Alberto Aparicio, Peyton Swanson, Daniel Aillaud De Uriarte
{"title":"Reassessing the role of informed decision-making in cardiac xenotransplantation.","authors":"Alberto Aparicio, Peyton Swanson, Daniel Aillaud De Uriarte","doi":"10.1136/jme-2024-110496","DOIUrl":"https://doi.org/10.1136/jme-2024-110496","url":null,"abstract":"","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":"142769721","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}
Dominic Wilkinson, Safoora Teli, Claire Litchfield, Anna Madeley, Brenda Kelly, Lawrence Impey, Rebecca Ch Brown, Elselijn Kingma, Helen Lynne Turnham
{"title":"Ethics round table: choice and autonomy in obstetrics.","authors":"Dominic Wilkinson, Safoora Teli, Claire Litchfield, Anna Madeley, Brenda Kelly, Lawrence Impey, Rebecca Ch Brown, Elselijn Kingma, Helen Lynne Turnham","doi":"10.1136/jme-2024-110503","DOIUrl":"https://doi.org/10.1136/jme-2024-110503","url":null,"abstract":"<p><p>Decisions about how and where they deliver their baby are extremely important to pregnant women. There are very strong ethical norms that women's autonomy should be respected, and that plans around birth should be personalised. However, there appear to be profound challenges in practice to respecting women's choices in pregnancy and labour. Choices carry risks and consequences-to the woman and her child; also potentially to her caregivers and to other women.What does it mean for women's autonomy to be respected in obstetrics? How should health professionals respond to refusals of treatment or requests for care outside normal guidelines? What are the ethical limits to autonomy? In this clinical ethics round table, service users, midwives, obstetricians, philosophers and ethicists respond to two hypothetical cases drawn from real-life scenarios.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755236","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}
Lieke van Kempen, Martine C de Vries, Nienke de Graeff
{"title":"A heart for everyone? The need to include diverse populations in first-in-human trials.","authors":"Lieke van Kempen, Martine C de Vries, Nienke de Graeff","doi":"10.1136/jme-2024-110492","DOIUrl":"https://doi.org/10.1136/jme-2024-110492","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755233","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}
{"title":"It is not about autonomy: realigning the ethical debate on substitute judgement and AI preference predictors in healthcare.","authors":"Marco Annoni","doi":"10.1136/jme-2024-110343","DOIUrl":"https://doi.org/10.1136/jme-2024-110343","url":null,"abstract":"<p><p>This article challenges two dominant assumptions in the current ethical debate over the use of algorithmic Personalised Patient Preference Predictors (P4) in substitute judgement for incapacitated patients. First, I question the belief that the autonomy of a patient who no longer has decision-making capacity can be meaningfully respected through a P4-empowered substitute judgement. Second, I critique the assumption that respect for autonomy can be reduced to merely satisfying a patient's individual treatment preferences. Both assumptions, I argue, are problematic: respect for autonomy cannot be equated with simply delivering the 'right' treatments, and expanding the normative scope of agency beyond first-person decisions creates issues for standard clinical decision-making. I suggest, instead, that the development of these algorithmic tools can be justified by achieving other moral goods, such as honouring a patient's unique identity or reducing surrogate decision-makers' burdens. This conclusion, I argue, should reshape the ethical debate around not just the future development and use of P4-like systems, but also on how substitute judgement is currently understood and justified in clinical medicine.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739138","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}
{"title":"On interpreters: the ethics of interpreter use in general practice.","authors":"Richard Armitage","doi":"10.1136/jme-2024-110389","DOIUrl":"https://doi.org/10.1136/jme-2024-110389","url":null,"abstract":"<p><p>In the absence of language congruency between patient and general practitioner (GP), the use of an interpreter is essential for a safe and effective clinical consultation. A substantial proportion of individuals living in the UK lack sufficient command of the English language to allow direct communication with their GP. Interpreters in UK general practice can be classified into three major categories: Casual, professional in-person and professional telephone interpreters. The use of casual interpreters threatens the safety and quality of care provided in interpreted consultations, increases the potential for safeguarding concerns to go unrecognised by the GP, poses a potential legal risk to the GP and is burdensome for and potentially harmful to the relatives, friends and carers who act as such interpreters. The use of professional in-person interpreters greatly improves the safety and quality of care above that of casually interpreted consultations, increases the probability that safeguarding concerns will be recognised by the GP, avoids the legal risk inherent to casually interpreted consultations, is neither burdensome nor potentially harmful to accompanying relatives, friends and carers or the interpreter and permits interpreter continuity while generating a small non-clinical opportunity cost borne by administrative staff. The use of professional telephone interpreters shares the same advantages as the use of professional in-person interpreters but prevents interpreter continuity and generates a large clinical opportunity cost borne by other patients. The paper also explores ethical challenges that are common to the use of all major categories of interpreter and offers four policy recommendations in light of the analysis.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739156","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}
{"title":"Cardiac xenotransplantation: between experimental therapy and palliative care.","authors":"Marta Szabat","doi":"10.1136/jme-2024-110487","DOIUrl":"https://doi.org/10.1136/jme-2024-110487","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738803","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}
{"title":"Towards an ethics of pronatalism in South Korea (and beyond).","authors":"J Y Lee","doi":"10.1136/jme-2024-110001","DOIUrl":"https://doi.org/10.1136/jme-2024-110001","url":null,"abstract":"<p><p>East Asian countries such as South Korea have recently made headlines for experimenting with different methods to incentivise people to have (more) children, in a bid to reverse declining birth rates. Many such incentives-child benefits, cash bonuses, dating events, and so on-appear morally innocuous at first glance. I will demonstrate in this analysis, however, that they amount to stopgap measures which reveal fundamental shortcomings with the way various nation states are approaching the so-called 'problem' of fertility decline.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739534","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}
Daniel J Hurst, Anthony Merlocco, Luz A Padilla, Chris Bobier
{"title":"Argument for allowing first-in-human cardiac xenotransplantation clinical trials in paediatric patients.","authors":"Daniel J Hurst, Anthony Merlocco, Luz A Padilla, Chris Bobier","doi":"10.1136/jme-2024-110452","DOIUrl":"https://doi.org/10.1136/jme-2024-110452","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692744","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}
Adrian Villalba, Anna Smajdor, Iain Brassington, Daniela Cutas
{"title":"The ethics of synthetic DNA.","authors":"Adrian Villalba, Anna Smajdor, Iain Brassington, Daniela Cutas","doi":"10.1136/jme-2024-110124","DOIUrl":"https://doi.org/10.1136/jme-2024-110124","url":null,"abstract":"<p><p>In this paper, we discuss the ethical concerns that may arise from the synthesis of human DNA. To date, only small stretches of DNA have been constructed, but the prospect of generating human genomes is becoming feasible. At the same time, the significance of genes for identity, health and reproduction is coming under increased scrutiny. We examine the implications of DNA synthesis and its impact on debates over the relationship with our DNA and the ownership of our genes, its potential to disrupt common understandings of reproduction and privacy, and the way in which synthetic DNA challenges traditional associations between genes and identity. We explore the degree to which synthetic DNA may further undermine overgeneticised accounts of identity, health, reproduction, parenthood and privacy that are prevalent in the public domain and in some areas of policy-making. While avoiding making normative claims of our own, we conclude that there is a need for reflection on the ethical implications of these developing technologies before they are on us.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682034","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}
{"title":"Advancing the scholarship of clinical ethics consultation.","authors":"Clare Delany, Sharon Feldman, Lynn Gillam","doi":"10.1136/jme-2024-110534","DOIUrl":"https://doi.org/10.1136/jme-2024-110534","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682031","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}