Journal of Medical Ethics最新文献

Revisiting medical oaths: how student-driven ethical codes reflect changing values.

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-18 DOI: 10.1136/jme-2024-110460

Michael Stein, Shaun Evan Gruenbaum, Alan Jotkowitz

{"title":"Revisiting medical oaths: how student-driven ethical codes reflect changing values.","authors":"Michael Stein, Shaun Evan Gruenbaum, Alan Jotkowitz","doi":"10.1136/jme-2024-110460","DOIUrl":"https://doi.org/10.1136/jme-2024-110460","url":null,"abstract":"Background: Medical oaths and ethical codes play a crucial role in guiding physicians through their professional responsibilities. This study extends prior research on ethical codes created by students at the Medical School for International Health (MSIH) by analysing codes from the years 2007 to 2022.Objective: The objective of this study is to evaluate changes in the ethical principles emphasised by MSIH students over time and to compare these with previous cohorts.Methods: Ethical codes from MSIH classes (2007-2022) were analysed using the framework developed by Baker. This framework categorises oaths into four sections: preamble, covenant, code of duties to patients and peroration. The focus was primarily on the code of duties to patients. Quantitative analysis was used to assess the prevalence of specific ethical principles.Results: The study found an increased emphasis on principles such as 'respect for patients' and 'cultural competence/sensitivity', while traditional values like 'benevolence' and 'honesty' were mentioned less frequently. New themes, including 'patient autonomy' and 'cultural competence', emerged, reflecting a shift towards patient-centred care and justice, though emerging issues like artificial intelligence ethics were not addressed.Conclusions: MSIH students' ethical codes have evolved to emphasise patient respect and cultural competence. The findings suggest a maturation in the ethical perspectives of medical students, though gaps remain in addressing contemporary challenges. Future studies should explore how ethical codes can incorporate emerging issues in healthcare.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

When understanding fails: how diverging norms in medicine and research led to informed consent failures during the pandemic.

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-18 DOI: 10.1136/jme-2024-110440

Daniel Pinto

{"title":"When understanding fails: how diverging norms in medicine and research led to informed consent failures during the pandemic.","authors":"Daniel Pinto","doi":"10.1136/jme-2024-110440","DOIUrl":"https://doi.org/10.1136/jme-2024-110440","url":null,"abstract":"During the COVID-19 pandemic, there were many vaccine trials which had significant purposes which participants needed to understand to validly consent. For example, participants needed to understand that the purpose of dose-escalation vaccine trials was to give incremental doses of a vaccine until participants became ill. Likewise, participants needed to understand that even if they received placebos, they could not take a genuine vaccine to preserve the integrity of the trials. Yet, these intuitive judgements about what participants need to understand to validly consent are rejected by recent accounts of consent. According to these accounts, as long as participants were given a good opportunity to learn these purposes, they do not need to actually understand them to consent. In this paper, I reject this consensus, and I argue that participants who failed to understand these aims associated with vaccine trials failed to provide legitimate consent. I defend this claim by developing and defending a new understanding condition for valid consent. According to this understanding condition, a participant must understand when a consent transaction has features which violate the norms which govern the medical practice with which they are acquainted. I argue that this condition is independently plausible and best explains why participants needed to understand these aims associated with vaccine trials to validly consent.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Navigating the consent river: questions to consider before waiving consent requirements in pragmatic cluster randomised trials.

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-18 DOI: 10.1136/jme-2024-110392

Cory E Goldstein, Monica Taljaard, Stephanie N Dixon, Charles Weijer

{"title":"Navigating the consent river: questions to consider before waiving consent requirements in pragmatic cluster randomised trials.","authors":"Cory E Goldstein, Monica Taljaard, Stephanie N Dixon, Charles Weijer","doi":"10.1136/jme-2024-110392","DOIUrl":"https://doi.org/10.1136/jme-2024-110392","url":null,"abstract":"The robust design and conduct of pragmatic cluster randomised trials may be in tension with the ethical requirement to obtain written informed consent from prospective research participants. In our experience, researchers tend to focus on whether a waiver of consent is appropriate for their studies. However, pragmatic cluster randomised trials raise other important questions that have direct implications for determining when an alteration or waiver of consent is permissible. To assist those involved in the design, conduct and review of pragmatic cluster randomised trials, we outline four critical questions to consider: (1) What is the nature of the intervention being evaluated? (2) Is the choice to use cluster randomisation justified? (3) Can the risk of recruitment bias be addressed? and (4) Is an alteration or waiver of consent appropriately justified? We recommend that researchers and research ethics committees conduct a stepwise analysis of a planned cluster randomised trial using these questions. To illustrate the application of this stepwise analysis, we use three pragmatic cluster randomised trials in the haemodialysis setting as case studies.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Polygenic risk scores and embryonic screening: considerations for regulation. 多基因风险评分和胚胎筛选：监管考虑因素。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-16 DOI: 10.1136/jme-2024-110145

Casey M Haining, Julian Savulescu, Louise Keogh, G Owen Schaefer

引用次数: 0

Assessing the impact of information on patient attitudes toward artificial intelligence-based clinical decision support (AI/CDS): a pilot web-based SMART vignette study.

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-12 DOI: 10.1136/jme-2024-110080

Bohye Kim, Katie Ryan, Jane Paik Kim

{"title":"Assessing the impact of information on patient attitudes toward artificial intelligence-based clinical decision support (AI/CDS): a pilot web-based SMART vignette study.","authors":"Bohye Kim, Katie Ryan, Jane Paik Kim","doi":"10.1136/jme-2024-110080","DOIUrl":"https://doi.org/10.1136/jme-2024-110080","url":null,"abstract":"Background: It is increasingly recognised that the success of artificial intelligence-based clinical decision support (AI/CDS) tools will depend on physician and patient trust, but factors impacting patients' views on clinical care reliant on AI have been less explored.Objective: This pilot study explores whether, and in what contexts, detail of explanation provided about AI/CDS tools impacts patients' attitudes toward the tools and their clinical care.Methods: We designed a Sequential Multiple Assignment Randomized Trial vignette web-based survey. Participants recruited through Amazon Mechanical Turk were presented with hypothetical vignettes describing health concerns and were sequentially randomised along three factors: (1) the level of detail of explanation regarding an AI/CDS tool; (2) the AI/CDS result; and (3) the physician's level of agreement with the AI/CDS result. We compared mean ratings of comfort and confidence by the level of detail of explanation using t-tests. Regression models were fit to confirm conditional effects of detail of explanation.Results: The detail of explanation provided regarding the AI/CDS tools was positively related to respondents' comfort and confidence in the usage of the tools and their perception of the physician's final decision. The effects of detail of explanation on their perception of the physician's final decision were different given the AI/CDS result and the physician's agreement or disagreement with the result.Conclusions: More information provided by physicians regarding the use of AI/CDS tools may improve patient attitudes toward healthcare involving AI/CDS tools in general and in certain contexts of the AI/CDS result and physician agreement.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Moral parenthood and gestation: replies to Cordeiro, Murphy, Robinson and Baron.

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-09 DOI: 10.1136/jme-2024-110605

Benjamin Lange

引用次数: 0

Ethical reflection of Chinese scientists on the dual-use concerns of emerging medical biotechnology.

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-06 DOI: 10.1136/jme-2024-110404

Xiaonan Wang, Mingtao Huang, Hui Shao, Kun Li, Xiaomei Zhai

{"title":"Ethical reflection of Chinese scientists on the dual-use concerns of emerging medical biotechnology.","authors":"Xiaonan Wang, Mingtao Huang, Hui Shao, Kun Li, Xiaomei Zhai","doi":"10.1136/jme-2024-110404","DOIUrl":"https://doi.org/10.1136/jme-2024-110404","url":null,"abstract":"Emerging medical biotechnology typically exhibits a 'dual-use' nature, which, while promoting human well-being, concurrently presents potential risks of misuse or abuse, thereby posing significant threats. Globally, including in China, emerging medical biotechnology is developing rapidly. To understand the views and perspectives of Chinese scientists on dual-use concerns, this empirical study conducted semistructured qualitative interviews with researchers (n=14) from various specialties within the Chinese medical field, analysing their perspectives and ethical considerations regarding dual-use concerns. The findings of this study reveal a spectrum of attitudes among interviewees towards the exploration and application of emerging medical biotechnology, ranging from aggressive to conservative. This tension reflects the complexity and challenges of seeking a balance between promoting scientific innovation and maintaining ethical boundaries. Furthermore, while there is a consensus among scientists that the development and application of biotechnology encompass both risks and benefits, their stances on weighing these factors differ, reflecting how risk perception is influenced by professional limitations. Moreover, although scientists recognise the indispensability of both self-regulation and external oversight in practice, they also exhibit misunderstandings in ethical cognition and misinterpretations of regulatory measures. In light of these findings, it is imperative for us to urgently fortify national regulatory mechanisms and the construction of legal and ethical frameworks while also enhancing the ethical awareness and risk assessment capabilities of researchers. These measures are crucial for minimising the potential risks associated with dual use and fostering the sustainable and responsible development of emerging medical biotechnology.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ecological preferences and patient autonomy.

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-05 DOI: 10.1136/jme-2024-110432

Sabine Salloch

{"title":"Ecological preferences and patient autonomy.","authors":"Sabine Salloch","doi":"10.1136/jme-2024-110432","DOIUrl":"https://doi.org/10.1136/jme-2024-110432","url":null,"abstract":"Healthcare systems contribute considerably to worldwide carbon emissions and therefore reinforce the negative health impacts of climate change. Significant attempts to reduce emissions have been made on the macro level of politics and on the institutional level. Less attention has been paid so far to decisions that take place at the micro level of immediate doctor-patient contact. Current bioethical debates discuss potential tensions between 'Green Healthcare' and an orientation towards ethical principles such as promoting patient welfare or respect for patient autonomy. The article addresses this debate from a different angle starting from the premise that at least some patients might have a preference to reduce carbon outputs that are often deeply rooted in their personal value system. Taking different accounts of patient autonomy as a starting point, the article analyses whether such preferences must be respected as being part of patient autonomy. The analysis comes to a positive conclusion but highlights that certain factors such as misinterpretation, lack of understanding or pressure must be carefully considered. In addition, a patient's climate-related preference does not per se justify the choice of treatment but must be integrated into shared decision-making and reconciled with the healthcare professional's expert judgement on the intervention being a legitimate and promising way for reaching certain treatment goals. As a recommendation, empirical research on stakeholders' attitudes, knowledge and practice regarding ecological sustainability in clinical decision-making is needed together with further ethical analyses.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Report on an audit of two decades' activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG).

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-04 DOI: 10.1136/jme-2024-110250

Raj K Mohindra, Stephen J Louw

{"title":"Report on an audit of two decades' activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG).","authors":"Raj K Mohindra, Stephen J Louw","doi":"10.1136/jme-2024-110250","DOIUrl":"https://doi.org/10.1136/jme-2024-110250","url":null,"abstract":"Background: 'The Clinical Ethics Advisory Group' (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG's way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG's paediatric case flow.Purpose: Review historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference ('sentinel') cases for use with a posited practical (casuistic) case-based reasoning model.Methods: Audit of the minutes of the first 22 years' meetings was undertaken by the two chairs of CEAG over that period of time.Results: 223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network 'round robin' cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were 'excellent' (*A4C4-A4C4) and 70% (156.5/223) 'good' or better (*A4C4-A3C3). By meeting the criteria of 'excellent' and 'prospective', 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.Conclusions: The audit provides a rich vein of information. There is demand for CEAG's services, workload is becoming more complex. Formal funding for such services seems justified.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Should newborn genetic testing for autism be introduced?

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-03 DOI: 10.1136/jme-2024-110166

Ramkumar Aishworiya, Hui-Lin Chin, Julian Savulescu

{"title":"Should newborn genetic testing for autism be introduced?","authors":"Ramkumar Aishworiya, Hui-Lin Chin, Julian Savulescu","doi":"10.1136/jme-2024-110166","DOIUrl":"https://doi.org/10.1136/jme-2024-110166","url":null,"abstract":"This manuscript provides a review of the potential role of newborn genetic testing for autism, and whether the state has an inherent responsibility to facilitate and subsidise this. This is situated within the broader construct of benefits and limitations of genetic testing currently. Potential benefits of such presymptomatic genetic testing include facilitating earlier diagnosis and access to appropriate intervention which can improve the treatment outcome for the child and indirectly benefit caregivers and society by reducing the care needs of the child and adult in future. However, there are several limitations to newborn genetic testing including the variable penetrance of 'autism-risk' genes, marked phenotypic heterogeneity of autism, real-world limitations in access to treatment, potential psychological harm to caregivers and financial considerations. We hence argue for facilitation of diagnostic genetic testing instead, especially for parents who seek to have greater understanding of recurrence likelihoods, related to reproductive decision-making. Facilitation of such testing can be in the form of both financial subsidies and infrastructural elements including availability of testing facilities and trained healthcare personnel for individualised pregenetic and postgenetic test counselling.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0