Monash Bioethics Review最新文献

{"title":"Illustrating the contribution of Confucian philosophy through a reinterpretation of Beauchamp and Childress' principle of respect for autonomy.","authors":"Charlene Tan, Ruth Neo","doi":"10.1007/s40592-025-00257-y","DOIUrl":"https://doi.org/10.1007/s40592-025-00257-y","url":null,"abstract":"<p><p>This article illustrates the contribution of Chinese philosophy to the field of medical humanities by focussing on the ideas and conduct of Confucius. Drawing on a Chinese philosophical classic, the Analects (Lunyu), this study proposes a Confucian reinterpretation of Beauchamp and Childress' principle of respect for autonomy in medical ethics. The paper begins by critiquing Beauchamp and Childress' three conditions of autonomous action, namely intentionality, understanding, and the absence of controlling influences that determine one's action. It is contended that the three conditions over-emphasise rationality and overlook the role of emotions and morality in autonomy. The second part of the article proposes a Confucian reformulation of the three conditions that is derived from the concepts of xin (heart-mind) and li (normative behaviour). The modified conditions are moral intentionality, the integration of understanding and emotions, and the absence of controlling influences that determine one's action and underlying values, beliefs, attitudes, feelings and predispositions. From a Confucian perspective, Beauchamp and Childress' positive obligation for the principle of respect for autonomy requires medical professionals to render empathetic treatment towards patients. By challenging and reconstructing major theories and assumptions in medical ethics, this paper demonstrates the saliency of non-Western philosophical traditions in medical humanities.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Historical perspectives in medical humanities: two views on vaccination during the plague pandemic in Calcutta.","authors":"Utsa Bose","doi":"10.1007/s40592-025-00251-4","DOIUrl":"https://doi.org/10.1007/s40592-025-00251-4","url":null,"abstract":"<p><p>The aim of this article is to complicate and rethink histories of non-Western responses to vaccination, as well as to see how a historical perspective may contribute to contemporary discussions of vaccines within the medical humanities. This is done through a case study approach. The focus of this article is a collection of essays written by a Bengali prophet-astrologer and published during the plague pandemic in Calcutta, British India, at the turn of the twentieth century (1899). While one essay in the collection was critical of the plague vaccine, another essay, in a later section of the same collection, celebrated the vaccine and its developer Waldemar M. Haffkine. The first part of the article situates the context of the text's production, as well as the background of the author. In the second part, it analyses the reasons why the plague vaccine was criticised. In the third part, it looks at how the author celebrated the plague vaccine in a later section of the collection. In the fourth section, it attempts to answer why the astrologer changed his view on vaccination. Finally, in the conclusion, it discusses how this case study intervenes historiographically, and how certain themes raised by the source persist today, reiterating the importance of a historical perspective.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracoabdominal normothermic regional perfusion: Is it ethical?","authors":"Caner Turan","doi":"10.1007/s40592-025-00229-2","DOIUrl":"10.1007/s40592-025-00229-2","url":null,"abstract":"<p><p>Thoracoabdominal normothermic regional perfusion (TA-NRP), a new method of controlled donation after circulatory death, seems to provide more and better organs for patients on organ transplant waiting lists compared to standard controlled donation after circulatory death. Despite its benefits, the ethical permissibility of TA-NRP is currently a highly debated issue. The recent statement published by the American College of Physicians (ACP) highlights the reasons for these debates. Critics' main concern is that TA-NRP violates the Dead Donor Rule. This paper presents an ethical analysis of the objections raised by the ACP against TA-NRP and argues that TA-NRP is not only morally permissible but also morally required where it is financially and technically feasible. To support this conclusion, the concepts of 'resuscitation,' 'intention,' 'irreversibility,' 'permanence,' 'impossibility,' and 'respect' in the context of TA-NRP are explored. Additionally, the ethical permissibility of this procedure is evaluated through the lenses of Utilitarianism, Kantianism, the core principles of bioethics, and the Doctrine of Double Effect. This ethical analysis demonstrates why the ACP's objection lacks a solid moral foundation and conflates moral and legal considerations. This paper also argues that extra measures are needed to ensure the moral permissibility of TA-NRP, emphasizing the importance of informed consent, additional brain blood flow and activity monitoring, and a contingency plan to abort the organ procurement process if a sign of morally relevant brain activity is detected.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"166-189"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A duty to enhance? Genetic engineering for the human Mars settlement.","authors":"Evie Kendal","doi":"10.1007/s40592-024-00221-2","DOIUrl":"10.1007/s40592-024-00221-2","url":null,"abstract":"<p><p>Humans living off-world will face numerous physical, psychological and social challenges and are likely to suffer negative health effects due to their lack of evolutionary adaptation to space environments. While some of the necessary adaptations may develop naturally over many generations, genetic technologies could be used to speed this process along, potentially improving the wellbeing of early space settlers and their offspring. With broad support, such a program could lead to significant genetic modification of off-world communities, for example, to limit radiation damage on body systems or prevent bone and muscle loss in reduced gravity conditions. Given the extreme stressors of living off-world, and the need to have a healthy workforce to support a fledgling human settlement, those in favour of using genetic technologies to enhance settlers might even claim there is a moral imperative to protect their health in the face of the unique threats of space travel, especially for children born in settlements who did not take on these risks voluntarily. For some, this might simply be an extension of procreative beneficence. However, ethical concerns arise regarding the risks of embracing a eugenicist agenda and the potential impacts on the rights of future settlers to refuse such genetic enhancements for themselves or their children.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"128-149"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the ethics expert in Spanish legislation on euthanasia and mental health.","authors":"Sergio Ramos-Pozón","doi":"10.1007/s40592-025-00228-3","DOIUrl":"10.1007/s40592-025-00228-3","url":null,"abstract":"<p><p>This article examines the assessment of mental capacity in the context of euthanasia, particularly when requested by patients with mental illnesses. It proposes a holistic alternative approach to the traditional functional model, arguing that the latter is insufficient to capture the complexity of these patients' decisions. Using approaches based on narrative, hermeneutic, and dialogical ethics, it offers an evaluation that considers the patient's life story, values, and context. Shared decision-making and empathy are identified as fundamental components to ensure informed and consensual decisions, promoting an environment of respect and mutual understanding. The article reviews Spanish legislation on euthanasia, highlighting the need to include medical ethics experts in the Guarantee and Evaluation Commissions. These experts provide a comprehensive ethical perspective essential for addressing the ethical complexities in euthanasia requests and ensuring fair decisions that reflect the patient's true will. It recommends reviewing and expanding current protocols, as well as including continuous ethics training to improve medical practice in this context. The conclusions suggest that an assessment of mental capacity based on ethical principles and an integrated narrative can significantly improve medical practice and decision-making in euthanasia, especially for these patients. Furthermore, the inclusion of ethics experts in the commissions can provide a more humane and just perspective, ensuring that decisions respect the patient's dignity and autonomy.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"82-96"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of lives in New Zealand.","authors":"Martin Lally","doi":"10.1007/s40592-024-00225-y","DOIUrl":"10.1007/s40592-024-00225-y","url":null,"abstract":"<p><p>There is currently a pronounced lack of uniformity in the values placed on a life or a QALY by different New Zealand government entities taking actions designed to save lives or QALYs. With some limited exceptions, equity suggests that all QALYs be equally valued, and therefore likewise for all lives with the same residual life expectancy and quality of life. Prima facie, this is attainable by adopting the best (and only credible) New Zealand estimate of the value of life (the NZTA's $12.5 m value of the life of a median age person in good health), and using that or its QALY equivalent as a cutoff figure to determine interventions throughout the public sector. This provides opportunities for large welfare gains, from curtailing existing interventions that currently use much larger cutoff values (such as earthquake strengthening regulations) and expanding interventions that currently use much smaller cutoff values (such as public health spending). However, the NZTA's figure is only applicable to small increases in lives saved, and must decline as the number of additional lives saved increases. This relationship should be estimated.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"60-81"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Confugenics - East Asian culture favors uptake of human cognitive enhancement and IVF genetic technologies amid demographic challenges.","authors":"Alexis Heng Boon Chin, Jon Rueda, Ningyu Sun, Truc Ngoc Hoang Dang, Jean Didier Bosenge-Nguma, Nik Norliati Fitri Md Nor, Sayyed Mohamed Muhsin","doi":"10.1007/s40592-025-00244-3","DOIUrl":"10.1007/s40592-025-00244-3","url":null,"abstract":"<p><p>This study examines the declining fertility rates in East Asian Confucian societies, focusing on the unique childrearing practices and how future advancements in human enhancement and reprogenetic technologies may further accelerate the demographic decline. The focus is on the obsession with \"child perfectionism\" driven by the pursuit of academic credentialism and hypercompetitive social norms. This phenomenon has roots in the historical imperial examinations of China and has evolved into modern college entrance exams. Recent growth in knowledge-based and technology-driven economies in East Asia has further fueled this trend, leading to the widespread practice of \"tiger parenting\" whereby parents push their children into the competitive educational system at an early age, often paying high fees for private tuition. Such intense pressure discourages many families from having more children, with some couples choosing not to have any children at all. The development of cognitive-enhancing brain chips and reprogenetic technology platforms for consumer eugenics, such as germline genome editing and polygenic embryo screening, may further increase financial strain on parents, potentially accelerating demographic decline. The term \"Confugenics\" is thus proposed to describe the intersection of these new eugenics and enhancement technologies with the Confucian emphasis on academic success, which may worsen the demographic crisis.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"97-127"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of members of ethics committees of medical institutions in India on controlled human infection studies (CHIS) following a sensitization workshop: a systematic survey.","authors":"Subitha Lakshminarayanan, P Muthu Kumaran, Suganya Jayaram, Jayanthi Mathaiyan, Medha Rajappa","doi":"10.1007/s40592-025-00231-8","DOIUrl":"10.1007/s40592-025-00231-8","url":null,"abstract":"<p><p>Controlled Human Infection Studies (CHIS) involving the deliberate exposure of healthy individuals to infectious agents, are emerging as a valuable tool for medical research. This systematic survey explores the perceptions of ethics committee members from various Indian medical research institutions after participating in a sensitization workshop on CHIS. This cross-sectional study was conducted on the workshop participants through an online survey. The workshop was held in a hybrid mode and around 60 participants from four tertiary care institutions and research institutes had participated. A structured questionnaire was used to assess their evolving perspectives, challenges, and recommendations related to CHIS and the effectiveness of the workshop. Both Likert scale and open-ended items were included in the survey. Responses are presented as percentage and views supported through the quotes from responses. Around 43 participants responded to the survey (72%). Participants acknowledged the potential benefits of CHIS but were concerned about the psychological harm and other risks. Challenges were identified in conducting and reviewing CHIS, including regulatory approvals, risk assessment, and robust informed consent. The need for development of regulatory guidelines, specialized training, risk mitigation strategies, community engagement, and compensation mechanisms were highlighted. The sensitization workshop was considered valuable in enhancing participants' understanding of CHIS, although participants expressed a need for continued training and experience to effectively review such studies. With the Indian Council of Medical Research (ICMR) releasing a policy statement on ethical conduct of CHIS in India, this study provides a foundation for future capacity-building initiatives among ethics committee members. The findings emphasize the significance of ongoing dialogue to standardize the ethical review process for CHIS, thus facilitating their acceptance and realization in India's medical research landscape.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"190-203"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on cardiopulmonary resuscitation in the frail population: a scoping review.","authors":"David Armour, Despina Boyiazis, Belinda Delardes","doi":"10.1007/s40592-024-00220-3","DOIUrl":"10.1007/s40592-024-00220-3","url":null,"abstract":"<p><p>Frail and elderly persons approaching end of life who suffer cardiac arrest are often subject to rigorous, undignified, and inappropriate resuscitation attempts despite poor outcomes. This scoping review aims to investigate how people feel about the appropriateness of CPR in this population. This review was guided by the PRISMA-ScR methodological framework. A search strategy was developed for four online databases (MEDLINE, EMCARE, PSYCHINFO, CINAHL). Two reviewers were utilised for title/abstract screening, full text review and data extraction. Full text, peer reviewed studies were eligible for inclusion which discussed perspectives in the frail and/or elderly population with a focus on cardiopulmonary resuscitation (CPR). The database search yielded 3693 references (MEDLINE n = 1417, EMCARE n = 1505, PSYCHINFO n = 13, CINAHL n = 758). Following removal of duplicates (n = 953), title and abstract screening was performed on 2740 papers. A total of 2634 articles did not meet the inclusion criteria. Twenty-five studies were included in the scoping review and analysed for data extraction. Five themes emerged: (i) Preferences towards CPR, (ii) Preferences against CPR, (iii) Poor knowledge of CPR/Estimated survival rates, (iv) Do Not Resuscitate Orders, and (v) Decisional authority. This scoping review maps and describes the common perspectives shared by CPR stakeholders in the frail/elderly population. Findings revealed CPR decisions are often made based on incorrect knowledge, DNAR orders are frequently underused, CPR decisional authority remains vague and healthcare professionals have mixed views on the appropriateness of CPR in this population.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"34-59"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of HRECs in regulating medical research: from peer review to regulation.","authors":"Lisa Eckstein, Jenny C Kaldor, Cameron Stewart","doi":"10.1007/s40592-025-00248-z","DOIUrl":"10.1007/s40592-025-00248-z","url":null,"abstract":"<p><p>In Australia, Human Research Ethics Committees (HRECs) play a ubiquitous role reviewing human subjects research, as do Institutional Review Boards in the US and elsewhere. While HRECs were established as peer review bodies, we argue they should now be characterised a 'devolved regulator' within the broader context of the regulatory state. We evidence HRECs' regulatory role through three examples of current responsibilities. By categorising HRECs as a regulator, we are able to assess their role through a regulatory lens. Drawing on Reeve and Magnusson's 'regulatory scaffolding' approach, we suggest key ways in which the role provided by HRECs could be improved. These include setting clear roles and responsibilities HREC review; ensuring HREC accountability for the substantive aspects of their decision making; and accountability for trial sponsors who seek review of trials under the Clinical Trials Notification Scheme. Deficits in the above must incur a credible expectation of escalation and review.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"204-224"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}