Bioethics最新文献

{"title":"The Concept of Harm in Medical Ethics","authors":"Marie-Christine Fritzsche,&nbsp;Charlotte Franziska Unruh","doi":"10.1111/bioe.70124","DOIUrl":"10.1111/bioe.70124","url":null,"abstract":"<p>The concept of harm is central to medical ethics. In particular, it is frequently used in ethical deliberation about clinical cases and harm-benefit analyses. Despite its significance, there has been surprisingly little discussion in practice about conceptual approaches and the nature of harm in medical ethics analyses. We examine how different conceptual accounts of harm shape ethical decision making through examples from clinical ethics consultation and data-intensive medical innovations. By applying three prevailing theoretical-philosophical frameworks—the counterfactual, temporal, and non-comparative accounts of harm—to these cases, we demonstrate that explicitly identifying and discussing stakeholders' varying concepts of harm is crucial for ethical analyses in medicine and healthcare. While harm is only one of many considerations influencing medical ethics decision-making, our analysis reveals that different conceptualisations of harm can lead to substantively different practical outcomes. In this way, how we understand harm can affect recommendation processes, stakeholder communication, and assessments of quality of life and best interests. Without making different types of harm explicit, stakeholders might talk past each other when weighing harm against benefit, as what constitutes harm in one case may not be considered harm in another. We argue that explicit consideration of the nature of harm ensures comprehensive ethical deliberation, and integrates multiple perspectives in healthcare settings. Our findings suggest that the ethical importance of conceptual analysis of harm extends beyond mere theoretical interest, with direct implications for clinical practice and ethical decision making in healthcare.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"871-877"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148310415","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":"Artificial Intelligence-Generated Synthetic Data in Healthcare: A False Promise for Underserved Populations?","authors":"Stéphanie Baggio","doi":"10.1111/bioe.70121","DOIUrl":"10.1111/bioe.70121","url":null,"abstract":"<p>Artificial intelligence (AI)-generated synthetic data has emerged as a promising solution to address the underrepresentation of underserved populations in medical AI systems. By artificially generating data that mimics real-world patient information, proponents argue that AI-generated synthetic data can fill data gaps, improve algorithmic fairness, and mitigate bias without requiring costly data collection or raising privacy concerns. However, in this article, I challenge this optimistic view. I argue that AI-generated synthetic data may amplify existing biases rather than mitigate them, and complicate informed consent processes in ways that disproportionately harm underserved populations. I examine two critical ethical dimensions: (1) how the opacity inherent in synthetic data generation can reproduce and amplify discriminatory patterns present in the source data, and (2) how AI-generated synthetic data complexifies informed consent. I conclude that while AI-generated synthetic data offers apparent technical advantages, it fails to address, and may worsen, data disparities affecting underserved populations. Rather than pursuing synthetic solutions, I believe that we should address the structural barriers that prevent genuine inclusion of underserved populations in medical research.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"865-870"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977264","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":"Should Terminal Sedation Be Expanded to Individuals Who Choose to Die Via the Voluntary Stopping of Eating and Drinking?","authors":"Laura Gilbertson,&nbsp;Dominic Wilkinson,&nbsp;Julian Savulescu","doi":"10.1111/bioe.70127","DOIUrl":"10.1111/bioe.70127","url":null,"abstract":"<p>The voluntary stopping of eating and drinking (VSED) is a phenomenon whereby an individual with decision-making capacity chooses to cease eating and drinking with the intention of ending their own life. This is widely acknowledged as a lawful, albeit uncommon, end-of-life decision. It is now generally accepted that patients undertaking VSED should have access to appropriate palliative care, as per any other form of dying. However, it remains unclear whether terminal sedation (TS), the use of sedative drugs to treat intolerable symptoms at the end of life, should form part of this palliative care. In this paper, we explore and defend the use of TS in the management of VSED. We argue that TS is medically appropriate in the management of patients undertaking VSED who develop refractory delirium and have previously consented to TS. We further argue that, given the life expectancy window in cases of VSED, the appropriate use of sedation during this time does not hasten death and fits within the 2-week limit applied to traditional TS. We conclude that TS is medically and ethically appropriate in the management of VSED.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"886-892"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977471","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":"Living Medicine in the Shadow of Genocide","authors":"Manar Alkhodari","doi":"10.1111/bioe.70146","DOIUrl":"10.1111/bioe.70146","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"836-837"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414003","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":"A Tale of Two Cities: From Hong Kong's Lecture Halls to Gaza's Ruins","authors":"Arthur Chuxi Liu","doi":"10.1111/bioe.70097","DOIUrl":"10.1111/bioe.70097","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"838-839"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349798","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":"On the Destruction and Humanitarianisation of the Health System in Gaza and the Need for a Biopolitical Bioethics","authors":"Mohammad Salaymeh,&nbsp;Arianne Shahvisi,&nbsp;Sohail Jannesari","doi":"10.1111/bioe.70118","DOIUrl":"10.1111/bioe.70118","url":null,"abstract":"<p>This paper examines Israel's destruction and ‘humanitarianisation’ of Palestinian health systems, arguing that this should be understood as an instance of ‘necropolitics,’ as conceived by Achille Mbembe. We review the extensive, long-term destruction of health systems in Palestine before 7 October 2023 and the catastrophic acceleration of that destruction in Gaza in the years since. We show that this process is central to Israel's project of limiting Palestinian life to what Mbembe calls a ‘death world’, a space where power is exercised through the systematic exposure of a population to death, and that it serves the security and economic agendas of Israel and its allies. By reducing Palestinians to death-like living conditions through the destruction and subsequent humanitarianisation of health infrastructure, Israel optimises its control over the remaining population of Gaza. We argue that necropolitics, and biopolitics more generally, are vital yet underused tools in bioethics, without which situations of extreme oppression cannot be adequately theorised.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"793-807"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297393","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":"‘Out of My Hands’: Palestinian Referral Care in East Jerusalem After October 7, 2023","authors":"Pieter Dronkers,&nbsp;Zeina Amro","doi":"10.1111/bioe.70077","DOIUrl":"10.1111/bioe.70077","url":null,"abstract":"<p>This paper examines the moral experiences of Palestinian healthcare professionals working at a specialised referral hospital in East Jerusalem during the early months of the Gaza War. Drawing on semi-structured interviews with hospital staff providing oncology care, it analyses how understandings of what constitutes “good” care in a context of occupation, segregation, and genocidal violence are shaped by competing normative frameworks. Three ethical perspectives initially emerged: medical ethics, which prioritises evidence-based protocols; humanitarian ethics, which emphasises neutrality in line with donor requirements; and communitarian ethics, which understands care as an expression of solidarity and national duty. The paper argues that to fully capture the moral labour of healthcare workers, a fourth frame is needed: care ethics, which highlights the relational and reparative dimensions of care work. This perspective is crucial in a context where occupation and segregation deeply affect the “care triangle” of patients, companions, and healthcare providers. Viewing care as a relational practice that resists division and exclusion also offers a strategy to alleviate the moral distress that can arise when professionals are unable to provide care they themselves see as “good enough.” The paper calls on employers, communities, and colleagues to value and support the care work professionals provide beyond their clinical tasks, while also recognising the limits of individual responsibility by acknowledging and addressing the structural barriers they face. Ultimately, an end to occupation and segregation remains the primary condition for enabling good care.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"808-818"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835341","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":"On the Immunity of Hospitals in Gaza: A Reply to Lederman","authors":"Simon Lucas","doi":"10.1111/bioe.70054","DOIUrl":"10.1111/bioe.70054","url":null,"abstract":"<div>\u0000 \u0000 <p>Zohar Lederman critically assesses the special protections afforded to hospitals under international humanitarian law, arguing that the conditions for revoking immunity are overly permissive and fail to safeguard medical facilities. Framing his argument within a conventionalist approach—where legal norms reflect historically refined moral principles—he neglects a central requirement of conventionalist ethics: explaining how such laws and conventions acquire normative authority. This omission produces internal inconsistencies that render his conclusions unpersuasive and risk making strategically significant military operations morally impermissible. Furthermore, a restrictive interpretation of civilian immunity may create perverse incentives, encouraging rogue actors to exploit civilian infrastructure and exposing the very patients that these protections aim to shield to greater harm.</p>\u0000 </div>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"833-835"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508084","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":"A Bioethical Assessment of the Environmental Impacts of War","authors":"Funda Gülay Kadioglu","doi":"10.1111/bioe.13431","DOIUrl":"10.1111/bioe.13431","url":null,"abstract":"&lt;p&gt;Global society remains influenced by recurring cycles of war and peace, even in the 21st century, despite advancements in technology, communication, and international cooperation. However, the aspiration for a truly global society lies in establishing a framework where individuals, communities, and nations coexist in harmony. Achieving such coexistence requires more than the mere cessation of armed conflict. Peace must be understood as a state that transcends the absence of war; it encompasses the eradication of all forms of violence, hostility, and coercion. True peace implies the elimination of threats, the avoidance of force, and the fostering of trust and mutual respect. It also involves addressing structural injustices, reducing inequalities, and promoting understanding among diverse cultures and ideologies. Furthermore, peace entails the active prevention of disturbances, civil unrest, and negative sentiments, creating an environment where collaboration and goodwill can flourish. Only by embracing this holistic vision of peace can global society hope to evolve into a sustainable and just future [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Today, modern wars have become bloodier and longer, largely due to advancements in technology. These technological developments, while designed to increase precision and efficiency, have also introduced paradoxical situations in warfare. For instance, unmanned aerial vehicles (drones) are hailed for their ability to minimize risks to the lives of military personnel. Yet, paradoxically, the same drones are used to carry out targeted strikes, often resulting in the loss of civilian lives and collateral damage, deepening the suffering caused by war. This duality reflects the complex and contradictory nature of modern warfare, where the lines between protection and destruction are increasingly blurred. Furthermore, technological advancements have not only intensified the scale of violence but also extended the reach of conflicts beyond traditional battlefields, affecting communities and ecosystems in unprecedented ways. These contradictions highlight the urgent need to pursue peace, not just as the absence of conflict but as an active effort to address the root causes of war and prevent its devastating consequences [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Can human rights truly be upheld during war, despite the inherent paradoxes of conflict? In a war initiated to protect rights and freedoms, is it genuinely possible to safeguard the rights of civilians, who are especially vulnerable? Isn't it inherently ironic to wage war to achieve peace? These conflicting situations highlight the ethical dilemmas that arise from war, particularly in the context of human rights violations. These dilemmas do not arise solely during or after the war but can also emerge in its lead-up. For example, the allocation of a country's limited resources or budget to armament for war instead of healthcare expenses leads to a significant ethical issue caused by a war that","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"842-844"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144403","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":"Israel's Post-War Healthcare Obligations","authors":"Daniel J. Hurst,&nbsp;Christopher A. Bobier","doi":"10.1111/bioe.70041","DOIUrl":"10.1111/bioe.70041","url":null,"abstract":"<p>Since the beginning of the Israel–Hamas war in 2023, the healthcare infrastructure within Gaza has been dismantled. While international humanitarian law mandates distinction between lawful targets (combatants and military objectives) and non-lawful targets (civilians and civilian objects), and acknowledging the inherent complexities of applying this principle in conflicts involving non-state actors like Hamas operating within civilian areas, numerous reports indicate that Israel's actions have resulted in significant and foreseeable consequences for the Gazan civilian population. Due to these substantial and foreseeable harms, which have led to a long-term humanitarian crisis, we argue that the Israeli government bears a moral responsibility to help mitigate the long-term humanitarian crisis, which, at a minimum, requires helping to rebuild the healthcare infrastructure to its <i>status quo ante bellum</i>.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 8","pages":"828-832"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350154","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}