Monash Bioethics Review最新文献

{"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}

{"title":"Ending the organ trade: an ethical assessment of regulatory possibilities.","authors":"Andreas Albertsen","doi":"10.1007/s40592-025-00232-7","DOIUrl":"10.1007/s40592-025-00232-7","url":null,"abstract":"<p><p>While the trade of human organs are illegal and widely condemned, a black market flourishes. Estimates indicate that 10% of kidney transplants from living donors involve illegal payments to the kidney seller. This paper presents a typology for approaches aimed at curtailing the black market in human organs. The policies are evaluated from two perspectives: their ethical permissibility and their expected efficiency in ending and minimizing the trade in human organs. To end or minimize organ trading, we must reduce the organ shortage in order to reduce demand for organs, alleviate poverty to reduce the supply of organs, and disincentivize brokers and medical facilitators through a concerted effort to reduce the profit rate of the international organ trade.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"150-165"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537861","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":"Chasing 'vulnerability' across six decades of the Declaration of Helsinki.","authors":"Oskar Lindholm, Sakari Karjalainen, Veikko Launis","doi":"10.1007/s40592-025-00235-4","DOIUrl":"10.1007/s40592-025-00235-4","url":null,"abstract":"<p><p>The year 2024 marked the 60th anniversary of the World Medical Association's Declaration of Helsinki (DoH). Coincidentally, the WMA published the 8th revision of this landmark document guiding medical research involving human subjects. One of the key changes in this latest revision concerns the notion of vulnerability, which has always been central to the DoH's ethos. The term 'vulnerability' was explicitly introduced in the 5th revision, published in 2000, which lists five vulnerable groups. Subsequent revisions have significantly altered how vulnerability is portrayed and understood within the document. This article traces the conceptualisation of vulnerability across the various versions of the DoH, culminating in its recently published 8th revision. We explore the underlying principles of each revision and examine how these principles have both influenced and been influenced by broader ethical discourses. Lastly, we address some of the challenges that future revisions must meet to ensure that the document remains internally coherent and practically applicable for researchers and research ethics committees alike.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":"1-33"},"PeriodicalIF":1.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504655","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":"Teaching humanities in UK medical schools: towards community-building and coherence.","authors":"Richard T Bellis, Sally Frampton, Gina Hadley, Jennifer Wallis, Alan Bleakley, Gabriele De Luca","doi":"10.1007/s40592-025-00249-y","DOIUrl":"https://doi.org/10.1007/s40592-025-00249-y","url":null,"abstract":"<p><p>Medical humanities teaching in UK medical schools has lacked cohesion, having developed opportunistically in different locations. Cohesion is necessary to develop an identifiable community of practice, but within that community there can be multiple readings of what 'medical humanities' are and how they may develop. This article details discussions held by medical humanities scholars teaching in UK medical schools at a workshop in January 2025 at the University of Oxford covering five key areas: the role of humanities scholars in medical schools, patients as partners in medical education, core curriculum teaching, intercalated teaching, and assessment. Our discussion highlights opportunities and challenges facing humanities teaching in UK medical schools today and calls for the creation of a community of medical humanities scholars working in UK medical education embracing diversity of opinion and practices. The article is specifically written as a synopsis of a brainstorming symposium.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162595","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":"Human enhancement, past and present.","authors":"Andrew Moeller, Jose Maria Andres Porras","doi":"10.1007/s40592-025-00250-5","DOIUrl":"https://doi.org/10.1007/s40592-025-00250-5","url":null,"abstract":"<p><p>One important role the medical humanities might and should play relates to public education. In this instance, we mean helping persons to think about their own aims or purposes as potential receivers of enhancement interventions, and similarly helping to inform the developers of said interventions. This article argues that, in the light of real and speculative applications of emerging biotechnologies and artificial intelligence aimed at human enhancement-including germline genetic engineering, the linking of the human brain with an artificial general intelligence by way of a brain-computer interface, and various interventions directed toward life extension-historians would do well to consider the following three practices as they participate in the medical humanities and the shared task of public education: (1) Taking under scrutiny a broad swath of topics and timeframes as it relates to past efforts aimed at human enhancement; (2) Focusing on past engagement with enhancement efforts and their perceived relation to the pursuit of living well; and (3) Entering into debates on enhancement as equal participants. In support of these assertions, this article takes efforts directed towards the prolongation of life in medieval Europe as an illustrative example. It also highlights continuities and discontinuities between past and present justifications for human enhancement, and addresses how similarities and differences can shape and challenge contemporary bioethical arguments.</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152080","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":"Contemporary human rights violations in female sterilization care: legal and ethical considerations when coerced patients do consent.","authors":"Liana Woskie, Mindy Jane Roseman","doi":"10.1007/s40592-025-00240-7","DOIUrl":"10.1007/s40592-025-00240-7","url":null,"abstract":"<p><p>In this piece we examine three forms of coercive or otherwise involuntary care that can occur with patient consent. To do so, we examine: (1) uninformed consent, (2) contingency-based consent and (3) constrained-market consent, amongst female sterilization patients. While there is broad recognition that \"coercion\" in sterilization care can manifest beyond instances of overt force and clarity on what constitutes coercion within clinical care, this has not translated to accountability. The current practice of identifying coercion through discrete civil cases may facilitate a narrow understanding of its contemporary prevalence; one that does not align with definitions of coercion supported by international human rights entities. We use three acute, and widely recognized, examples-hysterectomies in ICE detention facilities, India's sterilization camp deaths and birth control quotas for Uyghur women-as an entry point to highlight less overt contemporary forms of coercive sterilization care, pairing each example with data that explores prevalence at a broader population level. These data suggest less visible forms of coercion may persist relatively unchallenged-raising the ethical case for a functional approach to the measurement of coercion. In turn, we argue the relevant question may not be \"when is coercion ethically justified in public health,\" but rather, why is coercion already the status quo?</p>","PeriodicalId":43628,"journal":{"name":"Monash Bioethics Review","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054285","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}