Bioethics最新文献

{"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":" ","pages":""},"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":"Bioethics, public reason, and religion: The liberalism problem By \u0000 Fleck, Leonard M., Cambridge: Cambridge University Press. 2022. pp. 75. £17.00 (Paperback). ISBN: 9781009078054","authors":"Jeremy Williams","doi":"10.1111/bioe.13364","DOIUrl":"https://doi.org/10.1111/bioe.13364","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 1","pages":"151-152"},"PeriodicalIF":1.7,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142861729","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":"10.1111/bioe.13366","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 2","pages":"224-225"},"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":"38 9","pages":"825-826"},"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":"38 9","pages":"753-754"},"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":" ","pages":""},"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}

{"title":"Thinking like a mountain: A land ethical approach to healthcare resource.","authors":"Alistair Wardrope","doi":"10.1111/bioe.13355","DOIUrl":"https://doi.org/10.1111/bioe.13355","url":null,"abstract":"<p><p>Human activity is now having a defining influence on global systems. The Anthropocene epoch requires revisiting our ethical presuppositions to understand our relationship to the earth's life support systems. The Land Ethic of Aldo Leopold proposes an ethic that is diachronic, holistic, and biocentric, in contrast to the synchronic, individualist, and anthropocentric axioms of mainstream bioethics. I argue that these features of the Land Ethic make it more suitable to engage with the ethics of healthcare resource allocation in the Anthropocene; that understanding sustainability in a Land Ethical fashion requires that we view it as placing a side-constraint on all permissible healthcare resource use such that this use remains within planetary boundaries; and outline how this might re-shape debates around healthcare resource allocation.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382541","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":"Generative AI in healthcare: A call for a Māori perspective","authors":"Marta Seretny,&nbsp;Kerry Hiini,&nbsp;George Laking","doi":"10.1111/bioe.13354","DOIUrl":"10.1111/bioe.13354","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 1","pages":"155-157"},"PeriodicalIF":1.7,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382540","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":"Addressing the COVID-induced healthcare backlog: How can we balance the interests of people and nature?","authors":"Bridget Pratt","doi":"10.1111/bioe.13356","DOIUrl":"10.1111/bioe.13356","url":null,"abstract":"<p>The COVID-19 pandemic created healthcare backlogs of routine primary and preventive care, elective procedures, dental care, and mental healthcare appointments across the world. So far, governments are responding by enacting pandemic recovery policies that expand their healthcare sector activity, without much, if any, consideration of its effects on the environmental crisis that is (among other things) worsening human health and health equity. This paper argues that, as a matter of health and social justice, governments have an ethical responsibility to equitably reduce the backlog with minimal environmental damage. To do so, a first key action is to give priority to policy options that minimise negative human impacts on the environment. Yet these policies alone will not be sufficient to address the backlog, particularly in relation to elective procedures. The paper therefore contends that a second key action for governments is to enact the policy options that are best able to equitably reduce the remainder of the backlog, while accelerating the transition to sustainable health care in ways that are best able to reduce the specific environmental costs of those policy options. It concludes by considering whether limits apply to governments' ethical responsibilities that ultimately mean accelerating the transition to sustainable health care is not required when addressing the backlog.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 2","pages":"195-204"},"PeriodicalIF":1.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367578","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":"Passive euthanasia?","authors":"Miguel H. Kottow","doi":"10.1111/bioe.13358","DOIUrl":"10.1111/bioe.13358","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"39 2","pages":"223"},"PeriodicalIF":1.7,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367582","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}