Journal of Medical Ethics最新文献_第9页

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

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-05 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":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Report on an audit of two decades' activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG). 对临床伦理委员会二十年活动的审计报告：纽卡斯尔泰恩医院NHS基金会信托临床伦理咨询小组（CEAG）。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-04 DOI: 10.1136/jme-2024-110250

Raj K Mohindra, Stephen J Louw

{"title":"Report on an audit of two decades' activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG).","authors":"Raj K Mohindra, Stephen J Louw","doi":"10.1136/jme-2024-110250","DOIUrl":"10.1136/jme-2024-110250","url":null,"abstract":"Background: 'The Clinical Ethics Advisory Group' (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG's way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG's paediatric case flow.Purpose: Review historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference ('sentinel') cases for use with a posited practical (casuistic) case-based reasoning model.Methods: Audit of the minutes of the first 22 years' meetings was undertaken by the two chairs of CEAG over that period of time.Results: 223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network 'round robin' cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were 'excellent' (*A4C4-A4C4) and 70% (156.5/223) 'good' or better (*A4C4-A3C3). By meeting the criteria of 'excellent' and 'prospective', 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.Conclusions: The audit provides a rich vein of information. There is demand for CEAG's services, workload is becoming more complex. Formal funding for such services seems justified.","PeriodicalId":16317,"journal":{"name":"Journal of Medical Ethics","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780298","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

Should newborn genetic testing for autism be introduced? 应该引入新生儿自闭症基因检测吗？

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-03 DOI: 10.1136/jme-2024-110166

Ramkumar Aishworiya, Hui-Lin Chin, Julian Savulescu

{"title":"Should newborn genetic testing for autism be introduced?","authors":"Ramkumar Aishworiya, Hui-Lin Chin, Julian Savulescu","doi":"10.1136/jme-2024-110166","DOIUrl":"10.1136/jme-2024-110166","url":null,"abstract":"This manuscript provides a review of the potential role of newborn genetic testing for autism, and whether the state has an inherent responsibility to facilitate and subsidise this. This is situated within the broader construct of benefits and limitations of genetic testing currently. Potential benefits of such presymptomatic genetic testing include facilitating earlier diagnosis and access to appropriate intervention which can improve the treatment outcome for the child and indirectly benefit caregivers and society by reducing the care needs of the child and adult in future. However, there are several limitations to newborn genetic testing including the variable penetrance of 'autism-risk' genes, marked phenotypic heterogeneity of autism, real-world limitations in access to treatment, potential psychological harm to caregivers and financial considerations. We hence argue for facilitation of diagnostic genetic testing instead, especially for parents who seek to have greater understanding of recurrence likelihoods, related to reproductive decision-making. Facilitation of such testing can be in the form of both financial subsidies and infrastructural elements including availability of testing facilities and trained healthcare personnel for individualised pregenetic and postgenetic test counselling.","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":"142769722","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

Reassessing the role of informed decision-making in cardiac xenotransplantation. 重新评估知情决策在心脏异种移植中的作用。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-12-03 DOI: 10.1136/jme-2024-110496

Alberto Aparicio, Peyton Swanson, Daniel Aillaud De Uriarte

引用次数: 0

Ethics round table: choice and autonomy in obstetrics. 伦理圆桌会议：产科的选择与自主。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-11-29 DOI: 10.1136/jme-2024-110503

Dominic Wilkinson, Safoora Teli, Claire Litchfield, Anna Madeley, Brenda Kelly, Lawrence Impey, Rebecca Ch Brown, Elselijn Kingma, Helen Lynne Turnham

引用次数: 0

It is not about autonomy: realigning the ethical debate on substitute judgement and AI preference predictors in healthcare. 这与自主权无关：重新调整关于医疗保健中的替代判断和人工智能偏好预测的伦理辩论。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-11-27 DOI: 10.1136/jme-2024-110343

Marco Annoni

{"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":"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.","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}

引用次数: 0

On interpreters: the ethics of interpreter use in general practice. 关于口译员：全科医生使用口译员的伦理问题。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-11-27 DOI: 10.1136/jme-2024-110389

Richard Armitage

{"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":"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.","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}

引用次数: 0

Cardiac xenotransplantation: between experimental therapy and palliative care. 心脏异种移植：介于实验治疗和姑息治疗之间。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-11-27 DOI: 10.1136/jme-2024-110487

Marta Szabat

引用次数: 0

Towards an ethics of pronatalism in South Korea (and beyond). 在韩国（及其他地区）实现代孕伦理。

IF 3.3 2区哲学

Journal of Medical Ethics Pub Date : 2024-11-27 DOI: 10.1136/jme-2024-110001

J Y Lee

引用次数: 0

Argument for allowing first-in-human cardiac xenotransplantation clinical trials in paediatric patients. 允许在儿科患者中进行首次人类心脏异种移植临床试验的论据。