Journal of Medical Ethics最新文献

{"title":"Antinomy of pronatalist policies: it is time to shift focusing from population sustainability to population well-being.","authors":"Chengmeng Zhang, Gong Chen","doi":"10.1136/jme-2024-110663","DOIUrl":"10.1136/jme-2024-110663","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"386-388"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615689","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":"Ethics of pronatalism: a reply to critics.","authors":"Ji-Young Lee","doi":"10.1136/jme-2025-110908","DOIUrl":"10.1136/jme-2025-110908","url":null,"abstract":"","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"389-390"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674179","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":"Treating infertility as a missing capability, not a disease: a capability approach.","authors":"Michelle Jessica Bayefsky, Arthur Caplan","doi":"10.1136/jme-2024-109877","DOIUrl":"10.1136/jme-2024-109877","url":null,"abstract":"<p><p>Infertility patients and patient advocates have long argued for classifying infertility as a disease, in the hopes that this recognition would improve coverage for and access to fertility treatment. However, for many fertility patients, including older women, single women and same-sex couples, infertility does not represent a true disease state. Therefore, while calling infertility a 'disease' may seem politically advantageous, it might actually exclude patients with 'social' or 'relational' infertility from treatment. What is needed is a new conceptual framing of infertility that better reflects the profound significance of being infertile for many people and the importance of addressing infertility in order to improve their lives. In this paper, we argue that the capability approach provides this moral underpinning. The capability approach is concerned with what people are able to <i>do</i>, and whether they are able to act in a way that is in keeping with their own values and goals. The ability to procreate and build a family is a fundamental capacity and can be a major part of self-fulfilment, regardless of sexual orientation or family arrangement. Since the capability approach asks us to conceive of equality in terms of equal capabilities, it provides a strong ethical impetus for society to help those who cannot conceive on their own to do so with assisted reproduction.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"416-419"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906789","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":"Providing medically assisted dying in Canada: a qualitative study of emotional and moral impact.","authors":"Janine Penfield Winters, Chrystal Jaye, Neil John Pickering, Simon Walker","doi":"10.1136/jme-2024-110137","DOIUrl":"10.1136/jme-2024-110137","url":null,"abstract":"<p><strong>Purpose: </strong>Medical assistance in dying (MAiD) in Canada places the medical provider at the centre of the process. The MAiD provider holds primary responsibility for determining eligibility and becomes acquainted with patients' inner desires and expressions of suffering. This is followed by the MAiD procedure of administering the lethal agent and being present at the death of eligible patients. We report participants' perceptions of the emotional and moral impacts of this role.</p><p><strong>Methodology: </strong>Two years after MAiD was legalised in Canada, 22 early-adopting physician providers were interviewed. Data were examined using both phenomenological analysis and a novel ChatGPT-enhanced analysis of an anonymised subset of interview excerpts.</p><p><strong>Findings: </strong>Participants described MAiD as emotionally provocative with both challenges and rewards. Providers expressed a positive moral impact when helping to optimise a patient's autonomy and moral comfort with their role in relieving suffering. Providers experienced tensions around professional duty and balancing self with service to others. Personal choice and patient gratitude enhanced the provider experience, while uncertainty and conflict added difficulty.</p><p><strong>Conclusions: </strong>Participants described MAiD provision as strongly aligned with a patient-centred ethos of practice. This study suggests that, despite challenges, providing MAiD can be a meaningful and satisfying practice for physicians. Understanding the emotional and moral impact and factors that enhance or detract from the providers' experience allows future stakeholders to design and regulate assisted dying in ways congruent with the interests of patients, providers, families and society.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"400-410"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108141","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":"Practical, epistemic and normative implications of algorithmic bias in healthcare artificial intelligence: a qualitative study of multidisciplinary expert perspectives.","authors":"Yves Saint James Aquino, Stacy M Carter, Nehmat Houssami, Annette Braunack-Mayer, Khin Than Win, Chris Degeling, Lei Wang, Wendy A Rogers","doi":"10.1136/jme-2022-108850","DOIUrl":"10.1136/jme-2022-108850","url":null,"abstract":"<p><strong>Background: </strong>There is a growing concern about artificial intelligence (AI) applications in healthcare that can disadvantage already under-represented and marginalised groups (eg, based on gender or race).</p><p><strong>Objectives: </strong>Our objectives are to canvas the range of strategies stakeholders endorse in attempting to mitigate algorithmic bias, and to consider the ethical question of responsibility for algorithmic bias.</p><p><strong>Methodology: </strong>The study involves in-depth, semistructured interviews with healthcare workers, screening programme managers, consumer health representatives, regulators, data scientists and developers.</p><p><strong>Results: </strong>Findings reveal considerable divergent views on three key issues. First, views on whether bias is a problem in healthcare AI varied, with most participants agreeing bias is a problem (which we call the bias-critical view), a small number believing the opposite (the bias-denial view), and some arguing that the benefits of AI outweigh any harms or wrongs arising from the bias problem (the bias-apologist view). Second, there was a disagreement on the strategies to mitigate bias, and who is responsible for such strategies. Finally, there were divergent views on whether to include or exclude sociocultural identifiers (eg, race, ethnicity or gender-diverse identities) in the development of AI as a way to mitigate bias.</p><p><strong>Conclusion/significance: </strong>Based on the views of participants, we set out responses that stakeholders might pursue, including greater interdisciplinary collaboration, tailored stakeholder engagement activities, empirical studies to understand algorithmic bias and strategies to modify dominant approaches in AI development such as the use of participatory methods, and increased diversity and inclusion in research teams and research participant recruitment and selection.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":"420-428"},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10770376","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}

{"title":"On the moral (in)equivalence of human embryos and stem cell-derived embryo models.","authors":"Nienke de Graeff, Lien De Proost","doi":"10.1136/jme-2025-110866","DOIUrl":"https://doi.org/10.1136/jme-2025-110866","url":null,"abstract":"<p><p>Gyngell <i>et al</i> argue that no intrinsic differences exist between stem cell-derived embryo models (SCEMs) and embryos derived from fertilisation that would justify attributing a higher moral status to the latter. Consequently, they claim there is no ethical rationale for treating SCEMs differently from embryos and contend that endorsing SCEMs as having moral advantages over embryos constitutes an obfuscation. In this commentary, we challenge the assertion that human SCEMs and embryos are morally equivalent by painting a more nuanced picture of the moral value of (different kinds of) SCEMs and embryos. First, we highlight the diversity among SCEMs, noting that different types of SCEMs need not be morally equivalent. This point is illustrated by taking a closer look at their potentiality, a property often considered relevant to moral status. Second, we observe that Gyngell <i>et al</i>, like much of the broader debate, primarily concentrate on the direct moral status of SCEMs in their analysis of the moral (in)equivalence with embryos. We argue that a comprehensive moral evaluation should encompass different types of moral value, evaluating not only direct moral status but also relational, symbolic and instrumental value. Ultimately, we suggest that the real obfuscation lies not in endorsing SCEMs as having moral advantages over embryos but rather in the overemphasis on direct moral status and the binary thinking about the moral (in)equivalence of embryos versus SCEMs that dominates these discussions.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110991","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":"Health sufficientarianism and health inequality.","authors":"Lasse Nielsen","doi":"10.1136/jme-2025-110870","DOIUrl":"https://doi.org/10.1136/jme-2025-110870","url":null,"abstract":"<p><p>This paper asks: If we are sufficientarians about health, then why do we care about health inequality? This is an important ethical question which should be of interest to moral philosophers as well as decision-makers, bureaucrats, and healthcare professionals. I present a generic account of health sufficientarianism and I argue that this account offers a distinctive and plausible explanation for our concern with health inequality. Central to my argument is the claim that the driver of our reasons for concern with social inequality in health is not the inequality per se, but the underlying risk of absolute health deficiency, and that this phenomenon is most directly explained by health sufficientarianism. This gives strengthened confidence in a sufficientarian approach to health justice.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024065","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":"Communitarian ethics perspective on UK biobanking: the Newborn Genomes Programme.","authors":"Evie Edworthy","doi":"10.1136/jme-2025-110846","DOIUrl":"https://doi.org/10.1136/jme-2025-110846","url":null,"abstract":"<p><p>Genomic biobanks play a pivotal role in advancing healthcare research, particularly through large-scale initiatives such as the Newborn Genomes Programme (NGP). This report examines the ethical challenges associated with paediatric genomic biobanks, using the NGP as a case study. Central to these challenges is genomic data ownership and how it informs consent models to balance individual autonomy and the collective good. Ethical considerations in paediatric biobanking often involve tensions between respecting individual rights and informed consent and prioritising the societal benefits of genomic research through public health advancements and medical breakthroughs. While traditional bioethical frameworks prioritise either individual autonomy or societal benefit, communitarian ethics offers a more integrative approach, recognising that individual and collective interests are deeply interconnected. This is particularly relevant in paediatric biobanking where families and communities share a stake in genetic information. Guided by communitarian ethics, the NGP navigates these complexities through governance mechanisms, including a stewardship model, dynamic consent processes and an ethics working group. By moving beyond the strictly individualistic focus of traditional ethical frameworks, it fosters trust, transparency and a commitment to respecting donor autonomy to ensure ethical adaptability in response to the evolving landscape of genomic medicine. As genomic biobanks continue to expand globally, the UK's NGP serves as a valuable model for maintaining ethical integrity in paediatric research while still advancing public health objectives and evolving in response to emerging ethical challenges.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004395","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":"Misalignments of values and preferences: Finding an ideal elder care arrangement.","authors":"Yi Jiao Angelina Tian, Tenzin Wangmo, Julian Savulescu","doi":"10.1136/jme-2024-110559","DOIUrl":"https://doi.org/10.1136/jme-2024-110559","url":null,"abstract":"<p><p>The ageing of the global population prompts many countries to appropriately allocate healthcare resources that ensure adequate elder care. Nevertheless, the shortages in and burdens of professional care continue to persist. Assistive and remote monitoring technologies for home-use support professional carers in providing care to older persons. With secondary analyses of semistructured interviews with 27 older persons and 23 professional carers in Switzerland, we examined their reasons and expectations for accepting or rejecting technologies in elder care contextualised by their moral outlooks on care, life, death and the deterioration from age. Whereas some appreciate the opportunities for greater safety and reassurance from technologies, others may see the alerts as burdensome and the interventions superfluous. We argue that dissatisfaction in professional care may result from a misalignment of the subjective values between the carer and older person. This may exacerbate the problem of appropriate care provision and disrupt the potential of technologies to benefit older persons. An ideal caregiving arrangement may be found when their values do align. We argue that there exists intrinsic value to finding an alignment using the capabilities approach, followed by reflections on autonomy and privacy. Recommendations are offered to practically enable this alignment, with limits set to ensure adequate access to care. With the increasing enthusiasm for technical solutions in professional elder care, this paper contributes a novel perspective by presenting two reasons for inefficiencies in reducing care burdens that are linked to the alignment of core moral outlooks and the realisation of capabilities.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996607","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":"Conduit or conductor? Physician providers' descriptions of their role as MAiD assessors in the first years after legalisation in Canada.","authors":"Janine Penfield Winters, Simon Walker, Neil John Pickering, Chrystal Jaye","doi":"10.1136/jme-2024-110518","DOIUrl":"https://doi.org/10.1136/jme-2024-110518","url":null,"abstract":"<p><strong>Purpose: </strong>This qualitative study investigates how Canadian physician-providers of medical assistance in dying (MAiD) perceived their role in making judgements when assessing patients for MAiD.</p><p><strong>Methodology: </strong>21 Canadian physician MAiD providers were interviewed about their experience as early-adopting providers. The data were analysed using a phenomenological approach to identify themes and thematic groupings regarding providers' perceptions of roles and reasoning while undertaking MAiD assessments.</p><p><strong>Findings: </strong>Participants universally endorsed a focus on providing patient-centred care. They varied in how they approached decision-making for patients applying for MAiD and how they viewed their role within the doctor-patient relationship. Group 1 participants placed moral decision-making with the patient, indicating a limited role for the provider. They focused on guiding the competent patient through the statutory MAiD requirements to actualise patient autonomy. Some described their role as 'conduits'. Group 2 had intermediate views. Group 3 participants described their professional judgement as important to the moral calculus of approval for MAiD. Their role was like that of a train conductor in that they positioned themselves as responsible for wider patient interests as part of maintaining their own professional and moral integrity during MAiD.</p><p><strong>Conclusions/significance: </strong>Participants' narratives indicate that decisions about MAiD assessments are strongly influenced by provider reasoning regarding the physician's role in MAiD assessment and provision. This divergence reflects unclear role expectations in the context of rapidly changing cultural expectations regarding MAiD.</p>","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007017","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}