Bioethics最新文献

{"title":"Community Engagement Strategy for Building Trust in Human Challenge Studies Using Participatory and Creative Methods: An Ethical Imperative.","authors":"Evelyn Muleba Kunda-Ng'andu, Masuzyo Chirwa, Seke Muzazu, Natasha Laban, Caroline Chisenga, Michelo Simuyandi, Stanley Mwale, Roma Chilengi, Anjali Sharma","doi":"10.1111/bioe.70028","DOIUrl":"https://doi.org/10.1111/bioe.70028","url":null,"abstract":"<p><p>Human Infection Challenge studies (HICs) are crucial for advancing global understanding of disease pathogenesis, immune responses, and accelerating vaccine and drug development. Explorations on willingness to participate among medical students revealed the need to ensure full understanding of HIC requirements, for example, for residency, by the broader community. This raised the question of 'How could we ensure informed and understood consent for the ethical conduct of HIC?' We employed iterative participatory discovery and creative design methods, including three Zoom meetings and discussions with university students and community leaders. Neighbourhood Health Committee leaders further refined suggested creatives of a future mass-media campaign for building trust in HICs. Deliberative focus group discussions and workshops were conducted on communication strategies on HICs' requirements, risks, requirements, and benefits. The final creative brief suggested (1) using a pyramid approach utilizing existing community structures, to introduce HIC concepts progressively to larger groups, (2) engaging communities through theatre for development, community dialogue, and engagement meetings, and wide society through social and mass media advertisements, and (3) preference for the term 'Human Challenge Studies' over 'Human Infection Challenge Studies'. We learned that community engagement, if properly conducted, can create systems of ownership of research and build communication strategies to achieve an accurate understanding of HICs and use informed participation that results in trustworthy data. We need further research, including in rural areas, pilot testing of evaluation strategies, and continued engagement with diverse stakeholders to create products that can be adapted by future HIC studies in settings such as Zambia.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoughtful Accompaniment in Life's Final Stages: Philosophical Practice as a Complement to Ethics Consultation.","authors":"Patrick Schuchter, Sandra Radinger, Stefanie Veronika Rieger, Klaus Wegleitner","doi":"10.1111/bioe.70031","DOIUrl":"https://doi.org/10.1111/bioe.70031","url":null,"abstract":"<p><p>This paper argues that philosophical practice can complement existing medical ethics structures by offering a publicly accessible space for discourse and negotiation of basic concepts that are relevant to ethical decision making. The potential of collaboration becomes particularly evident by the example of assisted dying: it raises a wide range of philosophical questions which, however, tend to remain unarticulated where there is urgency for action and focus on ethical dilemma. In this paper, we first provide an analysis of the neglect of profound questions in ethics consultation and why these need to be considered and negotiated within a broader socio-philosophical framework and place. These reflections are grounded in conceptual approaches informed by Immanuel Kant, Charles Taylor, and the tradition of Hellenistic philosophy as interpreted by Pierre Hadot. These frameworks are not presented as final answers, but as productive starting points and historically significant philosophical thought figures for engaging with the complex philosophical dimensions of assisted suicide. Then, we draw upon insights from an ongoing research project on philosophical practice in palliative care and hospice work. Interim results indicate that people experience a need for a kind of dialogue that gives such philosophical considerations a space and a person who is capable of facilitating it. Synthesizing theoretical-philosophical and empirical insights, the paper provides an outlook for fruitful collaboration amongst medical ethics structures and philosophical practice.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering Patient Autonomy: The Role of Large Language Models (LLMs) in Scaffolding Informed Consent in Medical Practice.","authors":"Jemima W Allen, Neil Levy, Dominic Wilkinson","doi":"10.1111/bioe.70030","DOIUrl":"https://doi.org/10.1111/bioe.70030","url":null,"abstract":"<p><p>The principle of (respect for) patient autonomy has traditionally emphasized independence in medical decision-making, reflecting a broader commitment to epistemic individualism. However, recent philosophical work has challenged this view, suggesting that autonomous decisions are inherently dependent on epistemic and social supports. Wilkinson and Levy's \"scaffolded model\" of autonomy demonstrates how our everyday decisions rely on distributed cognition and various forms of epistemic scaffolding-from consulting others to using technological aids like maps or calculators. This paper explores how Large Language Models (LLMs) could operationalize scaffolded autonomy in medical informed consent. We argue that rather than undermining patient autonomy, appropriately designed LLM systems could enhance it by providing flexible, personalized support for information processing and value clarification. Drawing on examples from clinical practice, we examine how LLMs might serve as cognitive scaffolds in three key areas: enhancing information accessibility and comprehension, supporting value clarification, and facilitating culturally appropriate decision-making processes. However, implementing LLMs in consent procedures raises important challenges regarding epistemic responsibility, authenticity of choice, and the maintenance of appropriate human oversight. We analyze these challenges through the lens of scaffolded autonomy, arguing that successful implementation requires moving beyond simple questions of information provision to consider how technological systems can support genuinely autonomous decision-making. The paper concludes by proposing practical guidelines for LLM implementation while highlighting broader philosophical questions about the nature of autonomous choice in technologically mediated environments.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Anger Paradox: How Angry Should Physicians Be?","authors":"Sigrid Wallaert, Seppe Segers","doi":"10.1111/bioe.70029","DOIUrl":"https://doi.org/10.1111/bioe.70029","url":null,"abstract":"<p><p>This article starts from the question: how angry should physicians be? Since the literature so far has mostly focused on patient anger, we endeavor to turn bioethical attention to physician anger instead. After specifying our central question in four different ways-in terms of its normativity, its use of the term \"physicians,\" the implied patient-directed nature of this anger, and the difference between feeling and behaving angrily-we posit the anger paradox (AP) to help guide our argument. We discuss whether anger might damage the therapeutic relationship, or whether it could be a necessary expression of care. We follow three steps in looking at whether physicians can feel, should feel, or should express anger. We complicate the question of care and its objects by introducing Frankfurt's distinction between first- and second-order desires. Finally, we look at the distinction between apt and appropriate anger, concluding that while physician anger can sometimes be apt, it is never appropriate to express toward patients.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Islamic Bioethical Reflections on Organ Bioprinting: Promises and Challenges.","authors":"Seyma Yazici, Ahmad Rashad","doi":"10.1111/bioe.70025","DOIUrl":"10.1111/bioe.70025","url":null,"abstract":"<p><p>The shortage of organ donors poses a major challenge, often leading to patient deaths due to the lack of transplants. Additionally, transplant recipients face lifelong immunosuppression, which brings further health risks. The use of stem cells and biomaterials to develop bioinks for bioprinting technology holds the potential to create personalized tissues and organs that closely replicate the size and structure of their natural counterparts. This could provide a revolutionary solution to the organ shortage crisis. Even though the technology has not yet reached the stage of fully functional organs, it is becoming more accessible with the advent of affordable bioprinters and bioinks. As this technology develops, bioethicists are working with biomedical researchers to address the ethical issues that arise before its widespread therapeutic use. Nevertheless, the role of religion in these bioethical discourses remains relatively unexplored. This paper examines the bioethical issues surrounding bioprinting, with a particular focus on Islamic bioethics. In this study, we examined key bioethical issues within the Islamic framework, including the purpose of the technology, its safety, the use of stem cells and animal-derived biomaterials, and its commercialization. Additionally, we argued that certain organs, particularly reproductive organs, require deeper examination from an Islamic bioethical perspective, given the sensitive nature of reproduction and its wide-ranging social, cultural, and moral implications. The bioprinting of reproductive organs could have significant impact on parenthood, lineage, and familial structures and may give rise to intricate challenges concerning marital and inheritance rights, thereby necessitating careful consideration of the ethical and legal implications.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Participation in Clinical Ethics Interventions: A Requirement of Procedural and Epistemic Justice.","authors":"Marleen Eijkholt","doi":"10.1111/bioe.70027","DOIUrl":"https://doi.org/10.1111/bioe.70027","url":null,"abstract":"<p><p>The question whether or not patients ought to be involved in clinical ethics interventions (CEI) remains unresolved. While generally it has been recognized that patients' active participation in health care decisions and processes is important, this is not unequivocally accepted for CEIs. Patient participation in CEI (PP) is common in the United States, but PP seems far from the prevailing practice in Europe. In Europe, CEIs often involve discussions of the ethics issue by the healthcare team only; the patient or proxy is not included, consulted or even informed about such an intervention. In this paper, we submit that policies or standards which resist PP and disable it as an option conflict with procedural and epistemic justice requirements in CEIs. We conceptually develop how the two concepts of procedural justice (PJ) and epistemic justice (EJ) relate to CEIs and to PP. We also engage with four cases to illustrate the risks of injustices and how PP facilitates CEIs to meet justice requirements. We conclude that in settings where CEIs systematically do not involve PP, and where patients are neither asked about the ethics issue nor informed about the intervention, policy and practice presumptions should be adjusted.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Giving and Reflections on Life Extension: How Love Might Shape the Choice of Whether to Live Past a Natural Human Lifespan.","authors":"Andrew Moeller, Ann-Marie Shorrocks, Keith Lemna","doi":"10.1111/bioe.70024","DOIUrl":"https://doi.org/10.1111/bioe.70024","url":null,"abstract":"<p><p>Drawing upon a deprivationist account of the badness of death, Ingemar Patrick Linden advocates for a hypothetical state called \"contingent immortality.\" The future Linden champions is one in which every person would be able to live for as long as they would like, save for events like accidents or murder. We recognize Linden's foundational claims in defense of contingent immortality as weighty and reasonable, but consider whether there are defensible reasons to forgo the inhibition of aging and living well past a natural human lifespan. Drawing partly upon the work of Carter Snead and Alasdair MacIntyre, we outline the nature of self-giving love, how love provides for many persons a measure of meaning and purpose in life, and the ways in which given and self-imposed limitations can help imbue our actions as embodied beings with a particular and richer sense of that meaning and purpose. We conclude that love provides defensible grounds as to why one might reasonably choose to accept our shared human identity as creatures with naturally bounded lifespans. This conclusion takes into account both the benefits and costs of love, especially in light of our existence as embodied beings.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Doppelgängers, Human Relationships, and Practical Identity.","authors":"Cristina Voinea, Sebastian Porsdam Mann, Julian Savulescu, Brian D Earp","doi":"10.1111/bioe.70026","DOIUrl":"https://doi.org/10.1111/bioe.70026","url":null,"abstract":"<p><p>In this paper, we examine the potential effects of relationships with Large Language Model (LLM)-based digital doppelgängers (DDs) on users' values, concerns, and interests, that is, on their practical identity. DDs are artificially intelligent conversational agents trained on individuals' data to replicate their speech patterns, mannerisms, and personality traits. We start by showing that practical identity is largely defined by the relationships we find ourselves in or cultivate. Next, we discuss how DDs work and distinguish between task-specific and relational DDs, arguing that the latter are specifically created to take on the role of relational partners by imitating other people we care about. We then consider how relationships with DDs might shape individuals' practical identities, before concluding with some general thoughts regarding what we should be paying attention to before developing and deploying DDs.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Bias to Burden: How Weight Stigma Fuels Eating Disorders","authors":"Wietsze E.P. Groenewoud,&nbsp;R. Deneer","doi":"10.1111/bioe.70004","DOIUrl":"10.1111/bioe.70004","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 8","pages":"782-783"},"PeriodicalIF":2.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conscientious Refuser Accommodation Continues to Undermine Patient Care","authors":"Udo Schuklenk","doi":"10.1111/bioe.70023","DOIUrl":"10.1111/bioe.70023","url":null,"abstract":"&lt;p&gt;The case against the accommodation of conscientious refusers in the health care setting has been made [&lt;span&gt;1&lt;/span&gt;]. Not everyone agrees, of course [&lt;span&gt;2&lt;/span&gt;]. My objective is not to litigate the lack or otherwise of justifications for the accommodation of conscientious refusers. The reader should note that I am only concerned about the accommodation of conscientious refusers, because a conscientious objector could still decide to live up to their professional obligations, while a conscientious refuser has clearly decided not to. Allow me to address today specifically one claim made by critics of conscientious refuser accommodation, namely that by virtue of the idiosyncratic untestable nature of conscience claims access to health care turns into an access lottery, given that patients cannot possibly know what it is that their health care professional may object to on grounds of conscience. Catholic philosophers like Chris Kaczor did respond to this by saying that such concerns are wildly overblown and, for all practical intents and purposes, this isn't a real-world issue in the United States [&lt;span&gt;2&lt;/span&gt;]. Evidence to the contrary exists for a fair number of other countries [&lt;span&gt;1&lt;/span&gt;, pp. 103–109].&lt;/p&gt;&lt;p&gt;But what about the United States? Two Yale University law professors, Douglas NeJaime and Reva B. Siegel have reported some years ago that religious activist pressure groups have drafted model legislation aimed at enshrining conscience rights in state legislation across the United States [&lt;span&gt;3&lt;/span&gt;]. The objective here is on each occasion to subvert patient rights to access care that these groups consider objectionable (typically, but, as we shall see, not limited to, abortion care, life-shortening end-of-life care, IVF for same sex couples).&lt;/p&gt;&lt;p&gt;A risk of these kinds of policies, once enshrined in law, is that they might be so broad as to permit a wide range of unprofessional refusals by health care professionals, to the detriment of patients' access to needed care, even care that should be uncontroversial in the eyes of these pressure groups. This may or may not have been inadvertent, but it remains an uncontrolled effect of current legislation in many states in the United States. As NeJaime and Siegel note in a different paper, “many healthcare refusal laws allow doctors or nurses to refuse to treat a patient even in an emergency situation and do so without requiring that healthcare professionals provide advance notice of their objection to the employer so that the patient receives needed care” [&lt;span&gt;4&lt;/span&gt;]. While supposedly these kinds of laws were driven by the need to protect “life,” they quickly mutated into laws that readily discarded and disrespected human life in the name of cultural conquest.&lt;/p&gt;&lt;p&gt;Which takes me to the foreseeable consequences of the latest such legislation, the state of Tennessee's 2025 &lt;i&gt;Medical Ethics Defense Act&lt;/i&gt;. It passed into law in late April 2025 [&lt;span&gt;5&lt;/span&gt;]. Unsurpris","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 8","pages":"735-736"},"PeriodicalIF":2.1,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}