Bioethics最新文献

{"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}

{"title":"Rethinking Conscientious Objection in Health Care Alberto Giubilini, \u0000 Udo Schuklenk, \u0000 Francesca Minerva, and \u0000 Julian Savulescu, New York: Oxford University Press, 2025. 265 pp. ISBN: 978-0-19-778653-6","authors":"Mark R. Wicclair","doi":"10.1111/bioe.70129","DOIUrl":"https://doi.org/10.1111/bioe.70129","url":null,"abstract":"","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"741-743"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148704296","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":"Expanding the Taxonomy of Ethical Issues in Surgical Innovation","authors":"Jane Johnson,&nbsp;Katrina Hutchison,&nbsp;Wendy Rogers","doi":"10.1111/bioe.70107","DOIUrl":"10.1111/bioe.70107","url":null,"abstract":"<p>Surgical innovation poses significant ethical challenges. Previous work has grouped these challenges under four categories: potential harms to patients; compromised informed consent; unfair allocation of healthcare resources; and conflicts of interest. We argue that recent technological developments in surgery warrant the addition of three new ethical challenges to the existing taxonomy: allocating responsibility; impact on relationships; and risks to privacy. Although these challenges predate developments in robotic surgery and Artificial Intelligence, nonetheless these technologies highlight and make more urgent the need to consider these categories and identify how the concerns they raise may be addressed.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"679-687"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494797","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":"The Place of Marginalization in Bioethics: Do We Need the Concept?","authors":"Elisabeth Langmann,&nbsp;Verina Wild","doi":"10.1111/bioe.70103","DOIUrl":"10.1111/bioe.70103","url":null,"abstract":"<p>Marginalization is a widely studied phenomenon and recognized as a critical topic in relation to health, shaping health inequities, access to resources, health outcomes, and policy decisions. However, despite its normative importance for health and justice, its conceptual role in bioethics remains unclear. This paper critically examines how marginalization is addressed in bioethics, analyzing its meaning, conceptual usage, and potential for further normative theorization. By exploring available definitions and how marginalization appears in bioethical literature, recurring patterns and conceptual gaps are identified. The analysis reveals two major findings. First, while definitions from disciplines beyond bioethics provide valuable insights, marginalization has not been normatively theorized as a distinct conceptual phenomenon within bioethics. Instead, dynamics of marginalization are largely addressed through established bioethical concepts, such as vulnerability or epistemic injustice. Second, it stands out that the contemporary redefinition of vulnerability in bioethics increasingly incorporates discussions on systemic exclusion and structural injustice, both central to marginalization. This raises the question of whether marginalization requires distinct conceptualization in bioethics or if its core dimensions are already encompassed by existing approaches and concepts. Consequently, this paper argues that further conceptual debate on marginalization is needed to assess its potentially distinct contributions to bioethics. It develops arguments for making space for the concept of marginalization within bioethics in its own right. To address these conceptual gaps, this paper calls for a more explicit normative analysis of marginalization to establish its role in bioethical discourse and to clarify its implications for equitable health, healthcare practices, and policies.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"688-696"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505577","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":"When Is Social Value Proportionate to Research Risks?","authors":"Robert Steel","doi":"10.1111/bioe.70109","DOIUrl":"10.1111/bioe.70109","url":null,"abstract":"<p>Ethical human subjects research must have an acceptable risk-benefit ratio, which requires that the net risks participants face be proportionate to the research's social value. Yet existing scholarship does not explain what makes risks proportionate to social value. Here, I distinguish internal and external senses of proportionality and argue that it is internal proportionality that is the proper object of IRB/REC review. I propose understanding internal proportionality in terms of a literal ratio of expected health effects; I also argue against the alternative of attempting to assess proportionality through intuitive comparisons. I illustrate the potential implications of this account through a discussion of the proposal to engage in controlled human infection studies with the novel coronavirus. This case highlights that trials with enormous numbers of potential beneficiaries can be internally proportional even when they are very unlikely to succeed.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"707-716"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139903","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":"Between Safeguard and Constraint: Navigating Patient Autonomy in Protective Laws for Medical Assistance in Dying","authors":"Janet Delgado,&nbsp;Iris Parra Jounou,&nbsp;Mar Vallès-Poch,&nbsp;Ramón Ortega-Lozano,&nbsp;María Victoria Martínez-López,&nbsp;Luis Espericueta,&nbsp;Maria Isabel Tamayo-Velázquez,&nbsp;David Rodríguez-Arias,&nbsp;Rosana Triviño-Caballero","doi":"10.1111/bioe.70145","DOIUrl":"10.1111/bioe.70145","url":null,"abstract":"<p>There has been an increase in the number of jurisdictions legalizing or decriminalizing Medical Assistance in Dying (MAiD). Legal frameworks worldwide strive to balance respect for autonomy with regulatory safeguards that both operationalize voluntary choice and prevent access to MAiD in cases of remediable despair or coerced decision-making. However, the implementation of such an equilibrium diverges. Some legal systems prioritize personal autonomy and informed consent as the main criterion to access MAiD (e.g., US jurisdictions), while others also add the alleviation of suffering (e.g., The Netherlands). Using the lens of relational autonomy and focusing on Spain's MAiD legislation as a case study, this article poses the question of what notion of autonomy is implied in this system, and whether the imposition of certain safeguards might inadvertently undermine or restrict autonomy, in some specific cases. To that aim, we first analyze its stringent requirements for assessing the so-called “euthanasic context” which establishes eligibility conditions to access MAiD; then, we highlight how some of its assessments can interfere with the person's autonomy. The analysis highlights how protective measures (e.g., three external assessments before the request is either granted or denied) may imply forms of pathogenic vulnerability, in which safeguards meant to protect autonomy could paradoxically heighten an individual's vulnerability while diminishing autonomy through forms of epistemic injustice. We conclude that these highly protective laws might fall into the “trap of protection,” illustrating the tension between safeguarding autonomy and respecting individuals’ capacity for self-determination in the context of MAiD.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"757-766"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148354717","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":"Discrimination Against Healthcare Workers by Patients and Colleagues, Affective Injustice and the Impact on Well-Being and Practice","authors":"Brenda Bogaert","doi":"10.1111/bioe.70115","DOIUrl":"10.1111/bioe.70115","url":null,"abstract":"<p>Discrimination in healthcare is a pervasive issue that affects patients, healthcare providers, and quality of care. This article mobilizes the concept of affective injustice—a wrong done to someone as an affective being—to better understand the harms experienced by healthcare providers facing discrimination from both patients and colleagues. When patients discriminate, the duty to care often overrides the healthcare provider's ability to express justified emotions, particularly anger. In contrast, inter-colleague discrimination frequently takes the form of microaggressions, which are difficult to challenge. Because of these difficulties, healthcare providers often feel pressured to engage in emotional regulation strategies to manage their own affects. While emotional regulation strategies may be helpful in the short-term, we show that they do not address the root causes of discrimination and may exacerbate healthcare providers' distress, and impact care quality and staff retention. To better deal with these problems, the article will propose affective resources, opportunities, and freedoms that can be put into place to support healthcare providers and to make the workplace a more just space for all.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"717-723"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789636","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":"Information Discrimination and Its Implications on Distributing Healthcare Costs Fairly","authors":"Harisan U. Nasir","doi":"10.1111/bioe.70112","DOIUrl":"10.1111/bioe.70112","url":null,"abstract":"<p>When healthcare resources are scarce, they ought to be distributed fairly across society. For some theories of distribution, an assessment of individual health risk is required for a fair distribution of both healthcare resources and burdens. Despite this requirement, prevailing theories underappreciate the cost of information on health risk. Information relevant to health risk will be ignored when these costs are too high, leading to a form of discrimination that I term “information discrimination”. This leads to a potential source of unfairness for any health system that aims to distribute the burdens of healthcare across individuals according to their <i>expected</i> health states. Individuals whose risks are cheap to identify will have their risks personalized whereas individuals whose risks are expensive to identify will have their risks spread across society or the collective. This paper discusses the implications of this unfairness on two types of distributive theories in healthcare: responsibility-sensitive and responsibility-insensitive.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"724-733"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789837","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":"Autonomy-Only Approaches to Assisted Dying","authors":"Eric Mathison","doi":"10.1111/bioe.70164","DOIUrl":"10.1111/bioe.70164","url":null,"abstract":"&lt;p&gt;At the turn of the millennium, assisted dying was legal in only a handful of jurisdictions. Oregon, the first US state to permit it, passed its Death with Dignity Act in 1994. Following legal challenges, it came into effect in 1997. The Netherlands and Belgium formalized their euthanasia regimes in 2002. Following that, little happened for over a decade. Then, starting in the mid-2010s, there was a sharp rise in assisted dying legalization. Some form of assisted dying is now legalized or decriminalized in more than two dozen jurisdictions across Europe, the Americas, and Oceania, and new statutes continue to pass almost yearly, including Canada in 2016, the Australian states between 2017 and 2022, New Zealand and Spain in 2021, and, in the United States, a steady accumulation that reached its fourteenth jurisdiction in early 2026 (including New York and Illinois, which are taking effect in August and September respectively).&lt;/p&gt;&lt;p&gt;Each new jurisdiction has based its law on a fairly narrow set of criteria already in place in other jurisdictions. The Netherlands was the first jurisdiction to legalize any form of assisted dying. (Assisted dying has been &lt;i&gt;de facto&lt;/i&gt; lawful in Switzerland since 1942, but that is due to a gap in its criminal prohibition—assisting suicide is an offense only if done from selfish motives—not a positive law.) To qualify for an assisted death in the Netherlands, the core criterion is that a person must be experiencing intolerable suffering as judged by the patient and confirmed by the physician. Both physician administration (so-called euthanasia) and self-administration (so-called assisted suicide) are permitted.&lt;/p&gt;&lt;p&gt;In the United States, each state's laws are close copies of Oregon's 1994 law. Oregon requires, first, that a person be likely to die of her underlying condition within 6 months, and second, that she self-administer the medication that will end her life. All subsequent states have kept those two core criteria. As L.W. Sumner remarks, Oregon's requirements invert those of the Netherlands, which requires suffering but not a terminal illness, whereas Oregon requires a terminal illness but not suffering [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;From these two origins—the Netherlands and Oregon respectively—later jurisdictions have selected their own criteria, sometimes hewing closer to the Dutch model, sometimes to Oregon, or sometimes a mix. For example, Canada's initial legislation for medical assistance in dying (MAID) required that a person have a grievous and irremediable medical condition, which requires intolerable suffering, and must also have a “reasonably foreseeable natural death”. (Following a court challenge, the latter condition is no longer required in all cases.) New Zealand combines the two models, requiring both a terminal illness likely to end the person's life in 6 months and unbearable suffering [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Ethically speaking, the dominant view for the past few decades has been that assiste","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"746-747"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70164","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148498551","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":"“Yet the Problem Remains”: Why Genetic Determinism Still Haunts Biomedical Research","authors":"Christopher R. Donohue,&nbsp;Ian A. Myles","doi":"10.1111/bioe.70102","DOIUrl":"10.1111/bioe.70102","url":null,"abstract":"<p>After the horrors of the Holocaust and its connections to eugenics were revealed to the world, many post-war population geneticists sought to establish rhetorical distance from the Nazi's state-led campaigns, without abandoning their belief that actively shaping the population's genetics would produce a prosperous society. While many advancements in equity have come, well-intentioned geneticists continue to struggle to distance themselves from those weaponizing genetic data. Herein, we outline the practices which often prevent modern population genetics from ridding itself of the ghost of genetic determinism. These include the interlocking practices of: agnostically noting “genes matter” without detailing the degree or context of importance; using examples or explanations which can be ambiguously interpreted; using flawed data to assert that medical advances require genetic insights; homogenizing the environment in ways that ignore, rather than account for, deleterious exposures; insisting that populations be mathematically segregated prior to performing their analysis; then, when predictable harms arise, using lack of intent to harm as an excuse to refuse to change standard practices or to accept responsibility. Finally, discrete recommendations for improvements are presented. Unlike denouncements of overt eugenics, it is controversial to argue that those working on the genetics of diseases like asthma may unwittingly echo the eugenicists of the past. However, the consistency of associations between modern population genetics and historic eugenics demand mechanistic evaluation.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"40 7","pages":"658-666"},"PeriodicalIF":2.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494631","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}