Hec Forum最新文献

{"title":"Biological-Age Scoring and the Risk of Algorithmic Age Discrimination: An Institutional Ethics Framework.","authors":"Henry Bair","doi":"10.1007/s10730-026-09606-8","DOIUrl":"https://doi.org/10.1007/s10730-026-09606-8","url":null,"abstract":"<p><p>Biological-age scores translate biomarkers and other health data into an age, age gap, organ age, or pace-of-aging estimate. Consumer testing is expanding, and actuarial literature has begun to examine these scores, although widespread discriminatory use has not been documented. The ethical concern is anticipatory. Healthcare institutions can give biological-age scores clinical and social authority by interpreting them, entering them into records, and permitting secondary use. These scores warrant focused attention because they express a complex prediction through age, a familiar and legally salient classification that already structures access to employment, insurance, benefits, and care. Social disadvantage is also associated with accelerated biological aging, creating a pathway through which prior injustice could shape later decisions about access, eligibility, or cost. This commentary follows a biological-age score from creation to institutional use and shows how protections attached to particular data types, holders, sectors, regulated conduct, or statutory categories leave no comprehensive rule for decisions based on the derived age classification. It proposes an evidentiary gate, a distinction between supportive and adverse uses, scrutiny of normalizing effects, and procedural safeguards. The framework gives healthcare institutions, clinicians, and ethics committees practical guidance before biological age becomes an ordinary basis for allocating care, opportunity, or cost.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799263","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":"A War of All Against All? Futility, Value Impositions, and Professional Norms.","authors":"Samuel Berendes","doi":"10.1007/s10730-026-09608-6","DOIUrl":"10.1007/s10730-026-09608-6","url":null,"abstract":"<p><p>Defining and applying 'futility' has proven to be a contentious endeavor within bioethics. So contentious that our vocabulary about and conceptualization of futility have shifted to the use of 'potentially inappropriate' or 'non-beneficial' treatment. A longstanding concern has been that futility determinations are in no way objective and are instead a subjective, values-based determination. Recent scholarship has highlighted the relation of the undecided nature of futility to the problem of values imposition. Specifically, Autumn Fiester has argued that futility laws and policies can become an exercise of the 'tyranny of the majority'; the values system(s) of physicians become pitted against the values system(s) of normative minorities. In light of such critiques, I argue that futility determinations are more properly seen as an exercise of a professional objection to non-beneficence. Such a framework is distinct from conscientious objection, which generally centers an individual, as it takes into account the particular moral community(-ies) that shape understandings of futility. That is, I consider whether what is happening in futility determinations, and any subsequent disputes, is best described as a result of the medical profession's values system(s) and the moral significance of such a system. I further consider how specific institutions may legitimately give rise to divergent, localized understandings of futility that may provide a path forward in navigating futility disputes. Overall, I argue for a reframing of futility that seeks to recognize the practice for what it is and allows for a path forward without concealed values impositions.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724495","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":"Healing Without Certainty: The Ethical Significance of Uncertainty in Israeli Medicine in the Age of Artificial Intelligence.","authors":"Rotem Waitzman","doi":"10.1007/s10730-026-09610-y","DOIUrl":"10.1007/s10730-026-09610-y","url":null,"abstract":"<p><p>The growing integration of artificial intelligence into healthcare is frequently associated with efforts to reduce uncertainty through prediction, data analysis, and computational decision support. Recent work on generative and foundation models has intensified this aspiration while also documenting new uncertainties involving model error, variable performance, opacity, bias, and the conditions of meaningful human oversight. This conceptual and normative article argues that uncertainty in medicine is a multidimensional feature of practice rather than a single informational deficit that technology can progressively eliminate. Drawing on philosophy of medicine, medical ethics, sociology of medicine, and recent AI ethics literature, the article distinguishes epistemic, ontological, moral, communicative, and systemic uncertainty. Predictive technologies may reduce selected epistemic uncertainties, but they can also redistribute uncertainty to questions of model validity, workflow integration, and responsibility. Other uncertainties arise from value conflict, human variability, communication, and the application of population-level evidence to particular patients. The analysis examines predictive analytics, clinical decision support, and generative AI, and argues that predictive performance does not by itself settle clinical or ethical judgment. Israel is used as a bounded illustrative context, not as an empirical case study or as representative of all Israeli practice. Its digital infrastructure, current AI governance initiatives, and experience of prolonged emergency conditions make visible both the utility and the limits of prediction. The article proposes five principles for responsible integration: complementarity, proportionality, accountability, fairness, and human-centred care. Its claim is not that uncertainty is intrinsically valuable or should be preserved when it can safely be reduced. Rather, ethically responsible practice requires epistemic humility, honest communication, contestability, and deliberation where uncertainty persists. The framework is offered as a philosophical proposal requiring empirical testing with clinicians, patients, and institutions.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727002","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":"An Ethical Analysis of a Healthcare Scandal: Lessons from the \"Newborn Gang\" Case.","authors":"Fatma Zehra Oztek Celebi, Serap Sahinoglu","doi":"10.1007/s10730-026-09604-w","DOIUrl":"https://doi.org/10.1007/s10730-026-09604-w","url":null,"abstract":"<p><p>The \"Newborn Gang\" scandal, which emerged in Türkiye in 2024, exposed allegations of organized fraud, manipulation of neonatal intensive care referrals, financial exploitation of the healthcare reimbursement system, and preventable infant deaths. While previous publications have contributed important perspectives on the case, including its political, economic, and ethical dimensions, there remains a need for a more comprehensive ethical analysis integrating clinical, organizational, and health system perspectives. This study reconstructs the chronology of the case using publicly available documents, official reports, parliamentary records, academic publications, and media sources, and examines its ethical implications through a systems-oriented adaptation of the Four-Box Method. Rather than applying the framework as a bedside decision-making model, it is used as an analytical structure to evaluate ethical failures at clinical, organizational, and health system levels. The analysis demonstrates that the scandal involved profound violations of professional integrity, informed consent, patient autonomy, and the best interests of newborns, while exposing structural vulnerabilities in governance, financial incentives, regulatory oversight, and institutional accountability. The findings are further interpreted across micro, meso, and macro levels, highlighting the interaction between individual misconduct and systemic failures. The study argues that preventing similar events requires more than legal sanctions; it necessitates stronger ethical governance, organizational accountability, clinical ethics support, transparent auditing mechanisms, and healthcare policies that prioritize patient welfare over financial incentives. These lessons are relevant beyond Türkiye and contribute to broader discussions on ethics, and patient safety in contemporary healthcare systems.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674448","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":"Clinical Ethics in the Practice of Electroconvulsive Therapy: Between Beneficence, Autonomy, Personal Identity, and Social Taboo.","authors":"Guillaume Durand, Anne Sauvaget","doi":"10.1007/s10730-026-09602-y","DOIUrl":"https://doi.org/10.1007/s10730-026-09602-y","url":null,"abstract":"<p><p>Electroconvulsive therapy (ECT), although proven effective in the treatment of severe, treatment-resistant psychiatric disorders, remains the subject of persistent ethical controversy. When ECT is proposed to elderly patients with severe psychiatric illness who refuse treatment, ethical uncertainty is particularly acute. Drawing on a Clinical Ethics Consultation (CEC), a qualitative clinical-ethical analysis was conducted using an interdisciplinary approach and the four principles of bioethics: beneficence, non-maleficence, autonomy, and justice. The analysis focused on the case of an elderly patient with Cotard's syndrome who refused care. The case of Ms B. brought to light four major axes of ethical reflection: (1) the balance between beneficence and justice in the pursuit of a proportionate therapeutic benefit; (2) tensions between autonomy and consent when illness impairs decisional capacity; (3) the question of personal identity in the context of a treatment that acts on memory and self-awareness; and (4) the enduring weight of the social and historical taboo surrounding ECT. Clinical ethics emerges as a privileged space for collective reflection and discernment, articulating care, responsibility, and humanity. Far from trivializing ECT, clinical ethics helps restore its moral legitimacy, provided that prudence, transparency, and shared deliberation are ensured.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632284","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":"Toward Standard Approaches for Notification and Direct Communication with Families in Pediatric Clinical Ethics Consultation.","authors":"Aaron Wightman, Luke Mosley, Brennan Kim, Brittany Greene, Phoebe Winn, Arika Moore, Vanessa Madrigal, Jennifer Kett","doi":"10.1007/s10730-026-09603-x","DOIUrl":"https://doi.org/10.1007/s10730-026-09603-x","url":null,"abstract":"<p><p>The ASBH Core Competencies identify two core features of clinical ethics consultation: (1) identify and analyze the nature of the value uncertainty and (2) facilitate the building of a \"principled ethical resolution.\" Central to these processes is understanding the perspective of the patient and/or their surrogate, yet the practices of notification and communication with surrogates, often parents, are varied in pediatric ethics consultation. In this paper we will review guidance on notification and communication with surrogates in clinical ethics consultation, the published literature on practices in US pediatric clinical ethics consultation in particular, and analyze justifications for and against routine notification and communication. Finally, we will present draft guidance for a standard approach to communication with families in pediatric ethics consultation.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632271","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":"Bearing the Burden of Clinical Ethics Consultation: Requests, Roles, and Responses.","authors":"Anna D Goff, Marsha M Michie, Marcie A Lambrix, Monica L Gerrek","doi":"10.1007/s10730-026-09597-6","DOIUrl":"10.1007/s10730-026-09597-6","url":null,"abstract":"<p><p>The continued evolution of clinical ethics has prompted extensive discussion about the roles clinical ethicists ought to assume in practice, with the discussion focusing largely on what these professionals bring to healthcare. The emotional impact of assuming such roles is less commonly considered despite the fact that clinical ethicists frequently navigate situations of ethical complexity and conflict. We recently interviewed 34 U.S. clinical ethicists about their experiences and learned that the desire to be helpful is resulting in these professionals assuming a wide range of roles and responsibilities. Furthermore, we found that clinical ethicists are regularly emotionally impacted by their work and that they often carry an emotional burden as a result of the roles they assume in patient care. In this article, we explore this burden and discuss what it reveals about the field of clinical ethics at this pivotal point in its development.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593935","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":"Preventing Harm through Appropriate Surgical Intervention: An Ethical Analysis of Orthopedic Arthroscopic Surgery.","authors":"Anthony Peterson, Ashton Powell, Bryan Pilkington","doi":"10.1007/s10730-026-09601-z","DOIUrl":"https://doi.org/10.1007/s10730-026-09601-z","url":null,"abstract":"<p><p>Arthroscopic surgery (AS) for chronic joint pain has demonstrated limited and inconsistent long-term benefit over conservative management (CM), despite evidence of possible short-term symptomatic improvement in selected populations. Arguments supporting continued use often rely on informed consent. However, informed consent alone cannot justify an intervention without a reasonable expectation of meaningful patient benefit along with a favorable risk-benefit ratio. This paper proposes an ethical framework for evaluating when offering OAS may remain ethically justified despite limited evidence of long-term efficacy. We first identify two primary ethical considerations that should generally guide decisions regarding OAS: (1) the expectation of meaningful patient benefit, including long-term clinical improvement, prevention of greater structural harm, or other sufficiently important patient-centered outcomes, and (2) a favorable risk-benefit assessment that incorporates procedural risk as well as financial and opportunity costs. We then explore additional categories of patient-specific benefit-including temporal; psychological and identity-related; social and caregiving; and harm-reduction considerations-which, in selected cases, may constitute ethically relevant forms of benefit or avoided harm that support offering surgery even when traditional measures of long-term efficacy would otherwise not. Together, these considerations suggest that AS should not be routine but may be ethically appropriate in carefully selected cases where patient-specific factors meaningfully influence the overall risk-benefit balance.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473534","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":"The Dread Art.","authors":"Thomas S Helling","doi":"10.1007/s10730-026-09596-7","DOIUrl":"https://doi.org/10.1007/s10730-026-09596-7","url":null,"abstract":"<p><p>The career of a surgeon is among the most challenging of medical specialties. Demands for exactitude, endurance, and equanimity pile an even higher burden on an already terribly complex scope of knowledge, judgement, and technical expertise. It is no wonder that, despite the marvels of modern medicine, pitfalls abound in the life of the surgical practitioner. Nature does not always abide by the scientific algorithms of evidence-based skills. Patients suffer, patients die, blame abounds, disappointment ripens, and personal merit wavers. In its wake looms anger, volatility, depression, and withdrawal. Burnout: the triad of exhaustion, depersonalization, and discouragement sneaks in. The solution? Understanding of the pressures of surgical practice, compassion for fellow surgeons, an effort to teach better life-work balance, and, most of all, forgiveness for understandable acts of omission or commission; due diligence, of course, but also a recognition of the fallibility of not only human enterprises but the fallibility of medical science in general.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473437","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":"Beyond Resilience: Organizational Ethics and the Structural Production of Moral Distress in Healthcare.","authors":"Jay J Oh, Leanne Wakefield","doi":"10.1007/s10730-026-09599-4","DOIUrl":"https://doi.org/10.1007/s10730-026-09599-4","url":null,"abstract":"<p><p>Moral distress among healthcare clinicians is widely acknowledged but persistently misunderstood. The dominant institutional response has been to prescribe individual-level interventions, including resilience training, mindfulness programming, and wellness initiatives, to clinicians whose distress often arises from structural conditions beyond their control. This article argues that moral distress and its severe counterpart, moral injury, often arise from organizational ethics failure, while individual psychological factors shape how that distress is experienced rather than serving as its primary cause. Drawing on Pellegrino's account of institutional fidelity to the healing relationship, professional virtue ethics, and organizational ethics theory, the article identifies five structural drivers of moral distress, demonstrates that resilience-based responses constitute a form of moral offloading that compounds institutional harm, and proposes a four-component organizational ethics infrastructure as an affirmative institutional obligation. The article further argues that healthcare organizations must develop organizational ethics capacity beyond bedside consultation to include institutional review of the structures and policies that shape clinical practice. A healthcare institution that demands ethical commitment from its clinicians without ensuring the conditions necessary for ethical practice has violated a foundational professional obligation.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473462","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}