Journal of Bioethical Inquiry最新文献

{"title":"Mapping the Representation of Race and Other Health Disparities in U.S. Orthopaedic Journals : A Scoping Review.","authors":"D Vitkovska, C Wang, A Borole, A Tyagi, Y T Zhang, S Lamba, R Mittal","doi":"10.1007/s11673-026-10558-4","DOIUrl":"10.1007/s11673-026-10558-4","url":null,"abstract":"<p><p>Background Although interest in health disparities has expanded across medicine, the extent to which race and other social determinants of health are represented in orthopaedic research is unclear. Orthopaedics has traditionally emphasized biomechanical and procedural outcomes rather than structural or social drivers of inequity. This study maps how race and other determinants-gender, socioeconomic status, geography, and insurance-are represented within U.S. orthopaedic surgery journals. Methods A scoping review was performed following PRISMA-ScR guidelines. Searches in PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, and Web of Science (2014-2024) identified orthopaedic publications addressing health disparities. Eligible articles analysed or reported variables such as race, ethnicity, sex/gender, socioeconomic status, geography, or insurance. Two reviewers independently screened and charted data. Results Among more than 180,000 articles across sixty-nine orthopaedic journals, 333 (<0.5 per cent) met inclusion criteria. Race/ethnicity appeared most frequently (94 per cent), followed by sex/gender (77 per cent), insurance (39 per cent), socioeconomic status (29 per cent), and geography (24 per cent). Nearly half of the included articles were published in 2022 or later. Of race-related articles, 58 per cent included race only as a demographic descriptor, while 42 per cent analysed race as a primary focus. Conclusion Despite recent growth, health disparities remain minimally represented in orthopaedic literature, with most studies using race descriptively rather than examining structural inequity. Greater engagement with social determinants is needed to advance equitable musculoskeletal care and uphold core bioethical principles.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safeguarding Physical and Mental Health Rights in African Conflict Regions: Ethical Responsibilities, Barriers, and Collaborative Efforts.","authors":"Adetayo Emmanuel Obasa","doi":"10.1007/s11673-026-10585-1","DOIUrl":"https://doi.org/10.1007/s11673-026-10585-1","url":null,"abstract":"<p><p>Armed conflicts in Africa disrupt physical and mental healthcare, yet ethical frameworks guiding interventions remain underdeveloped and rarely grounded in local political, cultural, and global realities. Mental health, chronically underfunded, is further devastated by conflict. This paper advances a human rights ethics approach to safeguarding health rights. Integrating Martha Nussbaum's capabilities approach, John Rawls's difference principle, and the African value of ubuntu, it focuses on mental health while assigning responsibilities to global actors whose economic policies fuel conflict. It reframes destruction of health infrastructure, cultural stigma, and weak accountability as violations of dignity and justice, not logistical challenges. Subsidiarity assigns primary responsibility to local actors; international actors bear a duty of solidarity, including addressing upstream conflict drivers. Restoring mental health services empowers individuals and communities-agency is central to healing. Short-term actions include integrating mental health into emergency responses, scaling community-based care, and launching culturally grounded anti-stigma campaigns. Long-term, resilient health systems and accountability, through the African Court on Human and Peoples' Rights and targeted international measures that avoid civilian harm-can hold violators responsible, even governments. Grounded in a coherent, locally situated human rights ethics, even fragile settings can advance the right to health, affirming dignity and solidarity as non-negotiable in war.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ibsen's An Enemy of the People and the Ethics of Public Health Disclosure.","authors":"Halil Tekiner, Steven H Yale, Eileen S Yale","doi":"10.1007/s11673-026-10589-x","DOIUrl":"https://doi.org/10.1007/s11673-026-10589-x","url":null,"abstract":"<p><p>Henrik Ibsen's An Enemy of the People (1882) dramatizes a physician's discovery that his town's spa waters are contaminated. His efforts to disclose this danger lead to a collapse of civic support, as the truth threatens the town's economic and political interests. Beyond being a literary classic, the play serves as a case study in the ethics of public health disclosure. This article places the drama in the context of nineteenth century medical history and explores why Dr. Stockmann fails to communicate the truth effectively. Drawing on virtue ethics, public health frameworks, and organizational research, we argue that candor alone is insufficient: ethical disclosure requires courage tempered by prudence, solid evidence, community support, reciprocity, and institutional backing. Historical analogues and contemporary lessons show how verification, proportionate remedies, and clear communication channels can turn conflict into protection. In contrast to Stockmann's final solitude, medical ethics must ensure that clinicians who sound the alarm are not left to face opposition alone but are supported in safeguarding the public good, even amid seemingly overwhelming resistance.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Unconsciousness the Intention? Physicians' Perspectives on Palliative Sedation Outside Specialized Palliative Care: A Qualitative Study.","authors":"Charles Midol, Paulo Rodrigues","doi":"10.1007/s11673-026-10578-0","DOIUrl":"https://doi.org/10.1007/s11673-026-10578-0","url":null,"abstract":"<p><p>Background The principle of double effect is often invoked to interpret clinical intentions in palliative sedation (PS), considering that intended effect may differ from foreseen effect. Despite clarifications, intentions concerning patient consciousness remain ambiguous. Moreover, little is known about how non-palliative care specialists understand and apply these intentions. Methods This study aims to explore physicians' intentions regarding PS, with a particular focus on the relationship between their intentions and patients' consciousness. This qualitative study is based on twelve semi-structured interviews with physicians from a university hospital in France. The methodology combined hierarchical evocation, clinical vignettes, and semi-structured interviews. Results The study reveals considerable heterogeneity in physicians' intentions regarding patient unconsciousness. The distinction between intended and foreseen effects was often poorly understood. References to the doctrine of double effect were rare, whereas the principle of proportionality was more frequently acknowledged. Conclusion This study reveals important discrepancies between specialized frameworks and the conceptual models of clinical reasoning. We particularly highlighted the inadequacy of the principle of double effect to enable an explicit evaluation of the ethical significance of induced unconsciousness and proposed a more integrated approach to palliative sedation, grounded in contemporary evidence, and proportionality.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethics and Autonomy in Schizophrenia Care : Reflections from a Latin American Perspective.","authors":"Gonzalo Navarrete-Ríos, Patricia Rubí-González, Mariela Gatica-Saavedra, Alexis Vielma-Aguilera","doi":"10.1007/s11673-026-10569-1","DOIUrl":"https://doi.org/10.1007/s11673-026-10569-1","url":null,"abstract":"<p><p>Bioethics has undergone significant evolution in recent decades, particularly in its application to medical sciences and mental health. Its purpose has been to provide solutions to ethical conflicts that arise in healthcare. In this paper, we review the principle of autonomy in the context of people diagnosed with schizophrenia. In schizophrenia, the main difficulty people face is the ability to make decisions autonomously. This ability is affected primarily by the fluctuating nature of the symptoms and particularly their impact on cognition and judgement. This paper discusses the aspects of this condition that affect autonomy and how to address them from a healthcare perspective, with a view to avoiding depersonalization and respecting people's right to make decisions about their lives and treatment. Securing these aims proves to be highly complex when a person's consent must be obtained and health conditions prevent them from exercising this capacity. The possibility of establishing a balance between autonomy and obtaining the best possible care is an ethical dilemma that persists in mental health treatment, particularly for people diagnosed with schizophrenia. In this situation, advance directives in psychiatry are a viable mechanism to sustain the exercise of autonomy. However, they are still under-utilized, and some medical teams resist their implementation. In Latin America, their use is more restricted. With this in mind, it is necessary to discuss projections for their use, the requirements for their implementation, and to generate reflection among professionals regarding the bioethical and legal challenges raised by the prospect of incorporating advance directives in the treatment of people with schizophrenia.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advance Research Directives and Supported Consent in Dementia Research.","authors":"Nevena Divac, Nikola Samardžić","doi":"10.1007/s11673-026-10579-z","DOIUrl":"https://doi.org/10.1007/s11673-026-10579-z","url":null,"abstract":"<p><p>Obtaining ethically valid consent for clinical research involving persons with dementia remains a persistent challenge, as cognitive decline disrupts traditional models of informed consent based on participant's capacity to understand the content and freely decide. As a result, individuals are frequently excluded from research or enrolled through proxy consent that may insufficiently reflect their values and autonomous commitments. Recent ethical and policy debates have increasingly promoted advance research directives and supported decision‑making as means of addressing these challenges and enhancing inclusion. This manuscript examines the ethical roles and limitations of advance research directives and supported consent in dementia research. Based on the concept of precedent autonomy, we maintain that advance research directives have distinctive normative importance in the research setting, where participation may involve risks or burdens without direct therapeutic benefit. At the same time, we critically consider supported decision‑making, identifying ethical risks including undue influence, oversimplification of material information, misinterpretation of assent, and the substitution of supporters' preferences for participants' choice. To address these tensions, we propose a hybrid consent model that integrates advance research directives with supported decision‑making, ongoing assessment of assent and dissent, and procedural safeguards. This model implies consent as a continuous ethical process rather than a single event, balancing respect for prior autonomous commitments with sensitivity to present expressions, and well-being. We suggest that such an approach offers a more ethically defensible and practical framework for dementia research, consistent with rights‑based principles and established research ethics standards.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148254296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practice Guidelines in Surgical Malpractice Litigation: An Analysis of California Trial Court Orders.","authors":"E C Calabrese, J Cooks, W Babidge, M Bismark, G Maddern","doi":"10.1007/s11673-026-10576-2","DOIUrl":"https://doi.org/10.1007/s11673-026-10576-2","url":null,"abstract":"<p><p>Background Clinical practice guideline (CPG) development is a time- and resource-intensive process, yet their uptake may be limited by concerns among clinicians that guidelines could be used against them in malpractice cases. The role of CPGs in surgical litigation remains unclear. Aim To empirically evaluate how CPGs are used in surgical civil law and determine whether cited guidelines are surgery specific. Methods A systematic review of California Civil Trial Court Orders (Westlaw) was searched for surgery-related cases from 2021-2024. Case dockets were reviewed for guideline-based recommendations in expert testimony and in the Summary of Motion documents. Results A total of 192 cases were reviewed with eighty-three meeting inclusion criteria. CPGs were cited in three of eighty-three surgical malpractice cases (3.6 per cent), none of which were surgery specific. Conclusion CPGs appear to be rarely cited in surgical civil court cases and when referenced, they relate to non-surgical aspects of care. However, their violation may provide courts with decisive grounds for legal deliberation. Further studies evaluating a larger number of settlement cases using insurance company data would be invaluable to fully understand the role of surgical and non-surgical guidelines in shaping surgical medicolegal proceedings.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Imperative to Live Fully.","authors":"Karim Benammar","doi":"10.1007/s11673-026-10591-3","DOIUrl":"https://doi.org/10.1007/s11673-026-10591-3","url":null,"abstract":"<p><p>How did a philosopher who celebrated eccentricity, eroticism, and excess come to embrace the starkest of normative concepts, the imperative? This essay explores this productive tension in the work and life of Alphonso Lingis (1933-2025), drawing on a philosophical exchange and friendship spanning more than three decades. Lingis adapted Kant's concept of the imperative to argue that we are summoned, before and beyond reason, to accompany the dying, to respond to the elemental forces of nature, and to honour the singular gift of our lives by dedicating ourselves to the task that calls to us. Lingis's thinking resonates with Emmanuel Levinas's grounding of ethics in the vulnerability of the face of the Other, yet he anchored his imperative in deeply personal encounters with strangers who risked everything to save him. This personal and philosophical tribute traces how his extraordinary, unconventional life exemplified his insistence that we are all under an imperative to live fully.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulating Life, Challenging the Law: Creation and Responsibility in the Governance of Human Embryo Models.","authors":"S Soni","doi":"10.1007/s11673-026-10567-3","DOIUrl":"https://doi.org/10.1007/s11673-026-10567-3","url":null,"abstract":"<p><p>Rapid advances in stem cell science have generated stem cell-based embryo models (SCBEMs), multicellular structures derived from pluripotent stem cells that recapitulate key features of early human development without originating from fertilization. Although the literature also refers to these entities as \"human embryo models\" or \"embryoids,\" this article adopts the term SCBEM to reflect their stem cell derivation and to maintain terminological precision. Originally presented as an alternative research platform to embryos, SCBEMs are increasingly exhibiting embryo-like structural and developmental organization. Their trajectory raises a familiar ethical warning about scientific creation outpacing responsibility and exposes significant gaps in legal definitions that rely on origin-based criteria (fertilization, cloning, parthenogenesis) instead of functional characteristics and demonstrated developmental potential. This article develops a South African-centred analysis within a comparative frame, arguing for a bespoke governance framework that is principled, proportionate, and adaptive. It proposes: (i) revised statutory definitions that are tethered to potential and organization; (ii) specialist oversight and a national register; (iii) a culture-limit policy that is aligned with resemblance (and distinct from the fourteen-day rule which applies in relation to embryos); (iv) bright-line prohibitions on any reproductive use or transfer into human or animal hosts; and (v) mechanisms for public trust, transparency, and cross-border harmonization. The aim is to enable socially valuable research while closing loopholes that could erode ethics oversight and public confidence. This article clarifies the legal-ethical problem through the lenses of potentiality and developmental resemblance, maps the comparative governance of SCBEMs with lessons for South Africa, and offers a model framework which includes definitions, oversight architecture, culture-limit policy, prohibitions, and transparency that are designed to be future-ready. A doctrinal analysis of primary law and authoritative guidance was adopted, supplemented by comparative review and governance design principles (proportionality, accountability, transparency). Where formal sources are silent, policy-ready rules were derived from best-practice codes and ethics literature.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Do the Bells Toll? : How to Understand and Address the Disputes Around Evidence in Support of the Use of Puberty Blockers for Young People with Gender Incongruence/Dysphoria.","authors":"Simona Giordano","doi":"10.1007/s11673-026-10556-6","DOIUrl":"https://doi.org/10.1007/s11673-026-10556-6","url":null,"abstract":"<p><p>Disputes around puberty blockers and gender-affirming hormones for transgender and gender-diverse youth (TGDY) are often framed as disputes around evidence. Recent reviews, including NICE (2020) and the Cass Review (2024), have characterized the supporting evidence as \"remarkably weak,\" prompting calls for further research and regulatory restrictions. This paper explains why producing more or \"better\" data is unlikely to resolve these disputes. Drawing on Kuhn's account of paradigms and the theory-ladenness of observation, I show that disagreements in paediatric gender medicine reflect not merely gaps in knowledge but deeper metaphysical and normative divergences about sex, gender, health, human development, and the legitimate goals of medical intervention. What counts as evidence, which outcomes matter, and how findings are interpreted depend on competing conceptual frameworks and value commitments. In this light, the proliferation of studies and continuing dissatisfaction with their results are symptomatic of a paradigmatic crisis, rather than a simple evidentiary deficit. This paper does not deny in any way the value of empirical research. It rather points out that appeals to \"evidence\" risk obscuring the normative dimensions of clinical judgment. Resolution will depend less on the accumulation of data than on explicit ethical deliberation, clinical experience, and engagement with the worldviews that shape what is taken to be meaningful knowledge. This paper first explains why repeated calls for stronger evidence persist despite a substantial empirical literature, by showing that these calls rest on divergent standards of evidential relevance. Second, it shows that the dispute is paradigmatic and as such cannot be adjudicated by data alone. This paper resolves an apparent impasse in the literature and clarifies the limits of data-driven resolution, with implications for clinical guideline development and evidence review processes.</p>","PeriodicalId":50252,"journal":{"name":"Journal of Bioethical Inquiry","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148151789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}