Bioethics最新文献

{"title":"Ethical challenges in health care during collective hunger strikes in public or occupied spaces.","authors":"Dominik Haselwarter, Katja Kuehlmeyer, Verina Wild","doi":"10.1111/bioe.13306","DOIUrl":"https://doi.org/10.1111/bioe.13306","url":null,"abstract":"Public collective hunger strikes take place in complex social and political contexts, require medical attention and present ethical challenges to physicians. Empirical research, the ethical debate to date and existing guidelines by the World Medical Association focus almost exclusively on hunger strikes in detention. However, the public space differs substantially with regard to the conditions for the provision of health care and the diverse groups of healthcare providers or stakeholders involved. By reviewing empirical research on the experience of health professionals with public collective hunger strikes, we identified the following ethical challenges: (1) establishment of a trustful physician-striker relationship, (2) balancing of medico-ethical principles in medical decision-making, (3) handling of loyalty conflicts and (4) preservation of professional independence and the risk of political instrumentalization. Some of these challenges have already been described and discussed, yet not contextualized for public collective strikes, while others are novel. The presence of voluntary physicians may offer opportunities for a trustful relationship and, hence, for ethical treatment decisions. According to our findings, it requires more attention to how to realise autonomous medical decisions in the complex context of a dynamic, often unstructured and politically charged setting, which ethical norms should shape the professional role of voluntary physicians, and what is the influence of the hunger strikers' collective on individual healthcare decisions. Our article can serve as a starting point for further ethical discussion. It can also provide the basis for the development of potential guidelines to support health professionals involved in public collective hunger strikes.","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140965343","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":"Bioethical challenges in postwar development aid: The Rwandan case study.","authors":"Łukasz Wiktor, Maria Damps, Grace Kansayisa, Szymon Pietrzak, Bartłomiej Osadnik","doi":"10.1111/bioe.13304","DOIUrl":"https://doi.org/10.1111/bioe.13304","url":null,"abstract":"<p><p>This article considers aspects of a development aid that provides medical support to strengthen pediatric orthopedics in Rwanda. We present part of the Afriquia foundation work, a nonprofit foundation from Poland involved in supporting the medical sector in Rwanda as a sign of global solidarity and the human right to health. The main foundation's activity is the treatment of orthopedic problems among Rwandan citizens. We present a case study of two children under the care of the Afiquia foundation. 11-year-old Seraphine treated due to the consequences of right tibia osteomyelitis and 11-year-old Lavi suffering from osteogenesis imperfecta. Both children were treated surgically in Poland due to Rwanda's lack of treatment possibilities. After the applied treatment, Seraphine walks correctly without crutches and can attend school and thrive among her peers. Lavi has not sustained any fragility fracture since the surgery in Poland. He is healthy and constantly ongoing his rehabilitation including gait training. The described cases initiated development aid in Rwanda, supplying hospitals with orthopedic implants and training medical staff. The growing number of humanitarian crises across the globe and the people affected requires increasing organizations involved in providing relief. The emphasis should be on global education, aiming to make the recipients reflect and prepare them to face humanitarian crises.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961065","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":"Mental patient—Psychiatric ethics from a patient's perspective By \u0000 Abigail Gosselin, \u0000Cambridge, MA: \u0000The MIT Press. \u0000 2022. \u0000 308pp. $45.00 (Paperback), ISBN: 9780262544313","authors":"Sam Wilkinson","doi":"10.1111/bioe.13309","DOIUrl":"10.1111/bioe.13309","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140975342","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":"Does a lack of emotions make chatbots unfit to be psychotherapists?","authors":"Mehrdad Rahsepar Meadi,&nbsp;Justin S. Bernstein,&nbsp;Neeltje Batelaan,&nbsp;Anton J. L. M. van Balkom,&nbsp;Suzanne Metselaar","doi":"10.1111/bioe.13299","DOIUrl":"10.1111/bioe.13299","url":null,"abstract":"<p>Mental health chatbots (MHCBs) designed to support individuals in coping with mental health issues are rapidly advancing. Currently, these MHCBs are predominantly used in commercial rather than clinical contexts, but this might change soon. The question is whether this use is ethically desirable. This paper addresses a critical yet understudied concern: assuming that MHCBs cannot have genuine emotions, how this assumption may affect psychotherapy, and consequently the quality of treatment outcomes. We argue that if MHCBs lack emotions, they cannot have genuine (affective) empathy or utilise countertransference. Consequently, this gives reason to worry that MHCBs are (a) more liable to harm and (b) less likely to benefit patients than human therapists. We discuss some responses to this worry and conclude that further empirical research is necessary to determine whether these worries are valid. We conclude that, even if these worries are valid, it does not mean that we should never use MHCBs. By discussing the broader ethical debate on the clinical use of chatbots, we point towards how further research can help us establish ethical boundaries for how we should use mental health chatbots.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913434","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":"Value change, reprogenetic technologies, and the axiological underpinnings of reproductive choice.","authors":"Jon Rueda","doi":"10.1111/bioe.13287","DOIUrl":"https://doi.org/10.1111/bioe.13287","url":null,"abstract":"<p><p>Value change is a phenomenon that is gaining increasing attention in ethical analyses of technologies. However, a comprehensive study of how reprogenetic technologies and values coevolve is lacking. To remedy this gap, in this overview article, I address the relationship between reprogenetics and value change. This contribution thus argues for the importance of investigating the phenomenon of value change in relation to the technological controversies discussed in bioethics. To meet this goal, I begin by clarifying, first, how technologies shape reproductive choice. I then clarify what \"values\" and \"moral values\" are, how reprogenetic technologies are value laden, and what values are often discussed in reprogenetics debates. Next, I show five types of value changes that have occurred in advance in reproductive and genetic technologies. Finally, I argue for the bioethical relevance of discussing future techno-value change, pointing out the descriptive and normative challenges of this philosophical endeavor.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892981","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":"Refugees' right to health: A case study of Poland's disparate migration policies.","authors":"Krzysztof Kędziora","doi":"10.1111/bioe.13300","DOIUrl":"https://doi.org/10.1111/bioe.13300","url":null,"abstract":"<p><p>Poland has faced two waves of migration: the first was of irregular asylum seekers, which led to the humanitarian crisis on the eastern EU-Belarusian border since 2021; the second was of Ukrainians fleeing the Russian invasion. Although there are noticeable differences between these situations, and between the different reactions of the Polish authorities, it is possible to juxtapose them in terms of the right to health. The normative content of refugee and human rights law is the starting point for reconstructing the meaning of the terms 'refugee' and 'right to health'. A refugee is a person who needs international protection because of a well-founded fear of harm, which is not limited to persecution as defined by the Refugee Convention but also includes situations of international and non-international armed conflict. The right to health, which includes, inter alia, entitlements to a 'system of health protection' and 'underlying determinations of health', is reconstructed on the basis of human rights law and refugee and migration law. There are no legal and moral grounds to grant the right to health differentially to different groups of refugees. Nondiscriminatory health policy requires that refugees have the same access to health care as nationals, although their specific health needs resulting from past experiences and refugee situation require special treatment, that is, an appropriate refugee health policy. The broad understanding of the underlying determinants of health demonstrates the importance of overall migration policy for refugees' health, which can jeopardise the fragile good of refugee health.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892977","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":"Creating a safer and better functioning system: Lessons to be learned from the Netherlands for an ethical defence of an autonomy-only approach to assisted dying","authors":"Tessa Jane Holzman","doi":"10.1111/bioe.13296","DOIUrl":"10.1111/bioe.13296","url":null,"abstract":"<p>The proposal to allow assisted dying for people who are not severely ill reignited the Dutch end-of-life debate when it was submitted in 2016. A key criticism of this proposal is that it is too radical a departure from the safe and well-functioning system the Netherlands already has. The goal of this article is to respond to this criticism and question whether the Dutch system really can be described as safe and well functioning. I will reconsider the usefulness of the suffering criterion, and I will ultimately argue this criterion should be rejected altogether. Instead, we should consider moving towards an autonomy-only approach to assisted dying. This would resolve some significant issues occurring under the current system of assisted dying in the Netherlands and ultimately make the process safer and better functioning. I will then consider some possible objections to adopting an autonomy-only approach and provide some preliminary responses to these also. I will finally highlight some potential areas where further research may be necessary, namely, how to mitigate the effect of external factors such as poverty or other life aspects that may have the potential to distort the individual's ability to make autonomous decisions. I will also consider some possible international lessons that can be taken from both current as well as the proposed practice in the Netherlands.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861735","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":"Commercialization and the Olympics: A step too far?","authors":"Ruth Chadwick","doi":"10.1111/bioe.13295","DOIUrl":"10.1111/bioe.13295","url":null,"abstract":"<p>As Paris and the world prepare for the 2024 Olympics, attention turns to issues of security, of course, but also to ethical issues. There are several matters of ethical interest that arise in relation to sport, some of which concern, at bottom, issues of fair play (such as use of performance-enhancing drugs, enhancement, issues of gender and transgender eligibility policies), while others are political (e.g., exclusion of national branding from certain athletes who can compete only as neutral athletes, issues of disability and able-bodiedness), but this year the topic which has emerged central stage is that of commercialization. Commercialization has long been an issue in relation to influence in sport—for example, in the ownership of Premier League football clubs in the United Kingdom, but the question for the 2024 Olympics is that of providing prize money to (some) athletes.</p><p>Lord Sebastian Coe has defended the decision of World Athletics to give gold medal-winning athletes $50,000 in 48 events. Under the plan, prize money would be extended to silver medal-winners at the 2028 games in Los Angeles. Coe argues that the world has changed and that it is important to create a sport that is financially viable for its competitors. He says that if he thought athletes were competing only for the money, he might take a different view1 but he does not believe that to be the case. This last point suggests that he does actually attach some value to nonfinancial motivation, long associated with the ethos of the Olympics.</p><p>Against Coe's view, however, there are both arguments of principle and arguments about implementation. Some have argued that “the idea of rewarding competitors with pots of cash runs counter to the spirit of everything the Olympics supposedly stands for.”2 Iqbal describes the essence of the Olympics as a competition in which amateurs compete for glory. Pierre de Coubertin, the co-founder of the modern Olympics, was committed to the ideals of fair play and amateurism and the idea that the important thing was not to win but to take part. He also saw the Olympic sporting event as a contributor to international understanding and world peace.3 According to Eddie Pells, writing in <i>The Independent</i>, however, the announcement by World Athletics was “the latest step in a century's worth of unraveling the myth of amateurism at the Olympics.”4 Norman Baker, likewise, has written of the “gradual decline, though not extinction” of amateurism in the late 20th century5 (p. 1). Athletes would not be able to reach today's levels of excellence, or to travel to compete, without significant financial investment: the question concerns how rather than whether they should be financially supported and rewarded.</p><p>In addition to issues concerning the purported Olympic ethos, there are others of a more practical/process kind. One is that World Athletics has taken this decision without wider consultation with the International Olympic Committee","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869285","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":"Precision medicine and distributive justice: Wicked problems for democratic deliberation By \u0000 Leonard M. Fleck, \u0000Oxford University Press. \u0000 2023. xxvii + \u0000 404 pp. $82.00","authors":"Yoann Della Croce","doi":"10.1111/bioe.13297","DOIUrl":"10.1111/bioe.13297","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140832388","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":"Weighing the moral status of brain organoids and research animals","authors":"Julian J. Koplin","doi":"10.1111/bioe.13290","DOIUrl":"10.1111/bioe.13290","url":null,"abstract":"<p>Recent advances in human brain organoid systems have raised serious worries about the possibility that these in vitro ‘mini-brains’ could develop sentience, and thus, moral status. This article considers the relative moral status of sentient human brain organoids and research animals, examining whether we have moral reasons to prefer using one over the other. It argues that, contrary to common intuitions, the wellbeing of sentient human brain organoids should not be granted greater moral consideration than the wellbeing of nonhuman research animals. It does so not by denying that typical humans have higher moral status than animals, but instead by arguing that none of the leading justifications for granting humans higher moral status than nonhuman animals apply to brain organoids. Additionally, it argues that there are no good reasons to be more concerned about the well-being of human brain organoids compared to those generated from other species.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140806330","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}