Bioethics最新文献

{"title":"Little Things Mean A Lot","authors":"Ruth Chadwick","doi":"10.1111/bioe.70036","DOIUrl":"10.1111/bioe.70036","url":null,"abstract":"<p>For various reasons I have been doing a lot of hospital visiting lately and it has offered an opportunity to observe the care that is provided by obviously overworked health care professionals, who are routinely faced with challenging situations in conditions that inevitably involve scarcity of resources.</p><p>One incident that I witnessed concerned an apparently frail elderly person whose dentures had been lost in the hospital. The person's daughter was understandably annoyed by this and was offered an opportunity to claim for monetary compensation. While this may be the best that could be offered under the circumstances, it does not address the immediate needs of the patient, as obtaining new dentures may be difficult in this case. At the very least, it would take some time.</p><p>Thinking about this from a bioethical point of view, some might invoke a principle of dignity and argue that to leave a patient without his dentures infringes such a principle, although this obviously was not done deliberately. There are other ways of looking at it, however. With frail elderly patients, considerable focus is naturally placed on capacity to make decisions, and there is a surrounding legal framework to establish what counts as such capacity or the lack of it. There is another, natural, sense of capacity, however, concerning ability to function physically. Without one's dentures the capacity to take in nutrition is clearly compromised.</p><p>This thought leads to consideration of the class of ‘add-ons’ that might have similar importance. Artificial body parts and mobility aids should be considered. Spectacles and hearing aids are obvious examples that spring to mind. Another possible candidate is a watch. While younger generations might rely on their mobile phones for telling the time, for their seniors this might not be the case, and when eyesight is failing, seeing a clock on the wall might be challenging. Knowing what the time is, however, may be important to a patient in maintaining a sense of normality.</p><p>Hospitals cannot be expected to take responsibility for the possessions of their patients. The suggestion being put forward here, however, is that there should be some systems in place to safeguard those patient possessions that are key to their physical functioning. Obviously there are challenges to be faced, for example when patients have to move between beds or wards to facilitate the best care for themselves or for other patients. It is easy to see how possessions might get lost in the transfer. But some of those possessions, such as those mentioned above, are much more important than others (e.g., books and magazines), in so far as they support physical capacity. Where they do not already exist, there should therefore be a system of specific checks in place for these, just as there are mechanisms for checking that the proper medication has been administered. This is because they are in an important sense an extension of the patient's p","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234249","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}

{"title":"Can Global Bioethics Benefit From Islamic Jurisprudential Principles?","authors":"Sayyed Mohamed Muhsin, Abdurezak Abdulahi Hashi, Nageeb Gounjaria, Mohammed H Alashaikh, Alexis Heng Boon Chin","doi":"10.1111/bioe.70035","DOIUrl":"https://doi.org/10.1111/bioe.70035","url":null,"abstract":"<p><p>Contemporary bioethical debates in the West are often polarized between secular liberal and conservative Christian perspectives, leaving limited space for cultural viewpoints rooted in non-Western traditions such as those of Hinduism, Confucianism, Islam and various African value systems. Secular liberalism's emphasis on individual autonomy often clashes with the communitarian and family-centred ethics prevalent in many Asian and African societies (i.e., the Global South). Meanwhile, certain conservative Christian positions, such as blanket opposition to embryo-based stem cell research or abortion even in cases of rape, are increasingly being challenged, including within Western contexts, for their perceived inflexibility and impracticality. Historical trends suggest that rigid ideological frameworks may lose relevance over time, underscoring the need for a more inclusive and pragmatic model of global bioethics. This article examines the potential contribution of fiqh, the science of interpreting Islamic revealed texts, and Maqāṣid al-Sharī'ah (the higher objectives of Islamic law) to the discourse of global bioethics. It explores the intersection of Universalism and Realism in Islamic thought and discusses how Sharī'ah conceptualizes human life and the strategies for its protection, particularly through the principle of the Preservation of Life (ḥifẓ al-nafs) as a central objective. Furthermore, it analyses the role of maṣlaḥah (public interest), the function of Islamic legal maxims as a roadmap to achieving ethical goals, and the centrality of family and community in Islamic ethics. These themes are considered in contrast to the individualistic values predominant in Western bioethical frameworks.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179523","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":"I Feel I Need to Think about It: A Defence of Affective Moral Enhancement.","authors":"Pei-Hua Huang","doi":"10.1111/bioe.70033","DOIUrl":"https://doi.org/10.1111/bioe.70033","url":null,"abstract":"<p><p>Critics of affective moral enhancement generally contend that moral improvement can only be properly achieved through interventions that engage a person's rational faculties. Therefore, they view attempts to achieve moral improvement by targeting emotions as futile at best and detrimental to moral agency at worst. In this paper, I argue that even if we accept the view that genuine moral improvement requires the engagement of rational faculties, we need not reject all forms of affective moral enhancement. My argument premises on the view that certain types of affect are highly informative. Affective moral enhancement that aims to elicit these affective states grants enhancement recipients access to vital moral knowledge they may not be able to attain otherwise. I then introduce the distinction between two types of affect-emotions and moods-and argue that the concerns regarding affective moral enhancement only apply to interventions that aim to achieve moral improvement via direct mood modulation.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115085","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":"When Is It Safe to Introduce an AI System Into Healthcare? A Practical Decision Algorithm for the Ethical Implementation of Black-Box AI in Medicine.","authors":"Jemima Winifred Allen, Dominic Wilkinson, Julian Savulescu","doi":"10.1111/bioe.70032","DOIUrl":"https://doi.org/10.1111/bioe.70032","url":null,"abstract":"<p><p>There is mounting global interest in the revolutionary potential of AI tools. However, its use in healthcare carries certain risks. Some argue that opaque ('black box') AI systems in particular undermine patients' informed consent. While interpretable models offer an alternative, this approach may be impossible with generative AI and large language models (LLMs). Thus, we propose that AI tools should be evaluated for clinical use based on their implementation risk, rather than interpretability. We introduce a practical decision algorithm for the clinical implementation of black-box AI by evaluating its risk of implementation. Applied to the case of an LLM for surgical informed consent, we assess a system's implementation risk by evaluating: (1) technical robustness, (2) implementation feasibility and (3) analysis of harms and benefits. Accordingly, the system is categorised as minimal-risk (standard use), moderate-risk (innovative use) or high-risk (experimental use). Recommendations for implementation are proportional to risk, requiring more oversight for higher-risk categories. The algorithm also considers the system's cost-effectiveness and patients' informed consent.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082534","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":"Violence Toward Palestinians in Israeli Prisons During the \"Iron Swords\" War.","authors":"Daniel J N Weishut, Bettina Steiner-Birmanns","doi":"10.1111/bioe.70034","DOIUrl":"https://doi.org/10.1111/bioe.70034","url":null,"abstract":"<p><p>This study examines the violence inflicted upon Palestinians in Israeli prisons during the initial phase of the \"Iron Swords\" war, which commenced following a Hamas attack on Israeli civilians on October 7, 2023. It investigates how wartime circumstances can intensify the use of torture and ill-treatment within prisons, with a particular focus on the impact on detainees who were not implicated in activities connected to the attack. Utilizing the case files of Palestinian security prisoners who lodged complaints of mistreatment with Israeli NGOs, the study uses descriptive analysis to categorize and quantify diverse forms of reported violence that could potentially constitute torture. The study's findings reveal a concerning pattern: all 19 subjects reported experiencing violence from prison staff, with 18 of these cases involving physical violence. Multiple claims referenced more than one instance of violence, and eleven claims additionally reported violence against other detainees. The claims of violence spanned seven different prisons, underscoring the systemic nature of the issue. Reported methods of violence encompassed beatings, forced positioning in painful postures, threats, and humiliation, sometimes with sexual undertones, among other forms of abuse. Seven subjects had visible bruises and wounds, two suffered broken limbs, and one sustained a fractured tooth. These findings suggest a correlation between war, a decline in ethical standards, and the abuse of prisoners. By bringing these issues to light, the study advocates for evaluating prison practices and a commitment to upholding human rights standards, even during violent conflict and war.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066301","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":"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7618141/pdf/","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":"OA","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}