The American journal of bioethics : AJOB最新文献

{"title":"Against Whitecoat Washing: The Need for Formal Human Rights Assessment in International Collaborations.","authors":"Jacob M Appel","doi":"10.1080/15265161.2022.2116911","DOIUrl":"https://doi.org/10.1080/15265161.2022.2116911","url":null,"abstract":"","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"1-4"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral Wrongs, Epistemic Wrongs, and the FDA.","authors":"Jack Harris","doi":"10.1080/15265161.2022.2110967","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110967","url":null,"abstract":"tial and daunting task in defining the roles of the FDA in the setting of e-cigarette regulation. However, defining these roles while glossing over critical corporate, political, and industry-related forces within which these roles were and are enacted establishes a weak foundation for both understanding and action. The FDA’s relationship with the e-cigarette industry is one that carries the burden of its past, and the obscurity surrounding this allows for a general skepticism that can erode institutional trust. In a social context where federal health agencies risk permanently losing their identity as unbiased public servants, transparency must be appropriately prioritized.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"34-37"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Against Over-Protectionism: Riskier Decisions Require Clearer Evidence of Capacity But Don't Call for Stricter Criteria.","authors":"Manuel Trachsel, Paul S Appelbaum","doi":"10.1080/15265161.2022.2110990","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110990","url":null,"abstract":"assessments that are described or defined in one way but are, in fact, another thing all together. In summary, given the authors’ definitions of the relevant central terms, harm and risk are logically excluded as proper objects of Capacity assessments and so judgments of Competence and Incompetence. If harm is indeed treated as a direct object of Capacity assessments—that is, not merely as indicative or evidentiary—then such assessments do not reflect the accepted meanings of the terms Capacity, Competence, and Incompetence. The dangers of such incompatibility are not restricted to mere conceptual equivocation, but also undermine the important ethical values of transparency and informed consent.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"53-55"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the Relationship between Competence and Welfare.","authors":"Daniel Fogal, Ben Schwan","doi":"10.1080/15265161.2022.2110987","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110987","url":null,"abstract":"Pickering, Newton-Howes, and Young (2022) argue for externalism about competence—the view that “welfare judgments are part of judgments about competence” and posit an “explanatory connection” between “decision-making processes and harmful choices” (38, 44). Here, we first attempt to clarify the target of analysis. We then argue that Pickering et al.’s proposal faces a dilemma: either it fails to vindicate externalism, or it collapses into a competing account that they are inclined to reject. For present purposes, we’ll follow Pickering et al. in distinguishing capacity from competence, where capacity is gradable and refers to the extent of a patient’s decision-making abilities (to understand, reason, etc.), while competence is binary and refers to whether a patient possesses sufficient capacity “for them to be able to make a decision” (39). This latter phrase, however, should not be interpreted literally. While there are patients who literally cannot make a decision (e.g. the unconscious), many incompetent patients retain the basic ability to make decisions—i.e. to form and express intentions or preferences concerning their care. The level of abilities required to make a decision is (at least in most cases) significantly lower than that required to make a competent decision. Thus, “to be able to make a decision” should be understood normatively: as roughly equivalent to saying a patient “should be allowed to make a decision.” Competence is thus a matter of having sufficient capacity to count as appropriately having authority over the choice at hand, and hence for one’s decision to determine which option should prevail. Pickering et al. are concerned with the longstanding debate between “internalist” and “externalist” approaches to competence. In a recent systematic review, Berens and Kim (2022, 7) characterize the difference as follows:","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"73-75"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Value of Value in Decision-Making Competence Assessments.","authors":"Isaac Atley","doi":"10.1080/15265161.2022.2110984","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110984","url":null,"abstract":"102893. Department of Health and Social Care. 2021. New TV advert urges public to stay at home to protect the NHS and save lives. Press release dated January 10, 2021. Available from: https://www.gov.uk/government/news/ new-tv-advert-urges-public-to-stay-at-home-to-protectthe-nhs-and-save-lives Heart of England NHS Foundation Trust v JB. 2014. EWHC 342 (COP). Kings College NHS Foundation Trust v C and V. 2015. EWCOP 80. Marsh, P., and L. Kelly. 2018. Dignity of risk in the community: A review of and reflections on the literature. Health, Risk & Society 20 (5–6):297–311. doi:10.1080/ 13698575.2018.1519115. Parsons, J. A., 2021. Death or dialysis: The value of burdensome life extending treatments for the cognitively impaired. In Defining the value of medical interventions: Normative and empirical challenges, ed. J. Schildmann, C. Buch, and J. Zerth, 157–74. Stuttgart: Kohlhammer. Parsons, J. A., D. M. Taylor, F. J. Caskey, and J. Ives. 2021. Ethical duties of nephrologists: When patients are nonadherent to treatment. Seminars in Nephrology 41 (3): 262–71. doi:10.1016/j.semnephrol.2021.05.007. Parsons, J. A., and H. K. Johal. 2020. Best interests versus resource allocation: Could COVID-19 cloud decision-making for the cognitively impaired? Journal of Medical Ethics 46 (7): 447–50. doi:10.1136/medethics-2020-106323. Pickering, N., G. Newton-Howes, and G. Young. 2022. Harmful choices, the case of C, and decision-making competence. The American Journal of Bioethics 22 (10): 38–50. doi:10.1080/15265161.2021.1941422.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"81-83"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nature of Harm: A Wine-Dark Sea.","authors":"Eli G Schantz, Mark D Fox","doi":"10.1080/15265161.2022.2110981","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110981","url":null,"abstract":"In “Harmful Choices, the Case of C, and DecisionMaking Competence,” Pickering and colleagues advance an argument in favor of externalism, a view in which the competence of a decision maker is judged relative to factors external to their cognition (Pickering, Newton-Howes, and Young 2022). In advancing this argument, Pickering and colleagues focus on the external factor of harm: In their view, it is the harmfulness of a considered or chosen action that provides evidence against the competence of the decision maker. However, the proper identification of harmful choices and outcomes remains a demanding task, largely because our understanding of what harm is remains deeply incomplete. Despite 50 years of tempestuous debate, the metaphysics of harm remains an unsettled question. The existence of such a debate does not, in and of itself, provide evidence against the externalist position; rather, it is the theories of harm themselves that pose meaningful challenges for the externalist. Our purpose, here, is to illuminate these challenges. The canonical theories of harm can be divided into two opposing schools of thought: Comparitivism, in which facts about harm involve comparisons to past or potential states, and non-Comparitivism, in which facts about harm do not involve such comparisons. We begin by surveying these schools in turn, using the case of C to illustrate their judgments. The classical Comparitivist position, advanced by Joel Feinberg, centers on comparisons to counterfactuals: In Feinberg’s theory, one is harmed when one is made to be worse off than one otherwise would have been (Feinberg 1986). In the case of C, then, it is arguable that, following her refusal of dialysis, the worsening of C’s well-being constitutes a harm. A similar sort of analysis is offered by another Comparitivist position, advanced in Thomson (2011), which includes the consideration of prevention: by Thomson’s theory, C’s decision would constitute a harm to her insofar as it prevents her from being in a better state. The non-Comparitivist school, in contrast, rejects the relevance of such comparisons to determinations of harm. The classical non-Comparitivist view, advanced by Seana Shiffrin, holds that harm involves incongruency between one’s present state and what one wills (Shiffrin 1999). If you were to accidentally fall and break your arm, for example, Shiffrin’s theory holds that you are harmed insofar as you enter into a state that is incongruent with your will: You did not will to have your arm broken, and likely did will to do things that you now cannot. In the case of C, however, it was never in question that C willed to refuse dialysis and embrace the consequences thereof. She told the court that “they [the doctors] are doing their best ... and unfortunately that is not what I want,” and one of her family members told the court that C’s decision was “not only fully thought through, but also entirely in keeping with her value system and her personality” (Pic","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"63-65"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respecting Autonomy and Balancing Benefits by Disclosing the Secondary Finding of Klinefelter's.","authors":"Skye Adell Miner, D Micah Hester","doi":"10.1080/15265161.2022.2110974","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110974","url":null,"abstract":"","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"89-91"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clarifying the Blurry Boundaries between Research and Clinical Care.","authors":"Forough Noohi, Lainie F Ross","doi":"10.1080/15265161.2022.2110977","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110977","url":null,"abstract":"","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"96-98"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"E-Cigarette Use and Regulation: A Comparative Analysis between the United States, the UK, and China.","authors":"Hui Zhang, Yuming Wang, Lijun Shen, Yue Gu, Fengmin Shao","doi":"10.1080/15265161.2022.2110971","DOIUrl":"https://doi.org/10.1080/15265161.2022.2110971","url":null,"abstract":"Svirsky, Howard, and Berman (2022) have enumerated a variety of U.S. FDA (Food and Drug Administration) roles, arguing that although the public possess a “right to information” about health risks, the FDA should be hesitant about endorsing e-cigarette use given scientific uncertainty. In the authors’ view, as a knowledge purveyor, the FDA has a responsibility to inform the public about the harms and benefits of e-cigarettes; however, its roles as information producer, advisor, and market agent require that FDA be cautious in the way it interprets and communicates available evidence. Compared with disseminating information regarding the health risks and benefits of e-cigarettes, the FDA can make its most important contribution to public health by reducing combustible tobacco use, making such products less appealing while simultaneously making e-cigarette products safer. In this commentary, we aim to supplement the authors’ opinion by comparing the trends in e-cigarette use and governmental regulation in the U.S., the UK, and China. We selected these three typical countries because the U.S. is the world’s biggest vaping market (Knowledge Action Change 2020), China has the world’s largest smoking population (China Briefing 2022), and no country in the world other than the UK has announced support for medicinal licensing of e-cigarettes (Hopkinson et al. 2022). Although the e-cigarette was first invented by H. A. Gilbert in 1963, the subsequent commercially viable design was patented in 2003 by Chinese pharmacist, Hon Lik, who brought it to the Chinese domestic market the next year. Subsequently, e-cigarettes entered the U.S. and European markets in 2006 and 2007, respectively (Gupta et al. 2020). Governments generally categorize e-cigarettes as tobacco, imitation tobacco, medicinal, pharmaceutical, or consumer products, poisons, or electronic nicotine delivery systems (ENDS), and how e-cigarettes are defined affects its policies and regulations. Currently, there is no global standard for e-cigarette regulation, which varies from one country or region to another (Bianco et al. 2021). Thus far, different approaches to regulating e-cigarettes have been adopted internationally. First, we analyze the regulation of e-cigarettes in the U.S., the UK, and China. In mainland China, since e-cigarettes first emerged in 2004, their regulations have gone from relaxed to strict. Back then, with little international regulatory experience, the classification of e-cigarettes had not yet been determined. E-cigarette companies marketed their products as a safer alternative to tobacco and as a tool to facilitate quitting smoking. Since there is little evidence of health effects, government agencies started to pay attention to the regulation of e-cigarettes and gradually tightened it (Xu et al. 2016). In August 2018, the State Administration for Market Regulation (SAMR) and the State Tobacco Monopoly Administration (STMA) released a notice banning the sale of e-cigarette","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"29-31"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Against Externalism in Capacity Assessment-Why Apparently Harmful Treatment Refusals Should Not Be Decisive for Finding Patients Incompetent.","authors":"Brian D Earp, Joanna Demaree-Cotton, Julian Savulescu","doi":"10.1080/15265161.2022.2112462","DOIUrl":"https://doi.org/10.1080/15265161.2022.2112462","url":null,"abstract":"This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute, which is funded, in part, by UL1TR002529 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support was provided by the Gail & Joseph Mancini Research Fellowship.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"65-70"},"PeriodicalIF":13.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}