Journal of Medical Ethics最新文献_第2页

A qualitative study of true self judgments, epistemic access, and medical decision-making. 真实自我判断、认知获取和医疗决策的定性研究。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-23 DOI: 10.1136/jme-2025-110957

James Toomey, Jonathan Lewis, Ivar R Hannikainen, Brian D Earp

{"title":"A qualitative study of true self judgments, epistemic access, and medical decision-making.","authors":"James Toomey, Jonathan Lewis, Ivar R Hannikainen, Brian D Earp","doi":"10.1136/jme-2025-110957","DOIUrl":"https://doi.org/10.1136/jme-2025-110957","url":null,"abstract":"Background: Toomey et al (2024) found that US participants were more likely to follow a medical treatment preference-expressed after substantial cognitive decline-of a third person rather than their own future self. This correlated with a greater tendency to see the third person as still their true self. We hypothesised that the greater epistemic access one has to one's own true self as opposed to others might drive this difference.Methods: A codebook designed to capture different kinds of evidence and reasoning was developed, and participants' explanations for their treatment decisions in Toomey et al's study were coded and qualitatively analysed.Results: In first-person cases, participants were more likely to explain their treatment decision with reference to perceived direct access to their own true self. In contrast, in third-person cases, participants more often relied on proxies or heuristics, such as the presumption that an expressed preference is an authentic one or that preferences expressed with greater cognition tend to better reflect the true self.Conclusions: These findings support the hypothesis that differential epistemic access to the true self in first- and third-person cases may drive different medical treatment decisions. Participants may be trying to follow the patient's 'true' or 'authentic' preference in all cases, but relying on different kinds of evidence in so doing.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698843","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

Hope pluralism in antenatal palliative care. 产前姑息治疗中的希望多元化。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-23 DOI: 10.1136/jme-2024-110120

Sophie Bertaud, Mehrunisha Suleman, Dominic Wilkinson

{"title":"Hope pluralism in antenatal palliative care.","authors":"Sophie Bertaud, Mehrunisha Suleman, Dominic Wilkinson","doi":"10.1136/jme-2024-110120","DOIUrl":"10.1136/jme-2024-110120","url":null,"abstract":"When parents face the distressing news during pregnancy that their baby is affected by a serious medical condition that will likely lead to the baby's death before or soon after birth, they experience a range of complex emotions. Perhaps paradoxically, one common response is that of hope. Navigating such hope in antenatal interactions with parents can be difficult for healthcare professionals. That can stem from a desire to accurately communicate prognostic information and a fear of conveying 'false hope' to families. In this paper, we examine the role that hope plays when parents and healthcare professionals are grappling with a confirmed antenatal diagnosis of a life-limiting condition. We assess what it means to hope in this context and consider the different types of hopes held by both parents and healthcare professionals as well as why hopeful thinking might be helpful and not harmful. We propose 'hope pluralism' as a concept that might allow healthcare professionals to accommodate a multitude of parental and professional hopes, even where these conflict. Finally, we offer some practical suggestions for how professionals should evaluate and respond to hope in situations that might (from the outside) appear hopeless.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"521-525"},"PeriodicalIF":3.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467763","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

Are clinicians ethically obligated to disclose their use of medical machine learning systems to patients? 临床医生是否有道德义务向患者披露他们使用医疗机器学习系统的情况？

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-23 DOI: 10.1136/jme-2024-109905

Joshua Hatherley

引用次数: 0

Disclosure and consent: ensuring the ethical provision of information regarding childbirth. 披露和同意：确保有关分娩信息的道德提供。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-23 DOI: 10.1136/jme-2022-108283

Kelly Irvine, Rebecca Ch Brown, Julian Savulescu

引用次数: 0

Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in a community setting: does it facilitate best interests decision-making? 在社区环境中使用推荐的紧急护理和治疗总结计划（ReSPECT）：它是否促进了最佳利益决策？

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-23 DOI: 10.1136/jme-2024-110144

Karin Eli, Celia J Bernstein, Jenny Harlock, Caroline J Huxley, Julia Walsh, Hazel Blanchard, Claire A Hawkes, Gavin D Perkins, Chris Turner, Frances Griffiths, Anne-Marie Slowther

{"title":"Using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) in a community setting: does it facilitate best interests decision-making?","authors":"Karin Eli, Celia J Bernstein, Jenny Harlock, Caroline J Huxley, Julia Walsh, Hazel Blanchard, Claire A Hawkes, Gavin D Perkins, Chris Turner, Frances Griffiths, Anne-Marie Slowther","doi":"10.1136/jme-2024-110144","DOIUrl":"10.1136/jme-2024-110144","url":null,"abstract":"In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or, if the patient lacks capacity to participate in the conversation, a person close to the patient. A key outcome of the ReSPECT process is a set of recommendations, recorded on the patient-held ReSPECT form, that reflect the conversation. In an emergency, these recommendations are intended to inform clinical decision-making, and thereby enable the attending clinician-usually a general practitioner (GP) or paramedic-to act in the patient's best interests. This study is the first to explore the extent to which ReSPECT recommendations realise their goal of informing best interests decision-making in community contexts. Using a modified framework analysis approach, we triangulate interviews with patients and their relatives, GPs and nurses and care home staff. Our findings show that inconsistent practices around recording patient wishes, diverging interpretations of the meaning and authority of recommendations and different situational contexts may affect the interpretation and enactment of ReSPECT recommendations. Enacting ReSPECT recommendations in an emergency can be fraught with complexity, particularly when attending clinicians need to interpret recommendations that did not anticipate the current emergency. This may lead to decision-making that compromises the patient's best interests. We suggest that recording patients' values and preferences in greater detail on ReSPECT forms may help overcome this challenge, in providing attending clinicians with richer contextual information through which to interpret treatment recommendations.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"526-532"},"PeriodicalIF":3.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006866","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

Something old, something new? The Journal of Medical Ethics turns 50. 旧的，新的？《医学伦理学杂志》50岁了。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-23 DOI: 10.1136/jme-2025-111152

Arianne Shahvisi, Lucy Frith, Brian D Earp

引用次数: 0

Just culture as dialogical learning: theoretical foundations and practical implications of restorative justice. 作为对话学习的公正文化：恢复性司法的理论基础与实践意义。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-22 DOI: 10.1136/jme-2025-110761

Eva van Baarle, Guy Widdershoven, Bert Molewijk

{"title":"Just culture as dialogical learning: theoretical foundations and practical implications of restorative justice.","authors":"Eva van Baarle, Guy Widdershoven, Bert Molewijk","doi":"10.1136/jme-2025-110761","DOIUrl":"https://doi.org/10.1136/jme-2025-110761","url":null,"abstract":"Just culture is a recent perspective on responding to accidents or incidents in organisations. It refers to the importance of doing justice to the situation and the people involved, aimed at strengthening safety in the workplace and preventing future harm. There are two main conceptualisations of just culture, implying different views on justice, namely retributive and restorative justice. The concept of retributive justice emphasises individual responsibility for failures and the enforcement of given norms about right vs wrong via sanctions and punishment. Restorative justice emphasises the systemic and cultural dimension of accidents or incidents and aims to foster learning conditions for groups as well as the organisation involved. Elaborating on the theoretical presuppositions of the concept is important, both for theorising about just culture and for fostering just culture in practice. We extend the literature by looking into two approaches in contemporary philosophy and ethics that can deepen our understanding of what a restorative approach to just culture entails and how to foster it in practice: dialogical hermeneutics and care ethics. We show that dialogical hermeneutics and care ethics enable us to specify repair as a relational practice, understanding as an interpretation of the situation and identification of needs and moral learning as dialogical and democratic processes of joint reflection. By providing a concrete example of fostering restorative justice in a healthcare organisation, we demonstrate how the theoretical characteristics of a restorative justice inspired by dialogical hermeneutics and care ethics can be translated into practical processes of organisational moral learning.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698844","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

Ghairat: navigating cultural morality in patient care. 格拉特：在病人护理中引导文化道德。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-18 DOI: 10.1136/jme-2025-111188

Ammar Younas, Yi Zeng

引用次数: 0

Using a lottery to resolve indeterminacy when allocating resources for drugs for rare diseases. 利用摇号来解决罕见疾病药物资源分配的不确定性。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-18 DOI: 10.1136/jme-2023-109723

Kenneth Bond, Lars Sandman, Erik Gustavsson

引用次数: 0

When to create embryos or organoids for research. 何时为研究创造胚胎或类器官。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-17 DOI: 10.1136/jme-2025-110821

Sebastian Porsdam Mann, Julian Savulescu, Brian D Earp

{"title":"When to create embryos or organoids for research.","authors":"Sebastian Porsdam Mann, Julian Savulescu, Brian D Earp","doi":"10.1136/jme-2025-110821","DOIUrl":"https://doi.org/10.1136/jme-2025-110821","url":null,"abstract":"The development of brain organoids and use of human embryonic neural structures for research each raise distinct ethical considerations that require careful analysis. We propose that rather than attempting to resolve longstanding debates about embryonic moral status, a more productive approach is to examine how different positions on this fundamental question lead to distinct conclusions about appropriate research strategies. For those who ground moral status in species membership or developmental potential, even early-stage embryo research may be ethically impermissible, suggesting focus on carefully bounded organoid development. Conversely, for those who ground moral status in current capacities, embryonic neural tissue studied before the emergence of consciousness may offer significant advantages over organoids while raising fewer novel ethical concerns. Our analysis reveals inadequacies in current policies, particularly the 14-day rule, which appears difficult to justify under either ethical framework. We demonstrate how careful attention to the relationship between ethical premises and research implications can advance both scientific progress and ethical oversight, while suggesting specific policy reforms including capacity-based research guidelines and sophisticated monitoring protocols.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659423","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