Journal of Medical Ethics最新文献_第9页

Why de-identified data sharing for research should be in the public interest. 为什么为了研究而去识别的数据共享应该符合公众利益。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-10 DOI: 10.1136/jme-2025-110825

Marthe Smedinga, Angela Ballantyne, G Owen Schaefer

{"title":"Why de-identified data sharing for research should be in the public interest.","authors":"Marthe Smedinga, Angela Ballantyne, G Owen Schaefer","doi":"10.1136/jme-2025-110825","DOIUrl":"10.1136/jme-2025-110825","url":null,"abstract":"'Advancing the public interest' is a criterion for de-identified data use for research via several national data platforms and biobanks. This may be referred to via cognate terms such as public benefit, public good or social value. The criterion is often adopted without it being a legal requirement. It is a legal requirement in some jurisdictions for sharing identifiable data without consent, which does not apply to de-identified data. We argue that, even in circumstances where there are few or no legal restrictions on the sharing of de-identified data, there is a sound ethical reason for platforms to nevertheless impose a public interest criterion on data sharing. We argue that a public interest test is ethically essential for justifying research use of de-identified data via government-funded platforms because (1) it allows to promote public good and to minimise potential harmful consequences of research for both individuals and groups, for example, by offering grounds to reject research that could lead to stigmatisation of marginalised populations; (2) national data platforms hold public data and are made possible by government funds, and therefore should be used to support public interests and (3) it can demonstrate trustworthiness and contribute to promoting the social licence for data platforms to operate, which is especially important for efforts to align data governance policies with public norms and expectations.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742291","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

Lives worth living and the danger of ignoring non-identity limits on genetic preference. 值得活下去的生命，以及忽视基因偏好的非同一性限制的危险。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-10 DOI: 10.1136/jme-2025-110888

Marcus T L Teo

引用次数: 0

The problem of atypicality in LLM-powered psychiatry. 法学硕士精神病学的非典型问题。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-07 DOI: 10.1136/jme-2025-110972

Bosco Garcia, Eugene Y S Chua, Harman Singh Brah

引用次数: 0

AI-assisted consent in paediatric medicine: ethical implications of using large language models to support decision-making. 儿科医学中人工智能辅助同意：使用大型语言模型支持决策的伦理影响。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-06 DOI: 10.1136/jme-2024-110624

Jemima Winifred Allen, Brian David Earp, Dominic Wilkinson

{"title":"AI-assisted consent in paediatric medicine: ethical implications of using large language models to support decision-making.","authors":"Jemima Winifred Allen, Brian David Earp, Dominic Wilkinson","doi":"10.1136/jme-2024-110624","DOIUrl":"https://doi.org/10.1136/jme-2024-110624","url":null,"abstract":"Obtaining informed consent in paediatrics is an essential yet ethically complex aspect of clinical practice. Children have varying levels of autonomy and understanding based on their age and developmental maturity, with parents traditionally playing a central role in decision-making. However, there is increasing recognition of children's evolving capacities and their right to be involved in care decisions, raising questions about facilitating meaningful consent, or at least assent, in complex medical situations.Large language models (LLMs) may offer a partial solution to these challenges. These generative artificial intelligence (AI) systems can provide interactive, age-appropriate explanations of medical procedures, risks and outcomes tailored to each child's comprehension level. LLMs could be designed to adapt their responses to young patients' cognitive and emotional needs while supporting parents with clear, accessible medical information.This paper examines the ethical implications of using LLMs in paediatric consent, focusing on balancing autonomy promotion with protecting children's best interests. We explore how LLMs could be used to empower children to express preferences, mediate family disputes and facilitate informed consent. However, important concerns arise: Can LLMs adequately support developing autonomy? Might they exert undue influence or worsen conflicts between family members and healthcare providers?We conclude that while LLMs could enhance paediatric consent processes with appropriate safeguards and careful integration into clinical practice, their implementation must be approached cautiously. These systems should complement rather than replace the essential human elements of empathy, judgement and trust in paediatric consent.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794711","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

Missing voices: why youth perspectives are essential for Ubuntu bioethics in the context of HIV testing. 缺失的声音：为什么青年的观点是必不可少的Ubuntu生物伦理在艾滋病毒检测的背景下。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-05 DOI: 10.1136/jme-2025-111130

Archibong Edem Bassey, Chinaza Duke Nwosu, Abiola Oladejo

{"title":"Missing voices: why youth perspectives are essential for Ubuntu bioethics in the context of HIV testing.","authors":"Archibong Edem Bassey, Chinaza Duke Nwosu, Abiola Oladejo","doi":"10.1136/jme-2025-111130","DOIUrl":"https://doi.org/10.1136/jme-2025-111130","url":null,"abstract":"This article responds to Mwinsa and colleagues' work where they explore differences between Ubuntu-based bioethics and international bioethical principles through the lens of Zambia's HIV testing policy. While Mwinsa and colleagues offer valuable insights into Ubuntu bioethics as a considerable alternative to Western informed consent requirements for HIV testing, we argue that their suggestion on 'moderate communitarianism' and Ubuntu application could be profoundly enriched by meaningfully including youth perspectives in the bioethical deliberations. In sub-Saharan Africa, young people are disproportionately affected by the HIV epidemic and are more often the recipients of HIV testing services. These services are available as a result of HIV policies, such as the one in Zambia. Yet, their voices remain largely absent from policy and bioethics discussions, which largely centre around adult perspectives. To fully realise Ubuntu's foundational principle of 'I am, because we are', and the goal of collective good, we maintain that it is important to raise critical questions as to who constitutes the 'community' in ethical decision-making, to ensure that young people are not left behind. In their design, we argue that analysis of the Ubuntu framework would benefit from incorporating the perspectives of adolescents and young people-those most directly affected by HIV testing policies. Thus, our position canvasses for the realisation of Ubuntu's vision of collective wisdom through comprehensive community participation, and to align with growing evidence supporting youth-centred and youth-friendly approaches to HIV decision-making.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789365","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

On multiple problems: the ethics of multiple problems in single general practitioner appointments. 论多重问题：单一全科医生任命中多重问题的伦理问题。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-08-05 DOI: 10.1136/jme-2024-110693

Richard Armitage

{"title":"On multiple problems: the ethics of multiple problems in single general practitioner appointments.","authors":"Richard Armitage","doi":"10.1136/jme-2024-110693","DOIUrl":"https://doi.org/10.1136/jme-2024-110693","url":null,"abstract":"Bringing multiple problems to a single general practitioner (GP) appointment raises various ethical issues, all of which emerge from the central tension between the total number of problems brought to the appointment and the finite amount of time allocated to undertake it. This paper finds that it would be unreasonable to only consider autonomy as being respected if all problems are addressed in a single appointment; the GP is required to address those problems that would maximally promote beneficence within the constraints of the single appointment; dealing with multiple problems in single appointments might violate non-maleficence by reducing the time dedicated to each problem and fostering error-producing conditions and is likely to reduce patient satisfaction, while any GP lateness generated by dealing with multiple problems in single appointments has negative impacts on subsequent patients; justice requires an equity, rather than a strict equality, approach to GP appointment allocation, and therefore requires the booking of additional appointments to safely and effectively deal with a patient's multiple problems when relevant factors, such as complexity, are present and addressing multiple problems in single GP appointments exacerbates the burnout-producing conditions faced by GPs, which both negatively impacts GPs and patient safety and contributes to GPs leaving the workforce, which reduces the availability of GP appointments and thus violates beneficence. This paper makes three suggestions for practice, recognises various challenges to these recommendations and suggests how they should be addressed.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789366","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

Double-effect sedation: do physicians not intend a decrease in consciousness when it is caused by drugs that can also reduce specific symptoms? 双效镇静：当药物也能减轻特定症状时，医生难道不希望意识下降吗？

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-31 DOI: 10.1136/jme-2025-110912

Hitoshi Arima

{"title":"Double-effect sedation: do physicians not intend a decrease in consciousness when it is caused by drugs that can also reduce specific symptoms?","authors":"Hitoshi Arima","doi":"10.1136/jme-2025-110912","DOIUrl":"10.1136/jme-2025-110912","url":null,"abstract":"The ethics of palliative sedation has been debated intensely. Recently, it has been emphasised that many drugs with sedating effects are also effective in reducing specific symptoms like pain and seizures. For example, midazolam is commonly used to sedate terminally ill patients but it can also reduce seizures. Hence, when midazolam is administered to a patient suffering from seizures, it may also lower the patient's consciousness. Similarly, morphine is useful in the management of end-stage pain and dyspnoea, but can also reduce the patient's consciousness, especially when administered in large doses. Cases in which a drug thus alleviates a symptom as well as lowers patient consciousness are called double-effect sedation (DES). Many claim that the decrease in consciousness in DES is merely a side effect and not an intended consequence, even if its occurrence was foreseen in advance or it will be maintained for some time until the patient dies. Additionally, it is often contended that DES is therefore justifiable by the doctrine of double effect (DDE) even though the decrease in consciousness is bad. The purpose of this paper is to examine these claims. I argue that the claims, while sometimes correct, are very frequently false. It will be shown that physicians often intend to reduce consciousness in DES. In such cases, as I conclude, DDE may not serve to justify DES, and DES should be subject to the same rigorous moral evaluations as the use of sedating drugs that do not reduce specific symptoms.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718023","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

Response to Barker et al: The problem of living solid organ donation. 对Barker等人的回应：活体实体器官捐献的问题。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-28 DOI: 10.1136/jme-2025-111030

Richard Armitage

{"title":"Response to Barker et al: The problem of living solid organ donation.","authors":"Richard Armitage","doi":"10.1136/jme-2025-111030","DOIUrl":"https://doi.org/10.1136/jme-2025-111030","url":null,"abstract":"Barker et al argue that the ultimate goal of medicine is to cure and prevent disease and, because assisted dying is not in keeping with this goal, doctors should not be required, at least in their role as doctors, to act as active agents of assisted dying. They hold that, if assisted dying is to be taken forward in England and Wales, the distinct, novel profession of 'assisted dying practitioner' should be created, the ultimate goal of which is to facilitate a good, assisted death. In their argument, the authors overlook living solid organ donation. This is an established practice in many healthcare systems, in which the living donor is neither cured of nor prevented from developing any disease and is, in fact, rendered less healthy than their predonation condition. As such, one of two possible states is true: either the authors' view of what constitutes the primary goal of medicine is correct, and the medical practice of living organ donation stands in violation of this goal; or the authors' view is incomplete, and the primary goal of medicine does not necessarily prevent doctors, in the role of doctors, from partaking as active agents of assisted dying. This article explores the ethical and practical implications of each of these possible states.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731826","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

A critical examination of execution drugs in the USA: historical perspectives and ethical debates. 对美国死刑药物的批判性检查：历史观点和伦理辩论。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-28 DOI: 10.1136/jme-2025-110850

Armaan Singh, Shama Varghese, Dhanesh D Binda, Maxwell B Baker, Cory Faragon, Wendy Bernstein

{"title":"A critical examination of execution drugs in the USA: historical perspectives and ethical debates.","authors":"Armaan Singh, Shama Varghese, Dhanesh D Binda, Maxwell B Baker, Cory Faragon, Wendy Bernstein","doi":"10.1136/jme-2025-110850","DOIUrl":"https://doi.org/10.1136/jme-2025-110850","url":null,"abstract":"Nitrogen hypoxia has recently emerged as a method of execution in the USA, with Alabama conducting the first executions using this technique in 2024. This article examines the historical evolution, medicalisation and ethical dilemmas surrounding execution practices, with particular attention to the rise of nitrogen hypoxia. Drawing on a targeted review of medical, legal and ethical literature, we explore the development of lethal injection protocols, the legal and procedural drivers of nitrogen gas adoption and the complex role of healthcare professionals in executions. Central concerns include the experimental nature of nitrogen hypoxia, the lack of transparency in execution protocols and the ethical implications of involving clinicians in state-sanctioned killing. We argue that the conflation of medical tools with punitive practices obscures fundamental distinctions between clinical care and capital punishment, raising urgent questions about professional integrity and public trust. Ultimately, we call for greater clarity, ethical consistency and transparency in addressing the interplay of medicine, law and the death penalty. By confronting these issues, we underscore the critical role of the medical community in advocating for humane practices and fostering informed public and legislative discourse on the intersection of medicine, ethics and capital punishment. We aim to contribute to the ongoing debate on the ethical and procedural challenges of state-sanctioned executions and the responsibilities of healthcare professionals.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731824","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

Parental autonomy and ethical challenges in artificial placenta trials: addressing parental disagreements across phases of participation. 人工胎盘试验中的父母自主性和伦理挑战：解决参与阶段父母的分歧。

IF 3.4 2区哲学

Journal of Medical Ethics Pub Date : 2025-07-28 DOI: 10.1136/jme-2024-110485

Alice Cavolo, Daniel Pizzolato

{"title":"Parental autonomy and ethical challenges in artificial placenta trials: addressing parental disagreements across phases of participation.","authors":"Alice Cavolo, Daniel Pizzolato","doi":"10.1136/jme-2024-110485","DOIUrl":"https://doi.org/10.1136/jme-2024-110485","url":null,"abstract":"Artificial placentas (APs) are technologies developed to mimic the functioning of the human placenta to support extremely preterm infants in an artificial environment until the lungs are developed enough to support intensive care. AP trials will likely consist of two phases: the delivery into AP, which requires a C-section on the pregnant person, and the AP trial, which only involves the infant. This poses a unique challenge to the principle of respect for autonomy: What if parents disagree on trial participation? In the first phase, the pregnant person has the right to make the final decision as they are the one undergoing a C-section, but in the second phase, parents have equal rights. We identified three solutions. First, to only engage with the pregnant person. Although this is an actionable solution that respects the pregnant person's autonomy, it undermines the co-parent's autonomy. Second, to only enrol agreeing parents. This is again an actionable solution that superficially acknowledges the role of both parents, but it undermines the pregnant person's autonomy. We proposed a midway: Clinicians should engage both parents and strive for consensus. If consensus is not reached, then they should follow the pregnant person's decision. However, it must be clear from the beginning that once the infant is in the AP, for every other medical decision, both parents have equal rights and for entrenched disagreements they should resort to court. This has the advantage of providing an actionable solution while truly acknowledging the role and autonomy of both parents.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731825","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