Bioethics最新文献

{"title":"Assisting, Replicating, or Autonomously Acting? An Ethical Framework for Integrating AI Tools and Technologies in Healthcare.","authors":"Aasim I Padela, Rwan Hayek, Aliya Tabassum, Fabrice Jotterand, Junaid Qadir","doi":"10.1111/bioe.70019","DOIUrl":"https://doi.org/10.1111/bioe.70019","url":null,"abstract":"<p><p>Artificial intelligence (AI)-based technologies are increasingly being utilized, tested, and integrated into conventional healthcare delivery. Technological opportunities, ranging from machine-learning-based data analysis tools to large language model-based virtual healthcare assistants, offer significant potential to enhance healthcare access and improve outcomes. Researchers have discussed potential benefits, including improved resource allocation, diagnostic accuracy, and patient outcomes from greater AI integration in healthcare, and also have voiced concerns around data privacy, algorithmic bias, and diffused accountability. This paper adds to the literature by proposing an ethical framework that allows for both describing and normatively evaluating AI-mediated healthcare delivery based on its potential impact on human-centered patient care. Drawing upon Pelligrino's notions of the patient-doctor relationship, we propose a framework with two axes, one related to spectrum of patient engagement and the other related to the clinician's role, through which to assess the use of AI in healthcare. Technologies and tools that have minimal to no interaction with patients and primarily assist physicians in making clinical decisions tend to have the least ethical challenges. On the other hand, those that are fully patient-facing and work in parallel with doctors or autonomously in therapeutic or decisional roles are the most controversial, as they risk making healthcare less human-centric. As we advance toward more pervasive integration of AI in healthcare, our framework can facilitate upfront design and downstream implementation-related decisions.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661043","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":"Vulnerability: On a Welcome Paradigm Shift in the 2024 Declaration of Helsinki","authors":"Florencia Luna","doi":"10.1111/bioe.13427","DOIUrl":"10.1111/bioe.13427","url":null,"abstract":"<p>The 2024 version of the Declaration of Helsinki [<span>1</span>] provoked a flurry of commentaries from the international research community on a host of different issues [<span>2-6</span>]. These included the broadened scope of the revised Declaration, its emphasis on integrity, the inclusion of the notion of meaningful engagement, the importance of ethical research in public health emergencies, research ethics committees’ (RECs) independence and the importance of providing them with adequate resources. It should also be noted that, with regard to some very controversial issues such as placebo control and post-trial benefits, the Declaration is not vastly different from its 2013 version [<span>4</span>]. However, some significant changes have arguably not been sufficiently considered in the published commentaries. Here, I will focus on paragraphs 19 and 20 of DoH 2024 that refer to vulnerability and suggest that these changes usher in a welcome paradigm shift regarding the concept of vulnerability.</p><p>The importance of certain changes to language in the revised version of the DoH has been noted. For example, the term “research subject” was replaced by “participant” [<span>3, 6</span>]. Thus far, no scholarship has addressed the linguistic dimension surrounding the Declaration's revision of the notion of vulnerability. Yet in paragraph 19, there is indeed a crucial change in language related to this concept. A new description of vulnerabilities is introduced: individuals, groups, and communities are in a “situation of more vulnerability.” In other words, the 2024 DoH leaves behind the essentialist conception of vulnerability–that individuals and groups are particularly vulnerable (Paragraph 19 (DoH 2013)). Note that the term “vulnerable populations” has been avoided, as now different situations may render these groups or communities more vulnerable. Furthermore, this is dynamic and contextual and may change.</p><p>This addition of a more dynamic conception of vulnerability has important consequences for research ethics. Perhaps most significantly, it means not labeling a priori with a categorical or essential property or following a predetermined list of people already considered vulnerable. However, some commentators fail to appreciate this difference and still use the previous terminology from 2013 [<span>5, 7</span>] as the 2024 version still maintains that factors may be fixed. But the 2024 DoH expands and refers to “a situation of more vulnerability as research participants, due to factors that may be fixed or contextual and dynamic,”¹ thus introducing a different way of thinking about the concept that captures the various ways in which vulnerabilities are expressed. This non-essentialist vision avoids stereotyping and labeling individuals, groups, and communities as vulnerable. As when a label is applied, it fixes the content and is quite difficult to remove; but if we think there are circumstances or characteristics that a","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 7","pages":"663-665"},"PeriodicalIF":2.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644214","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":"Considering the Developing Entity in an Artificial Womb as a Patient","authors":"Frédérique Drouin,&nbsp;Alice Cavolo,&nbsp;Vardit Ravitsky,&nbsp;Charles Dupras","doi":"10.1111/bioe.70021","DOIUrl":"10.1111/bioe.70021","url":null,"abstract":"<p>Artificial womb (AW) prototypes are currently being developed with the aim of improving the medical care of extremely premature infants. Despite the seemingly imminent reality of partial ectogenesis (i.e., gestation partially outside a human womb), there is persisting debate about the moral status of the fetus transferred in an AW—henceforth, the “developing entity.” For some, AWs are simply another neonatal intensive cares’ technology. Thus, developing entities in AWs should deserve the same protections as newborns in incubators. Others consider that AWs are fundamentally different technologies than incubators. Therefore, they believe that developing entities in AWs are new moral entities. These differences in perception generate disagreement about how developing entities in AWs should be treated and how decisions about them should be made. We argue that developing entities in AWs should be considered patients by transposing Chervenak and McCullough's “The fetus as a patient” proposition to the context of partial ectogenesis. As pregnant persons will have to consent to transfer their fetuses in AWs, and this technology will ultimately present itself as a beneficial medical intervention for viable developing entities in AWs, these latter would be patients, even if they are not legally and morally recognized as person. Thus, the moral obligations of beneficence and non-maleficence owed by physicians to their patients would apply to entities in AWs, ethically guiding their treatment and decision-making toward them.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":"850-855"},"PeriodicalIF":2.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644213","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":"Classic Pro-Choice Thought Experiments and African Communitarianism","authors":"Kirk Lougheed","doi":"10.1111/bioe.70016","DOIUrl":"10.1111/bioe.70016","url":null,"abstract":"<p>I analyse two classic pro-choice thought experiments in the Anglo-American philosophical literature in Thomson's Violinist Case and Tooley's Kitten Serum Case, in light of two prominent African normative theories. Though each of these cases is designed to generate pro-choice intuitions, I suggest they do not do so nearly as clearly when African normative theories are in view. Furthermore, even where they might yield a pro-choice verdict, they do so for very different reasons. That African ethics, which is often labelled communitarian, differs from what one typically finds in the Anglo-American normative tradition is hardly a new insight. However, that these differences might undermine the universality of pro-choice thought experiments about abortion in Anglo-American bioethics has yet to receive significant attention.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":"842-849"},"PeriodicalIF":2.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644203","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":"Freedom as Non-Domination, Rules, and the Pandemic","authors":"M. Victoria Costa","doi":"10.1111/bioe.70017","DOIUrl":"10.1111/bioe.70017","url":null,"abstract":"<p>This paper examines the ways in which public health measures taken to contain the spread of COVID-19 impacted the freedom of those affected, understanding freedom as non-domination. It argues that, in the absence of effective vaccines, individuals who carry a virus with the profile of COVID-19 have the capacity to impose high risks of severe illness and death on other people. But formal and informal rules can help control this capacity, supporting the freedom of people in certain respects. With regard to governmental enforcement of public health measures such as lockdowns, it argues that—depending on the form they take—they can be consistent with the enjoyment of freedom as non-domination of the population. Still, for this to be the case, some demanding conditions must be met. First, the government must continue to operate under a number of suitable checks. Second, the relevant policies must protect the basic interests of all members of the population. The paper also responds to criticisms of this account of freedom, stressing the connection between the secure enjoyment of basic liberties and the enforcement of formal and informal rules.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":"834-841"},"PeriodicalIF":2.1,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621159","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":"Healthcare Resource Allocation and Environmental Sustainability","authors":"David G. Kirchhoffer,&nbsp;Bridget Pratt","doi":"10.1111/bioe.70009","DOIUrl":"https://doi.org/10.1111/bioe.70009","url":null,"abstract":"&lt;p&gt;Our healthcare systems are responsible for delivering essential, often life-saving care to patients within the society that they serve. It has long been recognised that healthcare systems, as basic social institutions, have duties of health and social justice.1 Healthcare systems should help ensure people are free of preventable morbidity and mortality2 and able to function normally3 such that they can achieve either a normal lifespan of decent quality4 or an optimal lifespan of high quality.5 As such, healthcare systems must provide &lt;i&gt;equal access&lt;/i&gt; to high-quality healthcare and services for their society's population and ensure &lt;i&gt;protection&lt;/i&gt; against financial hardship due to out-of-pocket healthcare expenditures, especially for the poor and disadvantaged.6 Healthcare systems, however, as they currently operate, are also substantial contributors to environmental damage through, among other things, greenhouse gas emissions, air pollution, toxic and nontoxic waste production, consumption of nonrenewable resources and changes to land-use that may damage existing natural environments.7 Some of these effects of healthcare provision are directly or indirectly detrimental to human health and well-being, such as pollution and greenhouse gas emissions, and others may irreparably harm the environment, such as threatening the survival of a particular species. Thus, the (ideally but not always in practice) equitable delivery of healthcare generates harm to the environment that has an adverse effect on the health of those that healthcare systems are trying to serve.&lt;/p&gt;&lt;p&gt;For that reason, healthcare systems across the world are endeavouring to reduce their environmental impacts. At COP26, 50 countries pledged to transition to climate-resilient and low-carbon health systems, with 14 countries setting a target date of reaching net-zero emissions by 2050.8 Yet this leaves healthcare as an enterprise with a conundrum: How should it allocate its resources in a way that accounts for the environment? How should it make decisions about allocating its resources to the equitable delivery of healthcare versus to minimising that healthcare's negative environmental impacts? The problem arises because allocating resources to measures to minimise environmental impacts seems to compete with healthcare's core mission of saving lives.&lt;/p&gt;&lt;p&gt;These resource allocation questions can also be posed at multiple levels of healthcare decision making: for example, from international and national policy makers, through hospital leaders and managers, and finally to individual healthcare practitioners in a clinical setting.&lt;/p&gt;&lt;p&gt;In this special issue, we present several contributions that explore those questions. They were each developed and refined through a series of webinars hosted by the Queensland Bioethics Centre at Australian Catholic University, during which the contributors to this issue were able to present and workshop their contributions through robust conversatio","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 6","pages":"527-529"},"PeriodicalIF":1.7,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573744","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":"Ethicists and the Gaza War.","authors":"David DeGrazia","doi":"10.1111/bioe.70001","DOIUrl":"https://doi.org/10.1111/bioe.70001","url":null,"abstract":"<p><p>Do bioethicists have an obligation to speak out against such atrocities as Hamas' terrorism and Israel's war crimes? I will argue that they do have such an obligation, but not because they are bioethicists or even ethicists. Before driving home this conclusion, I will highlight some crucial facts in applying criteria for ethical engagement in warfare. Although I maintain that Hamas' terrorist attack of October 7 involved crimes against humanity that deserve condemnation, here I will focus on Israel's subsequent conduct, the ethical significance of which has been insufficiently appreciated among those who embrace a highly prevalent double standard_.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555915","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":"Should We Use Behavioural Predictions in Organ Allocation?","authors":"Max Drezga-Kleiminger,&nbsp;Dominic Wilkinson,&nbsp;Thomas Douglas,&nbsp;Joanna Demaree-Cotton,&nbsp;Julian Koplin,&nbsp;Julian Savulescu","doi":"10.1111/bioe.13440","DOIUrl":"10.1111/bioe.13440","url":null,"abstract":"<p>Medical predictions, for example, concerning a patient's likelihood of survival, can be used to efficiently allocate scarce resources. Predictions of patient behaviour can also be used—for example, patients on the liver transplant waiting list could receive lower priority based on a high likelihood of non-adherence to their immunosuppressant medication regimen or of drinking excessively. But is this ethically acceptable? In this paper, we will explore arguments for and against behavioural predictions, before providing novel empirical evidence on this question. Firstly, we note that including behavioural predictions would lead to improved transplant outcomes. Fairness could also require prioritising those predicted to engage in healthier behaviours: consistent with using behavioural predictions in other contexts such as psychiatry and substance misuse. Conversely, behavioural predictions may be judged too inaccurate or discriminatory, or it may be thought unfair to deprioritise based on future behaviour. In part two, we performed an online survey of 172 UK adults. When presented with possible factors relevant to liver allocation, most thought predictions of higher medication adherence (78.6%) and lower future alcohol use (76.5%) should be used but not predictions of lower future criminality (24.7%) and higher societal contribution (21.2%). Randomising participants into two groups, 69.8% of participants found deprioritising a patient based on their predicted medication adherence acceptable (91.9% found a nonbehavioural prediction acceptable). We did not identify an ethically relevant difference between behavioural predictions and other medical predictions already used in organ allocation. Our sample of participants also appeared to support behavioural predictions in this context.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 8","pages":"737-747"},"PeriodicalIF":2.1,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7618015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531235","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":"Ethical Expertise Before and After Medically Assisted Dying: The Informal and Formal Role of the Ethicist in the Netherlands.","authors":"Eva Asscher, Suzanne Metselaar","doi":"10.1111/bioe.13437","DOIUrl":"https://doi.org/10.1111/bioe.13437","url":null,"abstract":"<p><p>Although we have a long-standing and well-institutionalized practice of medical aid in dying (MAID) in the Netherlands, it is insufficiently clarified which goals ethicists should pursue in the context of assisted dying, and which competencies they need to fulfil their role(s). We sought to contribute to this clarification. We argue that both in anticipation and in evaluation of MAID, ethicists fulfil a role that is highly valuable to good MAID practice, and complementary to that of other professionals. Whereas the involvement of the ethicist preceding MAID, for instance, to provide ethics support in the case of complex decision-making, is elective in the Netherlands, the participation of ethicists in evaluating performed MAID cases is obligatory, as they are required members of the interdisciplinary regional review committees that judge every case of MAID. We discuss some misconceptions and less-than-optimal performances of both these roles of the ethicist, then focus on how these roles should be perceived, and which kinds of ethics expertise are necessary for ethicists to make a valuable contribution to good MAID practice.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531234","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":"Well-Being, Pain and the Mere-Difference View of Disability","authors":"James Forsdyke","doi":"10.1111/bioe.70014","DOIUrl":"10.1111/bioe.70014","url":null,"abstract":"<p>I shall initially be discussing the term ‘disability’ in accordance with common-sense intuition. The term itself is contested. But importantly for our discussion, on the mere-difference view, Barnes attempts to philosophically define disability in conformity with what we ordinarily perceive to be disability day to day, and she does so by appealing to the rules of solidarity employed by the disability rights movement as definitive of those conditions that the movement should promote justice for and thus of who counts as disabled. I will operate on the assumption that this is correct during much of the essay, so as to assess whether Barnes' mere-difference view is vulnerable to an argument from pain. I suggest that Barnes could follow three lines of argument in order to try to circumvent these difficulties, but that each of these faces further problems. I argue that for certain disabilities, in specific cases, the mere-difference view cannot apply, particularly because pain is not necessarily sufficiently balanced by positives. Consequently, I discuss the nuances of when a mere-difference view may be helpful, as opposed to when it might be misguided in its application, and conclude that speaking of <i>disability as a whole</i> as mere-difference or otherwise is misguided, unless we are to reshape the concept of disability into something less heterogeneous.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 9","pages":"796-801"},"PeriodicalIF":2.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499457","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}