Hec ForumPub Date : 2025-09-01Epub Date: 2022-12-26DOI: 10.1007/s10730-022-09504-9
Shahin Davoudpour, John K Davis
{"title":"Life Extension and Overpopulation: Demography, Morals, and the Malthusian Objection.","authors":"Shahin Davoudpour, John K Davis","doi":"10.1007/s10730-022-09504-9","DOIUrl":"10.1007/s10730-022-09504-9","url":null,"abstract":"<p><p>One of the main objections to life extension is that life extension will cause severe overpopulation. This objection presents both moral and demographic issues. To explore the demographic issue, we present an updated and improved version of the formula in chapter six of New Methuselahs for projecting the demographic impact of life extension. The new version includes additional demographical factors such as non-aging related causes of death. According to projections generated with this revised formula, moderate life extension (a life expectancy of 120 years) will not significantly increase population at the fertility rates current in the developed world, but radical life expectancy (halting aging completely, leading to an average life expectancy of 1000 years) can lead to severe overpopulation even at very low fertility rates. This formula also enables us to ascertain what fertility rate and birth spacing will prevent life extension from causing severe overpopulation. The moral issues arise if radical life extension causes overpopulation severe enough to outweigh the benefits it brings. New Methuselahs proposed a reproductive policy for avoiding severe overpopulation by limiting reproduction for those who use life extension. We then consider a moral objection to this policy that was not discussed in New Methuselahs: it is not likely that society will succeed in imposing limits to reproduction, therefore, it is likely that radical life extension is morally wrong. We respond to this objection and defend our response against two further objections.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"305-331"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10423318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-09-01Epub Date: 2024-11-29DOI: 10.1007/s10730-024-09544-3
Matthew Shea
{"title":"The Ethics of Clinical Ethics.","authors":"Matthew Shea","doi":"10.1007/s10730-024-09544-3","DOIUrl":"10.1007/s10730-024-09544-3","url":null,"abstract":"<p><p>The concept ethics defines health care ethics as a professional practice. Yet the meaning of \"ethics\" is often unclear in the theory and practice of clinical ethics. Clarity on this matter is crucial for understanding the nature of clinical ethics and for debates about the professional identity and proper role of ethicists, the sort of training and skills they should possess, and whether they have ethics expertise. This article examines two different ways the ethics of clinical ethics can be understood: Real Ethics, which consists of objective moral norms grounded in moral truth; and Conventional Ethics, which consists of conventional norms grounded in bioethical consensus. Drawing on the bioethics literature and features of professional practice, it shows that Conventional Ethics is the dominant paradigm. Then it presents a critique of Conventional Ethics, arguing that it cannot avoid the challenge of moral pluralism, it fails to address vitally important moral questions, and it is incapable of providing an essential service to the people ethicists aim to help. It ends with suggestions about how the practice of clinical ethics might overcome these problems.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"389-410"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care.","authors":"Pernilla Pergert, Bert Molewijk, Cecilia Bartholdson","doi":"10.1007/s10730-024-09541-6","DOIUrl":"10.1007/s10730-024-09541-6","url":null,"abstract":"<p><p>Caring for children with cancer involves complex ethical challenges. Ethics Case Reflection (ECR) rounds can be offered to support teams to reflect on challenges and what should be done in patient care. A training course, for facilitators of ECR rounds, has been offered to healthcare professionals (HCPs) in childhood cancer care by a Nordic working group on ethics. During/after the course, the trainees implemented and facilitated ECR rounds in their clinical setting. The aim was to explore the trainees' experiences of implementing ECR rounds in childhood cancer care. HCPs, who participated as trainees in the course, participated in 3 focus group interviews (n = 22) and 27 individual interviews (n = 17). Interview data were analysed concurrently with data collection following classic grounded theory. Positioning ethics is the core category in this study, used to resolve the main concern of doing ethics in a context where direct patient care is prioritized. Being able to take time for ethics reflections, not perceived as the key priority, was considered a luxury in the clinical setting. Strategies for positioning ethics include allying, promoting ethics reflection, scheduling ethics reflection, and identifying ethical dilemmas. These strategies can be more or less successful and vary in intensity. The prioritisation of direct patient care is not surprising, but polarisation between care and ethics needs to be questioned and ethics reflection need to be integrated in standard care. Ethical competence seems to be central in doing ethics and more knowledge on the promotion of ethical competence in practice and education is needed.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"345-356"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-09-01Epub Date: 2024-12-07DOI: 10.1007/s10730-024-09542-5
Cathy L Purvis Lively
{"title":"Creating Barriers to Healthcare and Advance Care Planning by Requiring Hospitals to Ask Patients About Their Immigration Status.","authors":"Cathy L Purvis Lively","doi":"10.1007/s10730-024-09542-5","DOIUrl":"10.1007/s10730-024-09542-5","url":null,"abstract":"<p><p>Florida is currently collecting data on the \"costs of uncompensated care for aliens who are not lawfully present in the U.S.\" (Statutes of Florida, 2023). The Florida data collection law, enacted in 2023, is part of aggressive anti-immigrant legislation. Hospitals accepting Medicaid must inquire about patients' immigration status and submit de-identified reports. In August 2024, the Governor of Texas signed an Executive Order comparable to the Florida statute. Although presented as a data-collection measure, the legal requirements have far-reaching consequences. The potential adverse impacts on immigrants' health pose bioethical concerns. Immigration-related inquiries create barriers to healthcare access and advance care planning, exacerbating healthcare disparities and presenting ethical concerns. This article examines the effects on immigrants and the resulting ethical challenges, including respect for persons, beneficence, non-maleficence, and justice. The article proposes recommendations for mitigating these challenges, including community outreach, patient education, policy development, in-service education, and advocacy. While the legal requirements apply specifically to Florida and Texas, the ethical issues have nationwide relevance.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"357-372"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-09-01Epub Date: 2025-06-13DOI: 10.1007/s10730-025-09551-y
Tom Koch
{"title":"MAiD: How Slippery is its Slope?","authors":"Tom Koch","doi":"10.1007/s10730-025-09551-y","DOIUrl":"10.1007/s10730-025-09551-y","url":null,"abstract":"<p><p>In a November 2024 article of this journal Don A. Merrill suggested Tom Koch's (2023) article \"A Skeptic's Report\" either misunderstood or did not understand a \"slippery slope argument\". That article was an attempt to answer earlier authors who asked if the concerns of researchers prior to enabling legislation had been fulfilled. The \"slippery slope\" was one. In this article, the nature of those early concerns are again considered in relation to the nature of the \"slippery slope event\" that has resulted in an increasing annual number of deaths with progressively looser requirements for early medical termination. Like the original article, it uses Health Canada data to describe what has occurred, not a predictive argument on what may be.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"379-387"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-09-01Epub Date: 2024-12-27DOI: 10.1007/s10730-024-09545-2
Hunter Bissette, Dario Cecchini, Ryan Sterner, Elizabeth Eskander, Veljko Dubljević
{"title":"What's Left of Moral Bioenhancement? Reviewing a 15-Year Debate.","authors":"Hunter Bissette, Dario Cecchini, Ryan Sterner, Elizabeth Eskander, Veljko Dubljević","doi":"10.1007/s10730-024-09545-2","DOIUrl":"10.1007/s10730-024-09545-2","url":null,"abstract":"<p><p>Should we implement biomedical interventions like psychopharmaceuticals or brain stimulation that aim to improve morality in society? Since 2008, moral bioenhancement (MBE) has received considerable attention in bioethics, generating wide scholarly disagreement. However, reviews on the subject are few and either outdated or not structured in method. This paper addresses this gap by providing a scoping review of the last 15 years of debate on MBE (from 2008 to 2022). To enhance clarity, we map the debate into three key areas: the conceptual foundations of MBE (foundational questions), the practical feasibility of MBE (practical questions), and the normative legitimacy of MBE (normative questions). Beyond identifying specific research gaps within these domains, our analysis reveals a general lack of empirical evidence either supporting or opposing MBE, as well as a shift in the literature from a universal interpretation of MBE to a more pragmatic one, targeting specific groups.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"411-434"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-09-01Epub Date: 2024-09-27DOI: 10.1007/s10730-024-09539-0
Sharoon Shahzad, Rehana Sajid, Joel Fakhar, Ayesha Saleem Khan, Nizar Ali, Ahtisham Younas
{"title":"Survey of Moral Distress and Self-Awareness among Health Care Professionals.","authors":"Sharoon Shahzad, Rehana Sajid, Joel Fakhar, Ayesha Saleem Khan, Nizar Ali, Ahtisham Younas","doi":"10.1007/s10730-024-09539-0","DOIUrl":"10.1007/s10730-024-09539-0","url":null,"abstract":"<p><p>Health care professionals experience moral distress due to challenging ethical decision-making during patient care. Self-awareness can be associated with moral distress. This study determined the levels of and relationship between moral distress and self-awareness of health care professionals. A convenience sample of physicians and nurses was recruited. Data were collected using the Moral Distress and Self-Awareness Scales. In total, 168 physicians and 201 nurses participated with a mean age of 30.54 ± 7.87 and clinical experience of 6.40 ± 6.22 years. Moderate levels of moral distress (127.07 ± 71.90) and high levels of self-awareness (70.20 ± 11.37) were found. A weak positive correlation was found between self-awareness and moral distress (r = 0.21, p < 0.001) and weak negative correlation between moral distress (r = - 0.115, p = 0.03) and age. Nurses were more self-aware, but no differences were observed in moral distress based on sex and clinical settings. A weak correlation between self-awareness and moral distress may suggest that self-awareness can increase intrapersonal tensions, contributing to distress. Further research is needed to support any conclusive relationship between moral distress and self-awareness.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"333-344"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-09-01Epub Date: 2024-12-09DOI: 10.1007/s10730-024-09543-4
Don A Merrell
{"title":"Medical Assistance in Dying, Slippery Slopes, and Availability of Care: A Reply to Koch.","authors":"Don A Merrell","doi":"10.1007/s10730-024-09543-4","DOIUrl":"10.1007/s10730-024-09543-4","url":null,"abstract":"<p><p>In 2021, Canada revised its Medical Assistance in Dying (MAID) law, removing the \"reasonably foreseeable death\" requirement. Opponents of MAID voiced concerns about a \"slippery slope\" leading to broader access, with some arguing the line has already been crossed. I examine the arguments against expanded eligibility, particularly those presented by Tom Koch (2023). Koch's reasoning, I submit, is flawed, lacking nuance in its understanding of the slippery slope and relying on a problematic argument about healthcare access.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":"373-377"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-07-19DOI: 10.1007/s10730-025-09552-x
D Robert MacDougall
{"title":"Liberalism and Lockdowns.","authors":"D Robert MacDougall","doi":"10.1007/s10730-025-09552-x","DOIUrl":"https://doi.org/10.1007/s10730-025-09552-x","url":null,"abstract":"","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2025-07-02DOI: 10.1007/s10730-025-09554-9
Bryanna Moore, Shalom Schlagman, Laine E DiNoto, David C Kaufman, Nicholas Mercado, Michael J Nabozny, Marjorie Hodges Shaw
{"title":"\"Don't Tell Them Anything\": Should Surrogate Decision-Makers Be Allowed to Withhold Information from Other Family Members or Prevent Them from Visiting with a Patient?","authors":"Bryanna Moore, Shalom Schlagman, Laine E DiNoto, David C Kaufman, Nicholas Mercado, Michael J Nabozny, Marjorie Hodges Shaw","doi":"10.1007/s10730-025-09554-9","DOIUrl":"https://doi.org/10.1007/s10730-025-09554-9","url":null,"abstract":"<p><p>While patients have the right to control who has access to their health information and designate visitors, it is not always clear whether-when a patient lacks capacity-their surrogate also exercises such rights. States and federal laws are often vague about the limits of surrogate authority. Even where legal or institutional guidance on this issue is clear, requests by surrogates to withhold information or restrict visitation with a patient can be a source of ethical uncertainty and distress on the part of the clinical team. This paper explores the ethical issues raised by such requests. To date, there has been little exploration of this issue in the clinical ethics literature. First, we summarize the scant existing ethical and legal guidance on this issue. Second, we present two potential approaches to navigating requests from surrogates to withhold information or restrict visitation. Third, we discuss the merits and limitations of both approaches, and introduce some additional considerations that further complicate the picture. We argue for a flexible restrictive approach to information-sharing, and a constrained permissive approach to visitation. Finally, we propose several considerations that clinicians and clinical ethicists might think through in these situations to help guide their practice.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}