Bioethics最新文献

{"title":"Ethical xenotransplant research on human brain-dead decedents.","authors":"Christopher Bobier","doi":"10.1111/bioe.13375","DOIUrl":"https://doi.org/10.1111/bioe.13375","url":null,"abstract":"<p><p>Can it be ethical to conduct xenotransplant research on a human brain-dead decedent (HB-DD) whose organs could otherwise be given to persons in need? The ethical consensus is that it is better to save existing persons via organ donation than to devote a HB-DD to research that will not directly benefit anyone. I argue otherwise. Given how rapidly xenotransplant research is progressing, and its clinical promise in the next couple of years or decades, I argue that it can be ethical to conduct xenotransplant research on a HB-DD whose organs could otherwise be given to individuals in need.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577194","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":"Biomedical moral enhancement for psychopaths.","authors":"Junsik Yoon","doi":"10.1111/bioe.13373","DOIUrl":"https://doi.org/10.1111/bioe.13373","url":null,"abstract":"<p><p>This study examines the ethical permissibility of biomedical moral enhancement (BME) for psychopaths, considering both coercive and voluntary approaches. To do so, I will first briefly explain what psychopaths are and some normative implications of these facts. I will then ethically examine three scenarios of BME for psychopaths: (1) coercive BME for non-criminal psychopaths, (2) coercive BME for psychopathic offenders, and (3) voluntary BME for psychopathic offenders. I will argue that coercive BME for non-criminal psychopaths is ethically problematic due to issues of cost, invasion of privacy, and stigmatic effects of compulsory diagnosis. Similarly, I will argue that coercive BME for criminals is impermissible due to violations of the rights to bodily and mental integrity. However, I will show that voluntary BME for offenders may be ethically permissible under certain conditions, challenging the critique that the consent of vulnerable prisoners cannot be considered fully voluntary. I argue that when an offender is provided with sufficient medical and legal information, incentives such as the possibility of parole review based on BME results do not preclude the voluntariness of consent. Ultimately, I aim to advance the debate on BME for psychopaths by delineating and defending conditions for the ethical permissibility of voluntary BME.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577190","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 ethics of autonomous neurosurgical robots (ANRs).","authors":"Arturo Balaguer Townsend","doi":"10.1111/bioe.13369","DOIUrl":"https://doi.org/10.1111/bioe.13369","url":null,"abstract":"<p><p>It may only be a handful of years before fully autonomous neurosurgical robots (ANRs) are pushed into widespread clinical adoption. Nevertheless, whether it is ethical to greenlight the development and adoption of ANRs is still up for debate. On the one hand, the widespread adoption of ANRs may lead to unprecedented therapeutic effects, increase sterility, improve pain profiles, increase precision, and reduce complications over the long term. On the other hand, ANRs may lead to human neurosurgical skill atrophy, increased legal uncertainty, increased burnout rates, and may produce no significant effect on pain profiles or complication rates, all of which may put patients at novel levels of risk. At this watershed, it is critical for stakeholders to preemptively deliberate about whether they would ultimately agree to these ethical trade-offs and decide to consciously support, thus help usher in the advent of autonomous neurosurgical technology.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577197","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":"Accuracy is inaccurate: Why a focus on diagnostic accuracy for medical chatbot AIs will not lead to improved health outcomes.","authors":"Stephen R Milford","doi":"10.1111/bioe.13365","DOIUrl":"https://doi.org/10.1111/bioe.13365","url":null,"abstract":"<p><p>Since its launch in November 2022, ChatGPT has become a global phenomenon, sparking widespread public interest in chatbot artificial intelligences (AIs) generally. While not approved for medical use, it is capable of passing all three United States medical licensing exams and offers diagnostic accuracy comparable to a human doctor. It seems inevitable that it, and tools like it, are and will be used by the general public to provide medical diagnostic information or treatment plans. Before we are taken in by the promise of a golden age for chatbot medical AIs, it would be wise to consider the implications of using these tools as either supplements to, or substitutes for, human doctors. With the rise of publicly available chatbot AIs, there has been a keen focus on research into the diagnostic accuracy of these tools. This, however, has left a notable gap in our understanding of the implications for health outcomes of these tools. Diagnosis accuracy is only part of good health care. For example, crucial to positive health outcomes is the doctor-patient relationship. This paper challenges the recent focus on diagnostic accuracy by drawing attention to the causal relationship between doctor-patient relationships and health outcomes arguing that chatbot AIs may even hinder outcomes in numerous ways including subtracting the elements of perception and observation that are crucial to clinical consultations. The paper offers brief suggestions to improve chatbot medical AIs so as to positively impact health outcomes.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549084","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":"Purely performative resuscitation: Treating the patient as an object.","authors":"Aleksy Tarasenko-Struc","doi":"10.1111/bioe.13357","DOIUrl":"https://doi.org/10.1111/bioe.13357","url":null,"abstract":"<p><p>Despite its prevalence today, the practice of purely performative resuscitation (PPR)-paradigmatically, the \"slow code\"-has attracted more critics in bioethics than defenders. The most common criticism of the slow code is that it's fundamentally deceptive or harmful, while the most common justification offered is that it may benefit the patient's loved ones, by symbolically honoring the patient or the care team's relationship with the family. I argue that critics and defenders of the slow code each have a point. Advocates of the slow code are right that not all PPR is wrongly deceptive or harmful to the patient or his family and that the symbolic aspect of medicine is itself morally significant. But the critics are also correct: slow codes are prima facie wrong. I argue that pursuing a slow code amounts to treating the patient as a tool for others' benefit-hence, treating him as an object-and that this instrumentalizing quality constitutes one core prima facie wrong of the practice. I also build a case for the idea that the slow code may not always be all-things-considered wrong, specifying certain limited conditions under which acts of PPR might ultimately be permissible. Thus, the symbolic dimension of medical treatment is indeed morally important, both in morally favorable and in morally problematic respects-namely, in its symbolic denial of the patient's humanity.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513411","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":"Show and slow codes: A historical analysis of clinicians' adaptations to ethical overreach.","authors":"Robert Baker","doi":"10.1111/bioe.13367","DOIUrl":"https://doi.org/10.1111/bioe.13367","url":null,"abstract":"<p><p>After briefly reviewing the historical development and ethical regulation of resuscitative technologies, this study probes why clinicians engage in the morally problematic practice of show and slow coding and why hospitals tolerate it? Studies conducted in 1995 and 2020 indicate that conscientious clinicians engage in these practices to protect their patients from abusive or futile resuscitation. And hospitals' clinical cultures tolerate these practices to protect conscientious clinicians from censure, dismissal, delicensing, or legal prosecution for withholding or withdrawing abusive or futile resuscitative technologies without prior patient or surrogate consent. Show and slow coding evolved in American clinical cultures in the second half of the 20th century when closed-chest cardiac massage, defibrillators, ventilators, and other resuscitative technologies raised seemingly novel ethical questions. To address these questions, bioethics commissions, healthcare societies, lawmakers, and a Roman Catholic Pope developed ethics standards requiring clinicians to obtain patient or surrogate consent before withholding or withdrawing resuscitative technologies. They thus conferred on patients an implicit right of resuscitation even if it was abusive and/or futile. Conscientious clinicians circumvented this implicit right by show and slow coding to protect patients from abusive resuscitation. Recognizing clinicians' benign intent, hospitals' clinical cultures tolerate show and slow coding as acts of conscience, akin to civil disobedience. Thus, rescinding ethics standards and laws requiring prior patient/surrogate consent for non-resuscitation or for cessation of resuscitative technologies decisions should end show/slow coding. Such a reform should also recognize clinicians' right of conscientious refusal to perform CPR.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513412","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":"Social media or scholarly submission? Appropriate responses and academic attention.","authors":"Elizabeth Lanphier","doi":"10.1111/bioe.13366","DOIUrl":"https://doi.org/10.1111/bioe.13366","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481543","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":"Many thanks to Bioethics reviewers","authors":"","doi":"10.1111/bioe.13363","DOIUrl":"https://doi.org/10.1111/bioe.13363","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447493","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":"Digitalization, health, and ageing","authors":"Regina Müller,&nbsp;Elisabeth Langmann,&nbsp;Hans-Jörg Ehni","doi":"10.1111/bioe.13362","DOIUrl":"https://doi.org/10.1111/bioe.13362","url":null,"abstract":"&lt;p&gt;The use of digital technologies in health care has increased rapidly in recent decades and ranges from wellness apps via artificial intelligence and Big Data technologies to care robots. At the same time, there is a strong demographic shift in most European countries, with a growing number of individuals entering their older years. Population ageing generates new needs in healthcare sectors as they are confronted with an increasing demand for services for older adults. Digitalization, especially driven by advancements in data analytics and algorithm-based technologies, promises to deliver innovative solutions to address the complex healthcare requirements of an ageing demographic. Technologies for older adults, for example, digital technologies for communication, assistive robots for care or rehabilitation, and technologies for ageing at home, promise opportunities for more efficient, cost-effective, and patient-centred care for older adults. At the same time, there are a lot of questions regarding the ethical and social aspects in the context of digitalization and ageing. Exemplarily, what does “ageing at home” or “ageing well” mean in the context of digital technologies? How are autonomy, empowerment, and vulnerability related to digital technologies for older individuals? To what extent is ageism perpetuated in technology? What would be a just distribution of resources for digital health care, and how can we ensure access to digital health care for older adults? Despite these many questions, a debate is currently lacking that brings together the ethical and social aspects of digitalization in health care for older individuals. In this special issue, we will delve into the multifaceted relationship between digitalization and health care in the context of ageing, shedding light on the impact of technology on the way we understand and address the health and well-being of older adults.&lt;/p&gt;&lt;p&gt;We present five contributions here that examine these and other key questions raised by the convergence of digitalization, health care, and ageing. The issues were discussed at the DiGesA research retreat, hosted by the Institute of Ethics and History of Medicine, University of Tübingen, in 2023. This retreat brought together scientists and experts from different disciplines to explore the ethical, legal, and social issues related to digitization, health, and older age and helped to crystallize the key points at issue.&lt;/p&gt;&lt;p&gt;The special issue opens with an article on the paradox of ageing in the digital age by Joan Albreda Llorca and Pablo García-Barranquero. Emphasizing the importance of societal values and understandings of ageing, the authors draw on Rowe and Kahn's concept of “successful ageing” and critically analyses the relationships between digitization and societal perceptions of ageing. It is suggested that if ageing is associated with unproductivity and obsolescence, the rapid pace of digital change may cause biologically and chronologically youn","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13362","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447554","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":"Slow codes, multiple layers of deception, and partial solutions.","authors":"Christopher Meyers","doi":"10.1111/bioe.13361","DOIUrl":"https://doi.org/10.1111/bioe.13361","url":null,"abstract":"<p><p>It is not unusual for patients or families to disagree with healthcare professionals (HCPs) over best treatment options. Conversation typically results and mutually agreeable choices are implemented. Rarely, but increasingly, patients or families will request, even demand, interventions the treating team believes will be ineffective (they will not achieve the intended goal) or inappropriate (the medical or moral harms clearly outweigh any potential benefits). One's duty as an HCP requires one to refuse such interventions, but resulting patient or family conflict makes such refusals challenging, even traumatic, and HCPs often acquiesce. Some states have legal options that protect HCPs and their respective institutions when they make such unilateral choices, but the process is complex, time-consuming, and emotionally fraught. In this paper, We describe one especially difficult case, using it as a paradigmatic example of when, and why, a slow code is sometimes, if rarely, justified. We also discuss strategies HCPs can use to reduce the need for this, admittedly problematic, solution.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395518","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}