Bioethics最新文献

{"title":"Incidental Findings From Treatment Response Monitoring in Oncological Care: Ethical Reflections.","authors":"Jasper Debrabander, Stefano Fanti, Elisabetta Lalumera","doi":"10.1111/bioe.70167","DOIUrl":"https://doi.org/10.1111/bioe.70167","url":null,"abstract":"<p><p>The question of how to handle incidental findings in medicine has attracted a lot of attention in the bioethics literature. The most widely discussed examples come from genetics (e.g., next generation sequencing) and medical imaging (e.g., neuroimaging). While incidental findings in medical imaging research have sparked much debate, the way incidental findings arising from medical imaging are handled in clinical practice is taken to be relatively uncontentious. However, in this paper, I will challenge how incidental findings arising from treatment response monitoring in oncological care are handled. At present, oncological patients' consent is not obtained before disclosing incidental findings that arise during treatment response monitoring. Rather, all and only incidental findings that are taken to be clinically relevant are disclosed. Using treatment response monitoring in metastatic breast cancer care as an illustration throughout the paper, I will challenge the more general practice of not offering oncological patients the possibility to refuse being informed about incidental findings that arise during treatment response monitoring. Ultimately, I will argue for the introduction of a tiered-layered-staged consent regarding the disclosure of incidental findings before the initiation of treatment response monitoring in oncological care for much the same reasons as it has been advocated for in genetics.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802176","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":"The Moral (Un)Desirability of New Biomedical Technologies as Potential Techno-Fixes.","authors":"Lieke van Kempen, Martine C de Vries, Nienke de Graeff","doi":"10.1111/bioe.70177","DOIUrl":"https://doi.org/10.1111/bioe.70177","url":null,"abstract":"<p><p>The techno-fix argument, used to argue against technological interventions that address the consequences of social problems instead of their underlying causes, is increasingly invoked in biomedical discussions. However, especially in biomedicine, the techno-fix argument remains conceptually underdeveloped. Therefore, in this paper, we critically examine the techno-fix argument in the context of new biomedical technologies, using stem cell therapy as a central case study. First, a taxonomy is developed to determine if, and if so, for which conditions, new biomedical technologies such as stem cell therapy can be considered techno-fixes. Then, the ethical implications of the taxonomy are discussed. We argue that stem cell therapy functions as a techno-fix when developed for medical conditions and disabilities that are largely caused by an underlying social problem, and that its moral (un)desirability depends, at a minimum, on whether it (1) silences or highlights the social problem involved, and (2) hinders or supports the development of alternative, social solutions. With this paper, we aim to clarify and stimulate debate on how techno-fixes should be understood and evaluated within the context of biomedicine, and beyond.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802155","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":"Longitudinal Witness Should Accompany Psychiatric Assisted-Dying Assessments.","authors":"Wan-Chen Hsu, Lien-Chung Wei","doi":"10.1111/bioe.70175","DOIUrl":"https://doi.org/10.1111/bioe.70175","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762213","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":"Reasonable Exceptions From Unreasonable Policies: Requiring Treatment Agreements for Long-Term Opioid Therapy and Exemptions for Cancer and Terminal Illness.","authors":"Larisa Svirsky, Martin Fried, Minseo Kim, Sarah R MacEwan, Nathan Richards, Patricia Zettler, Dana Howard","doi":"10.1111/bioe.70165","DOIUrl":"https://doi.org/10.1111/bioe.70165","url":null,"abstract":"<p><p>Since drug overdose deaths began increasing in the United States, policy makers and the medical community have developed tools to try to address the crisis. Opioid Treatment Agreements (OTAs) are one such tool which purportedly seek to promote shared decision-making and informed consent with patients. OTAs are documents that clinicians present to patients when prescribing opioids for chronic pain that describe the risks of opioids and require patients to agree to certain conditions in order to receive their medication. This paper critically explores the ethics of three related features of OTA policies and guidance: First, OTAs typically integrate behavioral requirements that go beyond the detection of opioid misuse and diversion. Second, OTAs often designate for clinicians significant discretion in their responses to individual patient OTA violations. That is, codified in many OTAs is the clinician's discretionary power to decide to stop prescribing LTOT or to dismiss the patient from their practice altogether. Third, governmental policies that recommend OTA use often exempt patients with cancer or terminal illness, allowing them to access this type of chronic pain management without the same requirements. Each of these features may have been created in an attempt to address individual patient needs while also responding to an urgent public health crisis, but they also-on their own and working in concert - raise serious ethical concerns. We argue that these features identify some patients as \"respectable\" pain patients and others as less-so, risking compounding the stigmatization of pain management and exacerbating health disparities.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763915","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":"Preserving Patient Participation and Professional Moral Agency in Autonomous AI Healthcare.","authors":"Carlos M Ardila","doi":"10.1111/bioe.70173","DOIUrl":"https://doi.org/10.1111/bioe.70173","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763232","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":"The Clinician–Parent Paradox in Sharenting: Professional Responsibility, Parental Autonomy, and Children's Digital Vulnerability","authors":"Dilan Aydin Ayva,&nbsp;Melike Uysal","doi":"10.1111/bioe.70122","DOIUrl":"10.1111/bioe.70122","url":null,"abstract":"<div>\u0000 \u0000 <p>Sharenting—the practice of parents sharing children's personal data and images on digital platforms—has become increasingly normalized, raising concerns about privacy, safety, and psychological well-being. While existing literature emphasizes the role of healthcare professionals in guiding families on digital risks, less attention has been paid to how clinicians themselves navigate these practices as parents. This paper introduces the concept of the “clinician–parent paradox in sharenting,” describing situations in which professional guidance on children's digital safety coexists with personal online practices that may contribute to children's digital exposure. We further propose the notion of a “digital credibility shield,” whereby professional identity may generate a perceived sense of control and attenuate risk perception in personal digital behaviour. Drawing on ethical considerations related to autonomy, professional responsibility, and the child's right to an open future, we argue that this paradox reflects a broader tension between expertise and everyday practice in digital environments. Conceptualizing this phenomenon may support ethical self-reflection among healthcare professionals and provide a foundation for future empirical and normative research on digital parenting in clinical contexts.</p>\u0000 </div>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"744-745"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949814","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":"Capable, Unbearably Suffering, and Excluded: People With Mental Illness and the Ethics of Canada's Assisted-Dying Regime","authors":"Daphne Gilbert,&nbsp;Udo Schuklenk","doi":"10.1111/bioe.70149","DOIUrl":"10.1111/bioe.70149","url":null,"abstract":"&lt;p&gt;For over 30 years, Claire Brosseau has lived with a severe form of bipolar disorder and post-traumatic stress disorder. She tried every available treatment. And yet, she is still ill. She is trapped in her apartment, only able to leave with great effort and family support. Her once good life has gotten smaller and smaller over the years, and now she is ready to die.&lt;/p&gt;&lt;p&gt;Brosseau is the plaintiff in a constitutional challenge, in Canada, to the continued exclusion of mental illness as a sole underlying medical condition for MAiD (MI-SUMC). In June 2026, a joint parliamentary committee recommended that the exclusion be made indefinite. Brosseau is now also seeking an individualized court-ordered exemption that would let her access MAiD. Her personal journey is tortured, as is that of MAiD MI-SUMC. When the Supreme Court of Canada, in &lt;i&gt;Carter v. Canada&lt;/i&gt; (2015 SCC 5), struck down the absolute prohibition on medical assistance in dying, it transformed end-of-life care for Canadians. The plaintiffs there had physical, not mental, illnesses, yet the Court did not exclude mental illness from the grievous and irremediable conditions that might qualify. Cases interpreting the ruling before federal legislation bore this out: in &lt;i&gt;Canada v. E.F&lt;/i&gt;. (2016 ABCA 155), the Alberta Court of Appeal granted an exemption to a woman whose intolerable suffering arose from a psychiatric condition. It is not the courts, in their careful constitutional analysis, that are the basis for the exclusion; it is elected (and unelected) politicians. At every step in the evolution of Canada's MAiD system, patients had to sue to force governments to legislate in ways that protect their fundamental rights.&lt;/p&gt;&lt;p&gt;In &lt;i&gt;Truchon c. Procureur général du Canada&lt;/i&gt; (2019 QCCS 3792), Justice Baudouin found that the requirement that one's natural death be reasonably foreseeable (a restriction the government had added after the Supreme Court ruling) was unconstitutional. Parliament then amended the &lt;i&gt;Criminal Code&lt;/i&gt; to create two tracks for MAiD. Track One is the original pathway for those whose natural death is reasonably foreseeable. Track Two is for those with a chronic illness, disease or disability where death is not reasonably foreseeable. By definition, mental illness belongs in Track Two, but the government carved it out. The exclusion was meant to last 3 years, ostensibly to give provinces and territories time to ready their health care system for these challenging cases; it was then extended again, and again. It is due to lift in March 2027. But the parliamentary committee has now recommended making it permanent.&lt;/p&gt;&lt;p&gt;Beneath this procedural history sits an indefensible ethical stance. The exclusion does not merely slow access or add safeguards; it declares in advance that &lt;i&gt;no&lt;/i&gt; person whose suffering arises from mental illness alone can ever qualify for an assisted death, no matter how capable they are, how refractory their condition, or how settled their req","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"655-657"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70149","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383268","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":"A Human Rights-Based and Relational Justice Approach to Assisted Reproduction in Spain","authors":"Rocío Paricio del Castillo,&nbsp;María de los Ángeles Cano-Linares,&nbsp;Mónica Díaz-de-Neira-Hernando","doi":"10.1111/bioe.70105","DOIUrl":"10.1111/bioe.70105","url":null,"abstract":"<div>\u0000 \u0000 <p>This article explores the ethical and legal challenges posed by the regulation of assisted reproductive technologies (ART) in Spain, using a human rights-based framework. While the Spanish legal system provides relatively broad access to ART, including for single women and lesbian couples, it fails to adequately address key normative tensions between competing rights (such as bodily autonomy, the right to identity, protection from exploitation, and the best interests of the child). The analysis reveals how the existing legal model is shaped by an individualistic and liberal conception of reproductive rights, which overlooks the structural, interdependent, and relational dimensions of assisted reproduction. Building on feminist bioethics and reproductive justice theories, we propose a relational justice approach that foregrounds the ethical responsibilities and vulnerabilities shared by all actors involved (parents, donors, children, professionals, and the state). This framework allows for a more nuanced deliberation of rights in conflict, and calls for regulatory reforms that prioritize ethical consistency, reproductive equity, and care-based practices. The article concludes that strengthening ART regulation in Spain requires not only guaranteeing access, but also ensuring the conditions for ethically sustainable and socially just reproductive experiences.</p>\u0000 </div>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"667-678"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494748","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":"Why Death Is Not Necessarily Most in One's Self-Interest: A Reply to Kriska","authors":"Fumitake Yoshizawa","doi":"10.1111/bioe.70148","DOIUrl":"10.1111/bioe.70148","url":null,"abstract":"<div>\u0000 \u0000 <p>In this response, I examine Victor Kriska's defense of thanatism, the claim that a quick and painless death is necessarily most in one's self-interest, and its stronger extension to all possible lives. I argue that Kriska's conclusion does not follow. The principles on which Kriska's argument relies are internally ambiguous. Once disambiguated, these principles either fail to support thanatism or require unpromising theoretical commitments. My criticism goes further. Even if these internal difficulties are somehow resolvable, Kriska's central principle of self-interest lacks independent justification. Without an adequate rationale, it assigns much weight to the minimization of bad while systematically subordinating the minimization of good. In conclusion, Kriska offers only controversial and under-motivated principles of self-interest rather than a compelling case for thanatism.</p>\u0000 </div>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"734-740"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474440","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":"Voluntary Assisted Dying for Grief: Medicalisation, a Proposed Autonomy—Only Approach, and Lessons From Prepubescent Gender Care","authors":"Tessa Jane Holzman","doi":"10.1111/bioe.70063","DOIUrl":"10.1111/bioe.70063","url":null,"abstract":"<div>\u0000 \u0000 <p>The recent addition of the diagnostic criteria for prolonged grief disorder has attracted criticism and concern about the undue medicalisation of grief and other existentially distressing yet normal life events. However, prolonged grief disorder currently forms the only pathway to VAD access for those suffering from extremely prolonged or unrelenting grief in the Netherlands, as this satisfies the requirement that the request must be due to a medical condition, and these criticisms of the disorder could jeopardise that access. A potential solution to this tension could be the currently debated autonomy—only approach to VAD, which circumvents issues of medicalisation by removing VAD from the medical domain. However, this approach raises other problems that require investigation in the context of grief specifically. In this article, I will first consider how VAD for grief is currently treated within Dutch VAD policy. This will involve an examination of prolonged grief disorder as a diagnosable condition, and how it relates to the general concern of undue medicalisation. Following this, I will consider possible ways in which persistence of a death wish due to grief can be established without the use of a medical diagnosis, as would be the case according to the autonomy-only framework for VAD. Ultimately, I will borrow some guidelines from the field of prepubescent gender care as an area that shares many morally relevant features with the question of VAD for grief and propose what I will be calling the “watchful grief affirming waiting” model.</p>\u0000 </div>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"748-756"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643117","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}