Journal of Medical Ethics最新文献_第7页

Seva (सेवा): selfless service. Seva （सेवा）：无私的服务。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2025-111229

Javier Arredondo Montero

引用次数: 0

Ecological preferences and patient autonomy. 生态偏好和病人自主。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2024-110432

Sabine Salloch

{"title":"Ecological preferences and patient autonomy.","authors":"Sabine Salloch","doi":"10.1136/jme-2024-110432","DOIUrl":"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":"609-613"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418574/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Seeking consensus on dilemmas related to euthanasia in dementia based on an advance directive: a Delphi study from a medical, ethical and legal perspective. 基于预先指示寻求与痴呆患者安乐死相关的困境共识：从医学、伦理和法律角度的德尔菲研究。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2024-110276

Marike E de Boer, Djura O Coers, Eefje M Sizoo, Danique M J Ten Bokkel Huinink, Carlo J W Leget, Cees M P M Hertogh

{"title":"Seeking consensus on dilemmas related to euthanasia in dementia based on an advance directive: a Delphi study from a medical, ethical and legal perspective.","authors":"Marike E de Boer, Djura O Coers, Eefje M Sizoo, Danique M J Ten Bokkel Huinink, Carlo J W Leget, Cees M P M Hertogh","doi":"10.1136/jme-2024-110276","DOIUrl":"10.1136/jme-2024-110276","url":null,"abstract":"Euthanasia in dementia based on advance euthanasia directives (AEDs) is possible within the Dutch Euthanasia law. Yet, physicians struggle with the responsibility of interpreting the law's open norms in cases of advanced dementia, which includes the fulfilment of the due care criteria. This Delphi study aims to analyse arguments and seek consensus from medical, ethical and legal perspectives on ethical dilemmas in such cases. Thirty participants, equally divided in expertise, took part in a three-round Delphi with a total of 11 statements on ethical dilemmas. Despite differences in opinions and argumentations between panellists, consensus was reached on seven statements regarding different topics. Consensus was reached that the (behavioural) expressions of a person with dementia should be considered throughout the progression of decision-making disabilities. In such cases, a wish to live should be prioritised over an AED. Although substitute decision-making is not an option in case of euthanasia requests, both people around the person with dementia as well as their AED can be supportive in the decision-making process. Advance directives with formulations such as 'if I have to admitted to a nursing home, then I want euthanasia' are found to be infeasible. At all times, it is important to pay attention to alternatives to euthanasia, which includes following existing guidelines on problem behaviour. Physicians may benefit from the arguments pertaining to dilemmas encountered and the fulfilment of the due care criteria to either justify their decisions in euthanasia cases based on an AED, or to support decisions to refrain from euthanasia.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"593-602"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

About time: medical ethics through a temporal lens. 关于时间：时间透镜下的医学伦理。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2025-111258

Arianne Shahvisi

引用次数: 0

Wish to die trying to live: unwise or incapacitous? The case of University Hospitals Birmingham NHS Foundation Trust versus 'ST'. 死而求生：不明智还是无能力？伯明翰大学医院 NHS 基金会信托与 "ST "的案例。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2024-110365

Johnna Wellesley, Dominic Wilkinson, Bryanna Moore

{"title":"Wish to die trying to live: unwise or incapacitous? The case of University Hospitals Birmingham NHS Foundation Trust versus 'ST'.","authors":"Johnna Wellesley, Dominic Wilkinson, Bryanna Moore","doi":"10.1136/jme-2024-110365","DOIUrl":"10.1136/jme-2024-110365","url":null,"abstract":"The recent legal dispute about medical treatment for a 19-year-old patient, Sudiksha Thirumalesh, (known initially by the Court of Protection as 'ST') in A NHS Trust versus ST & Ors (2023) raised several challenging ethical issues. While Sudiksha's case bears similarities to other high-profile cases in England and Wales, there are key differences. Crucially, Sudiksha herself was part of the disagreement. She was alert, communicative and sought to advocate for herself. Furthermore, this case was framed in the courts as pivoting not on considerations of best interests but on a determination of decisional capacity. Sudiksha was deemed to lack capacity because she did not believe her doctors' view of her prognosis.While the legal questions in the case were central to a recent Court of Appeal decision (which overturned the original finding), in this commentary, we focus on the ethical questions therein. We start by describing Sudiksha's court case and the initial judgment. We then offer an ethical analysis of the relationship between false beliefs, values and the 'capacity' to make decisions, arguing for a need for particular care when judging patients to lack capacity based purely on 'false and fixed beliefs'. After briefly noting the legal basis for the appeal finding, we offer ethical implications for future cases. Although it appears that Sudiksha had decision-making capacity, this did not settle the ethical question of whether health professionals were obliged to continue treatment that they believed to have no prospect of success.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"584-587"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diversity and inclusion for rodents: how animal ethics committees can help improve translation. 啮齿类动物的多样性和包容性：动物伦理委员会如何帮助改进翻译。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2023-109166

Monika Piotrowska

引用次数: 0

Should vaccination status be a consideration during secondary triage? 二次分诊时是否应考虑疫苗接种情况?

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2023-109386

Isaac Jarratt Barnham

{"title":"Should vaccination status be a consideration during secondary triage?","authors":"Isaac Jarratt Barnham","doi":"10.1136/jme-2023-109386","DOIUrl":"10.1136/jme-2023-109386","url":null,"abstract":"The rapid development of widely available and effective vaccines has been integral to the international response to the COVID-19 pandemic. However, a significant minority of those offered vaccination have refused, often due to their adherence to 'anti-vax' beliefs. These beliefs include that vaccines are dangerous, render the recipient magnetic or contain government microchips.During the pandemic, numerous calls were made for those voluntarily refusing vaccination to be deprioritised when allocating scarce healthcare resources. While these calls were rejected, the likelihood of the same calls being made during future pandemics necessitates a thorough examination of the ethical implications entailed by such a policy.Here, I consider an intuitive argument for the use of vaccination status when allocating healthcare resources. This argument claims that, by avoiding vaccination, vaccine refusers are failing to fulfil a social obligation to protect those around them from harm by facilitating herd immunity. They are, therefore, less deserving of healthcare than their vaccinated peers.I explore three objections to this argument. While a first objection, asserting that no individual can be held responsible for a failure to develop herd immunity, fails, I find two further responses, respectively asserting the primacy of patient autonomy and highlighting the harms deprioritising vaccine refusers would cause to disadvantaged minorities, compelling. I, therefore, conclude that vaccination status should not be considered during healthcare resource allocation, as such discrimination would disproportionately harm marginalised communities.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"642-646"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482475","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

Distributive justice, best options and organ markets: a reply to Semrau. 分配正义、最佳选择和器官市场：对 Semrau 的答复。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2024-110561

Andreas Albertsen

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 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 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":"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":3.4,"publicationDate":"2025-08-20","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

Guerrilla eugenics: gene drives in heritable human genome editing. 游击优生学：基因驱动在可遗传的人类基因组编辑。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-20 DOI: 10.1136/jme-2023-109061

Asher D Cutter

{"title":"Guerrilla eugenics: gene drives in heritable human genome editing.","authors":"Asher D Cutter","doi":"10.1136/jme-2023-109061","DOIUrl":"10.1136/jme-2023-109061","url":null,"abstract":"CRISPR-Cas9 genome editing can and has altered human genomes, bringing bioethical debates about this capability to the forefront of philosophical and policy considerations. Here, I consider the underexplored implications of CRISPR-Cas9 gene drives for heritable human genome editing. Modification gene drives applied to heritable human genome editing would introduce a novel form of involuntary eugenic practice that I term guerrilla eugenics. Once introduced into a genome, stealth genetic editing by a gene drive genetic element would occur each subsequent generation irrespective of whether reproductive partners consent to it and irrespective of whether the genetic change confers any benefit. By overriding the ability to 'opt in' to genome editing, gene drives compromise the autonomy of carrier individuals and their reproductive partners to choose to use or avoid genome editing and impose additional burdens on those who hope to 'opt out' of further genome editing. High incidence of an initially rare gene drive in small human communities could occur within 200 years, with evolutionary fixation globally in a timeframe that is thousands of times sooner than achievable by non-drive germline editing. Following any introduction of heritable gene drives into human genomes, practices intended for surveillance or reversal also create fundamental ethical problems. Current policy guidelines do not comment explicitly on gene drives in humans. These considerations motivate an explicit moratorium as being warranted on gene drive development in heritable human genome editing.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"627-635"},"PeriodicalIF":3.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812037","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