Bioethics最新文献

{"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}

{"title":"Reimagining Social Value to Consider the Environment: How Should We Judge the Magnitude of Benefits in Health Research?","authors":"Bridget Pratt,&nbsp;Rieke van der Graaf","doi":"10.1111/bioe.70018","DOIUrl":"10.1111/bioe.70018","url":null,"abstract":"<p>Growing recognition of intersections between our health and the environment, healthcare systems and the environment, and health research and the environment has led bioethics scholars to advocate that the field readopt a broader perspective that considers nature. As part of doing so, we urgently need to reimagine research ethics concepts and frameworks so that they account for the environment. This paper focuses on how we should reinterpret the ethical concept of social value in health research. The concept is understood in absolute and relative terms, and both must be revised. The absolute social value of health research is determined by judging its magnitude of benefits and likelihood of benefits. This paper aims to generate considerations for judging health research's magnitude of benefits that capture its environmental benefits. We start from the most comprehensive definition of absolute social value to-date and show how it falls short of adequately capturing the magnitude of potential benefits generated by health research that yields knowledge related to nature. Based on that analysis, we propose how to revise the definition of absolute social value to better account for the environment. To conclude, we highlight questions that our suggested revisions raise for making relative social value assessments that consider the environment.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":"821-833"},"PeriodicalIF":2.1,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719209","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":"Disability, Subject-Dependence, and the Bad-Difference View","authors":"Shu Ishida,&nbsp;Mitsuru Sasaki-Honda,&nbsp;Tsutomu Sawai","doi":"10.1111/bioe.70012","DOIUrl":"10.1111/bioe.70012","url":null,"abstract":"<p>Philosophers have debated on the “mere-difference” view of disability, according to which disability as such is neutral in terms of well-being, just like race and gender. It is contrasted with the “bad-difference” view, which holds that disability is bad for its possessor even in a non-ableist situation. We first illustrate how neither view can be sensitive to the diversity of disabled people and their disabilities. Subsequently, we propose an alternative outlook—the conditional bad-difference view of disability: a disability is bad for its possessor if and only if it hampers her aspired way of life, even without ableism. In addition to being theoretically moderate and thus more plausible than the existing outlooks, this view also offers a robust ethical case for policies and practices catering to the varying needs and values of disabled people, such as personalized healthcare and the user-led research of assistive technologies.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":"802-809"},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700426","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 Ecological Genome Project and the Promises of Ecogenomics for Society: Realising a Shared Vision as One Health","authors":"Benjamin Capps,&nbsp;Ruth Chadwick,&nbsp;Yann Joly,&nbsp;Claire Lajaunie,&nbsp;Iva Hauptmannova,&nbsp;Susannah Mackenzie,&nbsp;John. J. Mulvihill,&nbsp;Elizabeth Mumford,&nbsp;Sonja A. Rasmussen,&nbsp;Kunal Sanghavi,&nbsp;Donrich W. Thaldar,&nbsp;James Yeates,&nbsp;Maud C. Quinzin,&nbsp;Zohar Lederman","doi":"10.1111/bioe.70020","DOIUrl":"10.1111/bioe.70020","url":null,"abstract":"<p>This paper develops a vision for <i>The Ecological Genome Project</i>: an aspirational, global endeavour to connect human genomic sciences with the ethos of ecological sciences. The Project's goal is to strengthen interdisciplinary networks that relate to diverse initiatives using genomic technologies, with respect to shared ethical frameworks and governance structures. To this end, this paper proposes a practical definition of ecogenomics to align various methodologies and values in a single environmental field using principles used to safeguard all forms of life in their habitats. We achieve this by using a One Health approach as a pretext for disparate disciplines to collaborate and also a lens to view the Ethical, Legal and Social Implications (ELSI) inherent in ecological systems.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":"788-795"},"PeriodicalIF":2.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700427","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":"Beneficial Bloodsucking","authors":"Parker Crutchfield,&nbsp;Blake Hereth","doi":"10.1111/bioe.70015","DOIUrl":"10.1111/bioe.70015","url":null,"abstract":"<div>\u0000 \u0000 <p>The bite of the lone star tick spreads alpha-gal syndrome (AGS), a condition whose only effect is the creation of a severe but nonfatal red meat allergy. Public health departments warn against lone star ticks and AGS, and scientists are working to develop an inoculation to AGS. Herein, we argue that if eating meat is morally impermissible, then efforts to prevent the spread of tickborne AGS are also morally impermissible. After explaining the symptoms of AGS and how they are transmitted via ticks, we argue that tickborne AGS is a moral bioenhancer if and when it motivates people to stop eating meat. We then defend what we call the Convergence Argument: If x-ing prevents the world from becoming a significantly worse place, doesn't violate anyone's rights, and promotes virtuous action or character, then x-ing is strongly <i>pro tanto</i> obligatory; promoting tickborne AGS satisfies each of these conditions. Therefore, promoting tickborne AGS is strongly <i>pro tanto</i> obligatory. It is presently feasible to genetically edit the disease-carrying capacity of ticks. If this practice can be applied to ticks carrying AGS, then promoting the proliferation of tickborne AGS is morally obligatory.</p>\u0000 </div>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 8","pages":"772-781"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683634","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":"Ethics of Identifying Individuals Involved in HIV Transmission Events by Phylogenetics in Molecular Surveillance","authors":"Francisca Faber,&nbsp;Lucie Abeler-Dörner,&nbsp;Stephanie Johnson,&nbsp;Tess Johnson,&nbsp;Euzebiusz Jamrozik","doi":"10.1111/bioe.70011","DOIUrl":"10.1111/bioe.70011","url":null,"abstract":"<p>Molecular HIV surveillance, involving the collection and analysis of HIV genome sequences, has become an integral part of public health programmes in high-income countries. By employing phylogenetic analysis, molecular HIV surveillance can identify individuals and their positions within networks of HIV transmission. While the primary aim of molecular surveillance is to yield public health benefits, such as linking people to care and reducing transmission, it also poses risks and potential infringements on individual privacy and liberty. This paper examines the ethical implications of using phylogenetics to identify individuals involved in multiple transmission events in high-income countries. Although public health responses tailored to such individuals can significantly reduce further transmission, these individuals often face multiple intersecting vulnerabilities and bear the greatest risks associated with molecular surveillance. We analyze the risks related to privacy, stigma, mistrust, criminalization, and liberty infringements, alongside the benefits of preventing further transmission and increasing healthcare engagement for people living with HIV. We conclude by outlining plausible and ethically acceptable policy options for molecular surveillance practice.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 8","pages":"762-771"},"PeriodicalIF":2.1,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683635","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}