Bioethics最新文献

{"title":"Revisiting slow codes","authors":"Parker Crutchfield, Jason Adam Wasserman","doi":"10.1111/bioe.13414","DOIUrl":"https://doi.org/10.1111/bioe.13414","url":null,"abstract":"<p>Every year, a small group of Michigan clinical bioethicists get together for a retreat “Up North.” The invitation to attendees instructs them to “bring your best, most out-of-the-box idea.” We workshop these ideas using the step-back consultation method, where, following the presentation of an idea, the audience, rather than subject it to attack, must “take it over” and offer constructive ways to develop it further.</p><p>The two of us are the early risers among the group and have made a habit of taking a brisk 6 a.m. hike through the Michigan woods. After commiserating about life and family and work, our conversations inevitably end up on bioethics. Through some combination of our friendship, the early hour, the intoxicatingly fresh air, and the ethos of the retreat itself, our discussions are always incredibly illuminating and productive. We come back brimming with ideas.</p><p>As we strolled along one morning, one or the other of us mentioned an argument he had been mulling over related to the ethical permissibility of slow codes. The other (we genuinely can't remember who was who) excitedly shared that they were working on something related to the same topic. Down the trails and back by the shores of Higgins Lake, our respective ideas were fleshed out.</p><p>Back home we each got right to work drafting separate pieces, and after trying unsuccessfully to think of ways to combine them, we were left with two distinct articles, but which felt very much like the product of our shared discussion in the woods. More importantly, we thought that if we both felt like the literature on slow codes had been dogmatic and incompletely theorized, maybe others out there thought so too.</p><p>Slow codes (i.e., insincere, fake, or merely performative attempts at resuscitation) have received almost no support as ethically permissible under any conditions in the literature, with the Lantos and Meadows1 piece offering a solitary and narrowly scoped exception. This is unsurprising in some ways. After all, a slow code is fundamentally dishonest. But there are lots of ethically permissible forms of deception in clinical medicine.2 Moreover, admonishments about the unethical nature of slow codes often reach the pollyannish and unsatisfying conclusion that better communication with patients and families and better policies surrounding the withholding or withdrawing of futile or inappropriate care will obviate the need for sham resuscitations.</p><p>While there has been almost no ethical defense of slow codes in the last 50 years, a recent study of clinicians who care for critically ill patients found that they remain prevalent in critical care settings.3 Moreover, half of the participants in this study believed slow codes to be ethical in some cases. The incongruence between clinical practice and ethical canon calls for a moment of disciplinary reflection and a willingness to re-engage in a critical and reflexive way with an issue everyone seems to assume was settle","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 4","pages":"307-308"},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861937","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":"Assisted Dying and Decision-Making Competence: Recent Developments in Austria.","authors":"Christian Arnezeder","doi":"10.1111/bioe.13422","DOIUrl":"https://doi.org/10.1111/bioe.13422","url":null,"abstract":"<p><p>The Austrian law on death disposition confirms that persons willing to die have the right to assisted suicide. The Austrian parliament has provided various measures to distinguish between self-determination, the consequences of disease, and external influence, and to minimize the dangers of abuse. These include an examination of decision-making competence by specialists in psychiatry or clinical psychology as an additional expert supplement if the two physicians who first examine the individual are insufficiently certain as to whether the patient is medically competent to make decisions regarding assisted suicide. The concrete details of this examination remain undetermined by law and can only be derived from other regulations or the science itself. Moreover, studying the decision-making process provides valuable insights into the distinction between assisted suicide and suicide due to mental illness and emphasizes the necessity of mature decisions when ending one's life and self.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046768","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":"Are menstrual periods an environmental liability? Period poverty and eco-feminist bioethics.","authors":"Cristina Richie","doi":"10.1111/bioe.13417","DOIUrl":"https://doi.org/10.1111/bioe.13417","url":null,"abstract":"<p><p>Period poverty has led to many initiatives across the world. In some places, period (or menstrual hygiene management [MHM]) products are free and readily found in restaurants, universities and pubs. However, conversations on mensuration management have also led to discussions on sustainability. One ad in a bathroom states, 'why not try swapping (from tampons or pads) to a…carbon lowering menstrual cup?' This begs the question not only how can menstruation management be more sustainable, but also, since it (ostensibly) is not, do females have an ethical obligation to limit, or eliminate, periods for the sake of environmental conservation? This question speaks to deeper themes whereby females are vilified for their bodies (think: blaming the victim in sexual assault; blaming females in the developing world for having 'too many children'; and blaming females for miscarriages related to high-risk behaviours). This paper will first offer the background of the period poverty movement. It will then explore salient themes related to gender, ecology, ethics and health through the lenses of eco-feminism and feminist bioethics. The third task of the paper will be to analyse the implications of environmental ethics on female physical functioning, with specific attention to menstruation: this may be thought of as a case study in the underdeveloped area of eco-feminist bioethics. After describing the ethical and social issues surrounding sustainability and menstrual hygiene management, the paper, fourth, will return to the question initially raised: the ethical obligation to eliminate menstrual periods for the sake of the environment. The paper will claim that (1) females do not have a special obligation for menstrual elimination based on an environmental rationale, but, like all people, have a general ethical obligation to sustainability in all areas of life, including health care choices. (2) Females retain the right for period elimination for any reason, including environmental reasons.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028337","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":"Simulated gestation: The social and ethical implications of in vivo fertilisation technology.","authors":"Ji-Young Lee, Adrian Villalba, Natalia Fernández-Jimeno","doi":"10.1111/bioe.13416","DOIUrl":"https://doi.org/10.1111/bioe.13416","url":null,"abstract":"<p><p>INVOcell is an in vivo fertilisation device marketed as an alternative to in vitro fertilisation treatment. In this paper, we explore the ethical implications that arise when this device is framed as a type or process of 'gestation'. We anticipate several effects that may be of ethical interest: marketing in vivo fertilisation as being comparable to traditional gestation may be misleading and even harmful to its users, but on the other hand, it captures a potential need to acknowledge and be more inclusive of those who wish to identify diverse reproductive experiences as gestative experiences. In light of these insights, we articulate the concept of 'simulated gestation' as a novel framework to explain, and potentially accommodate, the diverse ways in which assisted reproductive technologies are shaping people's ideas about-and desires for-gestation.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054659","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 commonsense case for common morality.","authors":"Jacob M Appel","doi":"10.1111/bioe.13418","DOIUrl":"https://doi.org/10.1111/bioe.13418","url":null,"abstract":"<p><p>Medical ethics has historically been grounded in principles and values that can be logically deduced from the broader moral principles of ordinary life or common morality. This approach has recently been challenged by philosopher Rosamond Rhodes, who argues the opposite: namely, that medical ethics embodies a system of beliefs that cannot be logically deduced from the moral principles of daily living. She offers seven \"counterexamples\" that seek to show that common morality is not the universal source for medical ethics. This paper examines each of these counterexamples closely, explaining how they are flawed, in that they adopt oversimplified descriptions of common morality, inaccurate descriptions of optimal practice, or both, ultimately leading Rose to debunk straw scenarios. This paper then argues that the distinction between medical ethics based upon common morality and medical ethics based upon a specialized form of medical morality is not merely academic, but highly deleterious in clinical practice, as the latter approach shifts power from patients to philosophers.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058786","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":"Are slow codes uniquely deceptive?","authors":"Michael B. Grosso,&nbsp;Paola Nicolas","doi":"10.1111/bioe.13415","DOIUrl":"10.1111/bioe.13415","url":null,"abstract":"<p>“Sham codes” or “slow codes”—defined here as resuscitative efforts undertaken only to the extent necessary to convey the impression that “everything was done,” rather than to achieve return of spontaneous circulation (ROSC)—have been almost universally condemned for the past five decades. To facilitate an examination of this practice, we consider how the clinician's obligations and prerogatives differ under four scenarios, all of which involve conflict between the physician who desires to withhold cardiopulmonary resuscitation (CPR) and the family who does not. Under two scenarios, involving quality of life considerations and quantitative futility (“long shots”), we argue that slow codes are ethically impermissible. Under two other scenarios, however, we maintain an agnostic view on the moral permissibility of slow codes. We observe that where the case for impermissibility is predicated on considerations of honesty and professional integrity, commonly practiced and commonly defended alternatives to the slow code, such as non-initiation of CPR after bedside assessment, limited trials of CPR, and futile CPR, are typically undertaken for beneficent reasons and, like the slow code, entail non-lying deception. Finally, we offer recommendations for care delivery reform that work “upstream” to prevent the conflicts and crises of trust that give rise to intractable conflicts surrounding CPR.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 4","pages":"350-358"},"PeriodicalIF":1.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765942","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 autonomy in the context of digital health","authors":"Salvador Tarodo Soria","doi":"10.1111/bioe.13410","DOIUrl":"10.1111/bioe.13410","url":null,"abstract":"<p>Digital health opens the door to a promising horizon where the combination of several sciences and the application of new technologies can improve health, hope and quality of life. However, it is essential to ensure that such advances are compatible with and respectful of the right to privacy, data protection, right to information and freedom of choice, in short, with the autonomy of the human being in healthcare. The application of new technologies in healthcare settings generates considerably major ethical and legal challenges. This paper identifies some of the problems that could be more relevant, that is, the patient's consent in digital health, assessment of patient's capacity, how the implementation of new technologies changes the concept of medical intervention, the arrival of virtual identity or the legal responsibility of the parties acting herein. These are some of the questions that must be painstakingly analysed and correctly resolved to ensure that scientific and technological advances respect fundamentals rights in this new paradigm of digital health.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 5","pages":"404-413"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755701","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":"Using Electroconvulsive Therapy (ECT) in emergency clinical situations against patient's autonomy: A case study analysis","authors":"Ekain Payán Ellacuria,&nbsp;Aníbal M. Astobiza","doi":"10.1111/bioe.13413","DOIUrl":"10.1111/bioe.13413","url":null,"abstract":"<p>In this paper, we present a comprehensive case study analysis of a specific legal order issued by the Court of First Instance Number 6 of Santiago de Compostela on March 21, 2023. The focal point of the case study is the utilization of Electroconvulsive Therapy (ECT), a specific neurotechnology, in an emergency clinical situation. The objective of this article is to examine the legal and bioethical dimensions surrounding the use of ECT, shedding light on the ethical implications and decision-making processes involved in such cases. The analysis delves into the legal aspects of the case, considering relevant laws and regulations governing the use of ECT. The examination includes an exploration of the court's interpretation of the legal framework within the context of emergency situations, highlighting the specific legal arguments presented in the court judgment. Additionally, the article provides an in-depth bioethical analysis, exploring the ethical principles that come into play when making decisions about ECT in emergency clinical scenarios. The examination considers the delicate balance between respecting patient autonomy and promoting beneficence, while also addressing potential harms and adverse effects associated with ECT. We also consider the moral issues created by the court judgment, specifically those involving patient autonomy and the invasive nature of the process, particularly in cases of mental illness.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 5","pages":"435-447"},"PeriodicalIF":1.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694536","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":"Slow codes as ethical disobedience","authors":"Jason Adam Wasserman","doi":"10.1111/bioe.13409","DOIUrl":"10.1111/bioe.13409","url":null,"abstract":"<p>KEY: Patients or families sometimes demand interventions that are of no benefit or are even harmful. Even in cases where cardiopulmonary resuscitation is futile or medically inappropriate, instituting a do not attempt resuscitation order requires either consent of the patient or family, or working through a cumbersome and conflictual institutional process to change code status over their objection. Sometimes they contest these decisions in court and sometimes they win. Avoiding such conflicts gave rise to the practice of “slow codes,” a situation in which the healthcare team responds to cardiac arrest in a patient in a deliberately slow or perfunctory manner, with the intention of not resuscitating the patient at all. Slow codes have been nearly universally decried as unethical in the literature, at least over the last three decades. After all, a slow code is fundamentally dishonest. But critics tend to avoid the socio-political and clinical realities that motivate the use of slow codes in the first place. In this article, I argue that in the context of judicial and legislative overreach into medical decision-making, the slow code serves a distinctly moral purpose beyond promoting the welfare of the patient: It is an act of disobedience against an unethical system.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 4","pages":"368-374"},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671893","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":"Moral enhancement and behavioral trait variance.","authors":"Brandon Long","doi":"10.1111/bioe.13412","DOIUrl":"https://doi.org/10.1111/bioe.13412","url":null,"abstract":"<p><p>Proponents of moral enhancement often link certain traits to virtuous behavior but typically focus on average trait scores, neglecting individual behavioral trait variance. Behavioral trait variance refers to the range of behaviors a person exhibits within a trait, which may partly arise from genetic factors independent of mean scores. Using Martha Nussbaum's capabilities approach and virtue ethics, I argue that increasing behavioral trait variance could promote moral flourishing. For example, a consistently disagreeable teacher might excel in specific contexts, like a philosophy seminar. However, such a teacher will struggle to find Aristotle's moral meaning of friendliness, limiting their virtue across diverse contexts. Since social virtues are context-dependent, reducing behavioral trait variance through personality enhancement could also hinder an individual's ability to achieve virtues or capabilities. This article investigates behavioral trait variance's moral role within virtue ethics and calls for other moral enhancement theories to address the ethical significance of behavioral trait variance and its potential impact on moral flourishing.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651932","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}