstances, the conclusion that MMTs are rarely preferable gives them further reason to eye MMTs with suspicion. On the other hand, for those who view MMTs as permissible in a wide range of circumstances, the conclusion may deflate their endorsement. (shrink)

Failure to follow prescribed treatment has devastating consequences for those who are seriously and persistently mentally ill. Nurses, therefore, try to get clients to take psychotropic medication on a long-term basis. The goal is either compliance or adherence. Although current nursing literature has abandoned the term compliance because of its implications of coercion, in psychiatric nursing practice with patients suffering from serious long-term mental illness compliance and adherence are in fact different goals. The ideal goal is adherence, which requires the (...) patient to be an active participant in the team. This goal is consistent with nurses’ ethical values, but for such patients this is frequently unrealistic. If the person is severely psychotic, treatment may be involuntary and the goal compliance. Psychiatric nurses participate in involuntary treatment and thus should acknowledge the ethical implications of compliance as a goal and not obscure the issue by calling compliance adherence. (shrink)

Background:In the face of scarcity, nurses may inevitably delay or omit some nursing interventions and give priority to others. This increases the risk of adverse patient outcomes and threatens safety, quality, and dignity in care. However, it is not clear if there is an ethical element in nursing care rationing and how nurses experience the phenomenon in its ethical perspective.Objectives:The purpose was to synthesize studies that relate care rationing with the ethical perspectives of nursing, and find the deeper, moral meaning (...) of this phenomenon.Research design:A systematic review and thematic synthesis of qualitative studies was used. Searching was based on guidelines suggested by Joana Brigs Institute, while the synthesis has drawn from the methodology described. Primary studies were sought from nine electronic databases and manual searches. The explicitness of reporting was assed using consolidated criteria for reporting qualitative research. Nine studies involving 167 nurse participants were included. Synthesis resulted in 35 preliminary themes, 14 descriptive themes, and four analytical themes. Discussion of relationships between themes revealed a new thematic framework.Ethical consideration:Every effort has been taken, for the thoroughness in searching and retrieving the primary studies of this synthesis, and in order for them to be treated accurately, fairly and honestly and without intentional misinterpretations of their findings.Discussion:Within limitations of scarcity, nurses face moral challenges and their decisions may jeopardize professional values, leading to role conflict, feelings of guilt, distress and difficulty in fulfilling a morally acceptable role. However, more research is needed to support certain relationships.Conclusions:Related literature is limited. The few studies found highlighted the essence of justice, equality in care and in values when prioritizing care—with little support to the ethical effects of rationing on nurses. Further research on ethical dimension of care rationing may illuminate other important aspects of this phenomenon. (shrink)

Research from behavioural sciences shows that people reach decisions in a much less rational and well-considered way than was often assumed. The doctrine of informed consent, which is an important ethical principle and legal requirement in medical practice, is being challenged by these insights into decision-making and real-world choice behaviour. This article discusses the implications of recent insights of research on decision-making behaviour for the informed consent doctrine. It concludes that there is a significant tension between the often non-rational choice (...) behaviour and the traditional theory of informed consent. Responsible ways of dealing with or solving these problems are considered. To this end, patient decisions aids are discussed as suitable interventions to support autonomous decision-making. However, current PDAs demand certain improvements in order to protect and promote autonomous decision-making. Based on a conception of autonomy, we will argue which type of improvements are needed. (shrink)

BackgroundHealth screening is undertaken to identify individuals who are deemed at higher risk of disease for further diagnostic testing so that they may possibly benefit from interventions to modify the natural course of disease. In Singapore, screening tests are widely available in the form of a package, which bundles multiple tests in one session and commonly includes non-recommended tests. There are various ethical issues associated with such testing as they may not be clinically appropriate and can result in more harm (...) than benefit. This article describes the practice of health screening packages, identifies the ethical issues arising from such packages and discusses the implications of these ethical issues on policy and practice of screening in Singapore.MethodsA content analysis of the websites of providers offering general health screening packages to individuals was conducted. A total of 14 health screening package providers were analysed for how packages were conducted and promoted, how clinically appropriate screening tests were, and the price range and composition of screening packages. A normative ethical analysis based on the four principles approach of beneficence, non-maleficence, autonomy and justice in biomedical ethics was used.ResultsTwelve of the 14 providers included non-recommended tests such as tumour markers, treadmill stress tests and MRI scans in their general health screening packages. Package prices ranged from S$26 to S$10,561, with providers charging higher when more tests were included. Health screening packages were broadly conducted in three stages: the offer and selection of a health screening package; medical assessment and performance of screening tests; a post-screening review. While material provided by all providers was factual, there was no information on the potential risks or harms of screening.ConclusionSeveral ethical issues were identified that should be addressed with regard to health screening packages in Singapore. A key issue was the information gap between providers and patients, which may result in patients undergoing inappropriate testing that may be more harmful than beneficial. Health screening packages can stimulate unnecessary demand for healthcare and contribute to an inequitable distribution of healthcare resources. (shrink)

Florijn’s analysis of the Dutch Supreme Court ruling on the Albert Heringa case demonstrates that the Dutch approach to justifying physician-assisted death is based primarily on the physician...

This paper discusses two approaches to climate ethics for practical reflection and decision-making in concrete local climate change governance. After a brief review of the main conceptual frameworks in climate ethics research, we show that none of these leading approaches is sufficiently context specific and pluralistic to provide guidance appropriate for concrete local climate governance. As alternatives, we present principlism as a methodology of mid-level principles and environmental pragmatism as an ethical approach. We argue that the two methodologies of principlism (...) and pragmatism offer a new pluralistic framework that allows real-world conditions and contexts to be properly integrated into ethical analysis and decision-making in climate governance. (shrink)

This paper discusses two approaches to climate ethics for practicalreflection and decision-making in concrete local climate changegovernance. After a brief review of the main conceptual frameworksin climate ethics research, we show that none of these leadingapproaches is sufficiently context specific and pluralistic to provideguidance appropriate for concrete local climate governance. Asalternatives, we present principlism as a methodology of midlevelprinciples and environmental pragmatism as an ethicalapproach. We argue that the two methodologies of principlismand pragmatism offer a new pluralistic framework that allows (...) realworldconditions and contexts to be properly integrated into ethicalanalysis and decision-making in climate governance. (shrink)

The adoption of web-based telecare services has raised multifarious ethical concerns, but a traditional principle-based approach provides limited insight into how these concerns might be addressed and what, if anything, makes them problematic. We take an alternative approach, diagnosing some of the main concerns as arising from a core phenomenon of shifting trust relations that come about when the physician plays a less central role in the delivery of care, and new actors and entities are introduced. Correspondingly, we propose an (...) applied ethics of trust based on the idea that patients should be provided with good reasons to trust telecare services, which we call sound trust. On the basis of this approach, we propose several concrete strategies for safeguarding sound trust in telecare. (shrink)

BackgroundUmbilical cord banks are a central component, as umbilical cord tissue providers, in both medical treatment and scientific research with stem cells. But, whereas the creation of umbilical cord banks is seen as successful practice, it is perceived as a risky style of play by others. This article examines and discusses the ethical, medical and legal considerations that arise from the operation of umbilical cord banks in Mexico.DiscussionA number of experts have stated that the use of umbilical cord goes beyond (...) the mere utilization of human tissues for the purpose of treatment. This tissue is also used in research studies: genetic studies, studies to evaluate the effectiveness of new antibiotics, studies to identify new proteins, etc. Meanwhile, others claim that the law and other norms for the functioning of cord banks are not consistent and are poorly defined. Some of these critics point out that the confidentiality of donor information is handled differently in different places. The fact that private cord banks offer their services as "biological insurance" in order to obtain informed consent by promising the parents that the tissue that will be stored insures the health of their child in the future raises the issue of whether the consent is freely given or given under coercion. Another consideration that must be made in relation to privately owned cord banks has to do with the ownership of the stored umbilical cord.SummaryConflicts between moral principles and economic interests (non-moral principles) cause dilemmas in the clinical practice of umbilical cord blood storage and use especially in privately owned banks. This article presents a reflection and some of the guidelines that must be followed by umbilical cord banks in order to deal with these conflicts. This reflection is based on the fundamental notions of ethics and public health and seeks to be a contribution towards the improvement of umbilical cord banks' performance. (shrink)

Moral distress is defined as the inability to act according to one’s own core values. During the COVID-19 pandemic, moral distress in medical personnel has gained attention, related to the impact of pandemic-associated factors, such as the uncertainty of treatment options for the virus and the accelerated pace of deaths. Measures to provide aid and mitigate the long-term pandemic effect on providers are starting to be designed. Yet, little has been said about the moral distress experienced by patients and the (...) relational and additive effect on provider moral distress. Pandemic-associated factors affecting moral distress in patients include the constraining effects of isolation on spiritual and religious traditions as well as the intentional separation of patients from their families. This paper will explore the idea that patients are suffering their own moral distress and further how this impacts the intensity of moral distress experienced by the providers—nurses and physicians. The paucity of research in this area with the implications on patient’s distress, decision making, and distress experienced by providers compels further investigation and analysis. (shrink)

For the past several years patients have been expected to play a key role in their recovery. Self management and disease management have reached a hype status. Considering these recent trends what does this mean for the division of responsibilities between doctors and patients? What kind of role should healthcare providers play? With findings based on a qualitative research project of an innovative practice for people with Chronic Obstructive Pulmonary Disease (COPD) we reflect on these questions. In-depth interviews conducted with (...) people with COPD, physiotherapists and a pulmonologist show that shifting responsibilities require a supportive attitude from healthcare providers and a dialogical communication between patients and professionals. Our findings show more is needed in order to motivate people with COPD to take responsibility and become co-owners in a process of recovery. The case example illustrates that people with COPD need support from fellow patients to learn to accept their disabilities. Awareness that COPD is more than just a lack of air, that mind and body interact, is a first step to investigate other potential problems and to enhance one’s quality of life. (shrink)

During the past few decades, the global food system has confronted new sustainability challenges related not only to public health and the environment but also to ethical concerns over the treatment of farmed animals. However, the traditional threedimensional framework of sustainable development is ill equipped to take ethical concerns related to non-human animals into account. For instance, the interests of farmed animals are often overridden by objectives associated with social, economic or environmental sustainability, despite their vast numbers and influence on (...) contemporary societies. Moreover, sustainability policies necessarily involve an element of ethical evaluation; yet this element is not explicitly incorporated in prevailing frameworks of sustainable development. Our purpose in this article is to address these shortcomings by developing a Sustainability Matrix that recognizes the need to consider food system sustainability from the perspective of all interest groups affected by the issue under consideration, from a plurality of ethical standpoints. Combing sustainability principles with the basic idea of an ethical evaluation tool, the proposed Sustainability Matrix evaluates the sustainability of food-related systems, decisions and policies from the perspectives of three major strands of ethical theory and from the perspectives of human beings, farmed animals and wildlife. In terms of policy implications, the Sustainability Matrix can be applied in deciding on the specific targets of food system sustainability that can then be utilized as a basis for designing policies and measures towards the achievement of these goals. (shrink)

In recent years, an old challenge to informed consent has been rediscovered: the challenge of ignorance. Several authors argue that due to the presence of irreducible ignorance in certain treatments, giving informed consent to these treatments is not possible. The present paper examines in what ways ignorance is believed to prevent informed consent and which treatments are affected by that. At this, it becomes clear that if the challenge of ignorance truly holds, it poses a major problem to informed consent. (...) The paper argues, however, that from both an empirical and a theoretical point of view, it is not convincing that ignorance prevents informed consent. Still, it seems important that the presence of irreducible ignorance is openly discussed during the informed consent process. (shrink)

Researchers sometimes engage in various forms of dishonesty and unethical behavior, which has led to regulatory efforts to ensure that they work according to acceptable standards. Such regulation is a difficult task, as research is a diverse and dynamic endeavor. Researchers can disagree about what counts as good and acceptable standards, and these standards are constantly developing. This paper presents and discusses recent changes in research integrity and ethics regulation in Norway, Denmark, and Sweden. Recognizing that research norms are developed (...) through practice and are therefore unsuited for comprehensive national regulation, the Scandinavian countries focus on empowering the research community to regulate itself instead, except for the most severe cases of misconduct. This empowerment takes the form of giving research institutions tools and investigatory powers while also holding them responsible for ensuring that both the institution and individual researchers are up to date on relevant norms. In this way, the Scandinavian governments seek to avoid some of the challenges found in more legalistic approaches, which risk lagging behind the continuous development of research norms and can be insensitive to the fact that different disciplines have different norms. While the new approach in Scandinavian has several potential benefits, it also involves potential trade-offs and limitations. The new laws can create confusion about what researchers are allowed to do. Another issue is that it only addresses the fundamental drivers of misconduct to a limited extent. (shrink)

The paper introduces a methodological proposal to teach bioethics relying on the lifelong education model called pedagogy of problematization. The general methodology and its main sources at the global and the Latin American level are presented. It describes the basic educative model, its goals and its differences with the Problem Based Learning model. The requirements necessary to implement this methodology in relation to a broad approach of bioethics including social, environmental and global bioethics and not only biomedical ethics are presented. (...) It is argued that this methodology represents a way of teaching bioethics from a broad perspective and targeting an interdisciplinary and diverse audience. Most important, the reflection-action model of education here proposed aims at a change of attitude in adult students and at transforming the reality into which the ethical problems emerge. After introducing this model, the paper, provides an account of the framework from which the Lifelong Learning Program in Bioethics in Latin America and the Caribbean has been developed, and how to use the tools necessary for making use of this methodology in a distance e-learning platform targeting adults. Finally, some of the main results of using this platform during its 10 years of existence are presented and it is showed that through this platform it has been possible involve almost 2000 participants from 26 countries in LAC. (shrink)

Cohen’s (2023) mapping exercise of possible bioethical issues emerging from the use of ChatGPT in medicine provides an informative, useful, and thought-provoking trigger for discussions of AI ethic...

Veterinary ethics is a coordination of ethical principles that apply morals, values and judgements to the practice of veterinary profession. Veterinary ethics cover its practical application in veterinary practices as well as on its history, philosophy, theology, and sociology. Veterinary ethics combine veterinary professional ethics and the focus of animal ethics. It can be inferred as a critical manifestation on the provision of veterinary services in hold of the profession’s responsibilities to animal kind and mankind. Many ethical issues arise in (...) a business unit in veterinary practice. Whenever such issues arise, it may lead to dilemmas, then proper and well-thought out ethical decision is to be made. Ethical decision making process in a business unit in veterinary practice is the use of ethical theories, principles, and rules by veterinary professionals and paraprofessionals in resolving ethical dilemmas in the veterinary practice. In order to resolve ethical dilemmas, being aware of and revelation to ethical theories is essential. Thoughtfulness of animal welfare and ethical issues is an essential component of a good ethical veterinary practice. This article reviews and discusses the ethics and major steps engaged in the ethical decision-making process in a business unit in veterinary practice. Strong commitment to the role, organization’s commitment to ethics and staff support could lower the levels of moral stress while facing ethical dilemma in a veterinary practice. Though using the ethical frameworks portrayed may not change the actual decisions finally reached by veterinary professionals, a good knowledge of ethical issues is imperative for client communication, better job satisfaction and preserving a positive public outline for both the individual and the veterinary practice. (shrink)

The United States and Canada regulate frearms, particularly handguns, quite differently. With only a few state and local exceptions, the U.S. approach emphasizes the ability of most individuals to purchase, possess, and carry handguns. By comparison, Canada has a form of restrictive licensing for handguns that places a premium on community safety. The authors first review the potential individual and community level harms and benefits associated with these differing fre-arm policies. Using this information, they explore the ethical dimensions of the (...) U.S. and Canadian approaches through three major themes of autonomy, prevention of harms, and social justice. The authors conclude that the Canadian approach is consistent with respect for the autonomy of persons, fosters the prevention of harms, and more appropriately furthers social justice. (shrink)

The Stoics considered that in order to die well, one must previously have lived and not merely existed, an assertion which will not be contested in this paper. The question raised here is whether an individual whose life expectancy is jeopardized by serious illness or whose life has not been lived to the ‘full’ for whatever reason should have to abandon all hope or, alternately, whether that life could still somehow be saved. One clear obstacle to achieving this stems from (...) moral character, given that moral character is an element which conditions an individual’s moral behaviour, as pointed out by Beauchamp and Childress and particularly Pellegrino and Thomasma. The transformation of moral character requires time and effort but the testimonies of patients who have given their lives a radical new direction upon being diagnosed with a serious illness seem to show the existence of a peculiar phenomenon of moral catharsis. In this paper we attempt to illustrate that this alleged phenomenon is not the result of a kind of cataleptic impression but rather the result of a dialectic and narrative process, during which a first hope of healing is dashed, unveiling a new sense in the illness. Its fulfillment provides the patient with a final hope. (shrink)

Control measures directed at carriers of multidrug-resistant organisms are traditionally approached as a trade-off between public interests on the one hand and individual autonomy on the other. We propose to reframe the ethical issue and consider control measures directed at carriers an issue of solidarity. Rather than asking “whether it is justified to impose strict measures”, we propose asking “how to best care for a person’s carriership and well-being in ways that do not imply an unacceptable risk for others?”. A (...) solidarity approach could include elevating baseline levels of precaution measures and accepting certain risks in cases where there is exceptionally much at stake. A generous national compensation policy that also covers for costs related to dedicated care is essential in a solidarity approach. An additional benefit of reframing the questions is that it helps to better acknowledge that being subjected to control measures is a highly personal matter. (shrink)

Can the theory of conceptual spaces developed by Peter Gärdenfors and others be applied to moral issues? Martin Peterson argues that several moral principles can be construed as regions in a shared similarity space, but Kristin Shrader-Frechette and Gert-Jan Lokhorst question Peterson’s claim. They argue that the moral similarity judgments used to construct the space are underspecified and subjective. In this paper, we present new data indicating that moral principles can indeed be construed as regions in a multidimensional conceptual space (...) on the basis of moral similarity judgments. Four hundred and seventy-five students taking a course in engineering ethics completed a survey in which they were presented with ten cases featuring ethical issues related to technology and engineering. Participants were asked to judge the moral similarity of each pair of cases and to select which moral principle they believed should be applied for resolving the case. We used interval multidimensional scaling as well as individual differences scaling for analyzing the moral similarity judgments. Despite noteworthy individual variations in the judgments, the five moral principles included in the study were discernable in the aggregate multidimensional spaces, even for participants with no previous exposure to the principles. Participants tended to apply the same moral principles to cases rated as morally similar. Our overall conclusion is that moral similarity judgments, and their representation in multidimensional spaces, can help us identify moral principles that are relevant for assessing difficult moral choice situations. (shrink)

The title of the article in the initial online publication was mixed up with copy editing information. The original article has been corrected.

The article investigates the validity of two different versions of the slippery slope argument construed in relation to human gene therapy: the empirical and the conceptual argument. The empirical version holds that our accepting somatic cell therapy will eventually cause our accepting eugenic medical goals. The conceptual version holds that we are logically committed to accepting such goals once we have accepted somatic cell therapy. It is argued that neither the empirical nor the conceptual version of the argument can provide (...) a conclusive moral reason for banning somatic cell therapy. According to a third interpretation, referred to as the arbitrary result argument, the many apparent similarities between somatic cell therapy and eugenic-based human genetic engineering drive us to make principled choices concerning what differences and similarities between the two practices should be regarded as morally (ir)relevant. Decisions of this kind are likely to have unpredictable moral consequences. Thus formulated, the slippery slope argument has much plausibility. One objects to somatic cell therapy not so much because of what is at the bottom of the slope on which it lies, but because it is on a slope of which one does not know what is at the bottom. While the arbitrary result argument does not provide a conclusive reason for prohibiting human gene therapy, it reminds of a very important thing: when making bioethical decisions, we should be as specific and as consistent as possible about our basic moral and medical concepts. (shrink)

Informed consent bears significant relevance as a legal basis for the processing of personal data and health data in the current privacy, data protection and confidentiality legislations. The consent requirements find their basis in an ideal of personal autonomy. Yet, with the recent advent of the global pandemic and the increased use of eHealth applications in its wake, a more differentiated perspective with regards to this normative approach might soon gain momentum. This paper discusses the compatibility of a moral duty (...) to share data for the sake of the improvement of healthcare, research, and public health with autonomy in the field of data protection, privacy and medical confidentiality. It explores several ethical-theoretical justifications for a duty of data sharing, and then reflects on how existing privacy, data protection, and confidentiality legislations could obstruct such a duty. Consent, as currently defined in the General Data Protection Regulation – a key legislative framework providing rules on the processing of personal data and data concerning health – and in the recommendation of the Council of Europe on the protection of health-related data – explored here as soft-law – turns out not to be indispensable from various ethical perspectives, while the requirement of consent in the General Data Protection Regulation and the recommendation nonetheless curtails the full potential of a duty to share medical data. Also other legal grounds as possible alternatives for consent seem to constitute an impediment. (shrink)

This paper introduces the model of Utilitarian Principlism as a framework for crisis healthcare ethics. In modern Western medicine, during non-crisis times, principlism provides the four guiding principles in biomedical ethics—autonomy, nonmaleficence, beneficence, and justice; autonomy typically emerges as the decisive principle. The physician–patient relationship is a deontological construct in which the physician’s primary duty is to the individual patient and the individual patient is paramount. For this reason, we term the non-crisis ethical framework that guides modern medicine Deontological Principlism. (...) During times of crisis, resources become scarce, standards of care become dynamic, and public health ethics move to the forefront. Healthcare providers are forced to work in non-ideal conditions, and interactions with individual patients must be considered in the context of the crisis. The COVID-19 pandemic has forced healthcare to shift to a more utilitarian framework with a greater focus on promoting the health of communities and populations. This paper puts forth the notion of Utilitarian Principlism as a framework for crisis healthcare ethics. We discuss each of the four principles from a utilitarian perspective and use clinical vignettes, based on real cases from the COVID-19 pandemic, for illustrative purposes. We explore how Deontological Principlism and Utilitarian Principlism are two ends of a spectrum, and the implications to healthcare as we emerge from the pandemic. (shrink)

In celebration of the fortieth anniversary of the publication of Beauchamp and Childress’s Principles of Biomedical Ethics, a review is undertaken to compare the lists of principles in various bioethical theories to determine the extent to which the various lists can be reconciled. Included are the single principle theories of utilitarianism, libertarianism, Hippocratism, and the theories of Pellegrino, Engelhardt, The Belmont Report, Beauchamp and Childress, Ross, Veatch, and Gert. We find theories all offering lists of principles numbering from one to (...) ten. Many of the differences can be reconciled, but some critical differences remain. (shrink)

The origins of professional ethical codes and oaths are explored. Their legitimacy and usefulness within the profession are questioned and an alternative ethical source is suggested. This source relies on a commonly shared, naturally knowable set of principles known as common morality.

Although rapid genomic sequencing (RGS) is improving care for critically ill children with rare disease, it also raises important ethical questions that need to be explored as its use becomes more widespread. Two such questions relate to the degree of consent that should be required for RGS to proceed and whether it might ever be appropriate to override parents’ decisions not to allow RGS to be performed in their critically ill child. To explore these questions, we first examine the legal (...) frameworks on securing consent for genomic sequencing and how they apply to the specific context of RGS for critically ill children. We then use a tool from clinical ethics, the Zone of Parental Discretion, to explore two case studies and identify under which circumstances it might be appropriate for parental refusal of RGS to be overridden. We argue that RGS may be a context where, in addition to assessing the complexity of the test offered, it is ethically appropriate to consider an effect on patient outcomes when deciding the degree of consent required. We also suggest that there are some contexts where it may be ethically justified to perform RGS, even when it is actively against the wishes of the parents. More work is needed to examine exactly how ‘time-sensitive’ exceptions to current guidance on consent for genomic sequencing could be formulated and operationalised for RGS for critically ill-children. (shrink)

The goal of this paper is two-fold. First, I begin by reviewing several of themajor points of emphasis among health educatorsas they begin to incorporate multiculturalissues into healthcare education. I thenconsider the role of moral relativism, which iscurrently being endorsed by some healtheducators, as the foundation for resolvingcross-cultural conflicts in healthcare. Iargue that moral relativism is ultimatelyinconsistent with the stated goals inmulticultural curricular proposals and fails toprovide an effective framework for consideringmoral conflicts in cross-cultural settings. Instead, I propose that those (...) methods seekingto establish a common morality, built uponmutually shared values, offer the mostpromising means of resolving cross-culturalconflicts. This leads to my second goal, tocompare recent work in moral pragmatism withwhat is now widely known in bioethics as moral``principlism.'' I argue that while proponentsof principlism and pragmatism each seek toestablish a common foundation for moraldeliberation, they fail to appreciatesignificant similarities between theirrespective approaches. Instead of offeringtwo completely unique and independent methodsof moral deliberation, I suggest thatprinciplism and pragmatism embrace commonthemes that point us in a positive direction,providing an effective framework useful forconsidering cross-cultural conflicts inhealthcare. (shrink)

It has been proposed that reoffending could be reduced by manipulating the neural underpinnings of offenders’ criminogenic mental features with what have been called neurocorrectives. The legitimacy of such use of neurotechnology – criminal neurorehabilitation, as the use is called – is usually seen to presuppose valid consent by the offenders subjected to it. According to a central criticism of nonconsensual criminal neurorehabilitation, nonconsensual use of neurocorrectives would express a degrading attitude towards offenders. In this article, I consider this criticism (...) of nonconsensual criminal neurorehabilitation. By using cases of autonomous persons who lead a subservient existence as an example, I propose that nonconsensual criminal neurorehabilitation need not express a more degrading attitude towards offenders than consensual criminal neurorehabilitation. The argument of this article does not show that nonconsensual criminal neurorehabilitation is morally or legally acceptable. Yet, in view of the argument, criticizing nonconsensual criminal neurorehabilitation for expressing a degrading attitude towards offenders is not compatible with simultaneously endorsing consensual criminal neurorehabilitation. (shrink)

This articles assesses the arguments that bioethicists have presented for the view that patient’ autonomy has value over and beyond its instrumental value in promoting the patients’ wellbeing. It argues that this view should be rejected and concludes that patients’ autonomy should be taken to have only instrumental value in medicine.

This paper aims to clarify the nature of understanding in medicine. The first part describes in more detail what it means to understand something and links a type of understanding (i.e., objectual understanding) to explanations. The second part proceeds to investigate what objectual understanding of a disease (i.e., biomedical understanding) requires by considering the case of scurvy from the history of medicine. The main hypothesis is that grasping a mechanistic explanation of a condition is necessary for a biomedical understanding of (...) that condition. The third part of the paper argues that biomedical understanding is necessary, but not sufficient for understanding in a clinical context (i.e., clinical understanding). The hypothesis is that clinical understanding combines biomedical understanding of a _disease_ or pathological condition with understanding _illness,_ which involves some degree of personal understanding of the patient. It is argued that, in many cases, clinical understanding necessitates adopting a particular second-personal stance and using cognitive resources _in addition_ to those involved in biomedical understanding. (shrink)

The concept of dignity figures prominently in legal and moral discussion on such topics as human rights, euthanasia, abortion, and criminal punishment. Yet the notion has been criticized for being indeterminate and either insufficient or redundant (or both) in justifying the kinds of legal and moral rights and views its proponents use it to vindicate. The criticisms have inspired some novel conceptions of dignity. One of them is Tarunabh Khaitan’s proposal that dignity should be understood as an expressive norm. In (...) this article, I assess Khaitan’s suggestion. I maintain that it faces two challenges that its advocates should be able to solve for the proposal to be plausible. (shrink)

An adaptation of Pascal’s Wager argument has been considered useful in deciding about the provision of life-sustaining treatment for patients in persistent vegetative state. In this article, I assess whether people making such decisions should resort to the application of Pascal’s idea. I argue that there is no sufficient reason to give it an important role in making the decisions.

It is commonly accepted that voluntary active euthanasia and physician-assisted suicide can be allowed, if at all, only in the cases of patients whose conditions are incurable. Yet, there are different understandings of when a patient’s condition is incurable. In this article, I consider two understandings of the notion of an incurable condition that can be found in the recent debate on physician-assisted dying. According to one of them, a condition is incurable when it is known that there is no (...) cure for it. According to the other, a condition is incurable when no cure is known to exist for it. I propose two criteria for assessing the conceptions and maintain that, in light of the criteria, the latter is more plausible than the former. (shrink)

In this essay, I argue that at least in two phases of pharmaceutical research, especially while assessing the adequacy of the accumulated data and its interpretation, the influence of non-epistemic values is necessary. I examine a specific case from the domain of pharmaceutical research and demonstrate that there are multiple competing sets of values which may legitimately or illegitimately influence different phases of the inquiry. In such cases, the choice of the appropriate set of values—epistemic as well as non-epistemic—should be (...) made on the basis of the set’s viability to promote specific epistemic and social aims of the research, in the case at hand, rather than other competing aims. I put forth an account which addresses two philosophically significant and interrelated questions in the context of values in science debates: which aim should be prioritized when there are different stakeholders who try to achieve competing but, sometimes, conflicting goals; and what should be the criteria according to which the prioritization of a particular goal over other competing goals can be determined? I argue that both these questions can be addressed by invoking the principle of non-arbitrariness and the mere means principle and self-determination right. The philosophical import of raising and addressing these questions from an ethical perspective is that this approach leads to a better understanding of problems in today’s pharmaceutical research and guides us in efforts to alleviate these problems. (shrink)

It has been suggested that neuroenhancements could be used to improve the abilities of criminal justice authorities. Judges could be made more able to make adequately informed and unbiased decisions, for example. Yet, while such a prospect appears appealing, the views of neuroenhanced criminal justice authorities could also be alien to the unenhanced public. This could compromise the legitimacy and functioning of the criminal justice system. In this article, I assess possible solutions to this problem. I maintain that none of (...) them qualifies as a satisfactory general solution to it, a solution that could reasonably be taken to solve the problem or to suffice for dealing with it in at least most cases. Yet I also suggest that, depending on contingent empirical circumstances, the responses – either singly or together – can sometimes amount to a sufficient answer to it. (shrink)

It has been suggested that neuroenhancements could be used to improve the abilities of criminal justice authorities. Judges could be made more able to make adequately informed and unbiased decisions, for example. Yet, while such a prospect appears appealing, the views of neuroenhanced criminal justice authorities could also be alien to the unenhanced public. This could compromise the legitimacy and functioning of the criminal justice system. In this article, I assess possible solutions to this problem. I maintain that none of (...) them qualifies as a satisfactory general solution to it, a solution that could reasonably be taken to solve the problem or to suffice for dealing with it in at least most cases. Yet I also suggest that, depending on contingent empirical circumstances, the responses – either singly or together – can sometimes amount to a sufficient answer to it. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated (...) to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)