Bioethics最新文献

{"title":"Reproductive Technologies and family ties","authors":"Ji-Young Lee, Seppe Segers","doi":"10.1111/bioe.13334","DOIUrl":"10.1111/bioe.13334","url":null,"abstract":"<p>In vitro fertilization (IVF) revolutionized procreation and family-making in the late 1970s by making possible the separation of <i>conception</i> from <i>sex</i>. Since the birth of the first “IVF baby” Louise Brown in 1978, techniques like IVF have routinized rapidly, against initial predictions: it is estimated that at least 12 million babies have been born with the help of IVF and other assisted reproductive technologies (ART).1 Furthermore, ART-related births are projected to reach at least 167 million people by the year 2100—if not much more.2 On the surface, it seems that everybody's reproductive autonomy is expanding in virtue of these developments: aspiring parents can potentially procreate with the help of third parties, as with innovations like gestational surrogacy and uterus transplantation (UTx), and even those not actively trying to procreate have options to cryopreserve their own gametes for later use. Given that people nowadays delay childbearing for various reasons3 and one in six people are reported to experience infertility worldwide,4 it seems plausible to assume that aspiring parents will continue to turn to reproductive technologies in the hopes of attaining biogenetic procreation where “natural” conception is not an option.</p><p>Despite this apparent normalization of ART as a mode of family-making, however, it would be naïve as bioethicists to assume that the only effect of such technologies is that of medically “solving” people's infertility problems and expanding reproductive autonomy.5 The narrative that the aim of ART is to treat infertility obscures and simplifies its far-reaching (and perhaps unintended) social implications and side effects, including for example, the gendered burdens and costs it can exacerbate for would-be gestators,6 and also disputes over parental rights.7 Bioethicists have shown that ART may be a useful lens through which to probe the normative boundaries of kinship,8 and even the legitimacy of the desire for biogenetically related children.9 At the same time, it is clear that the differentiated (un)availability of ART at the global level reflect pre-existing inequalities in the social sphere, such as socioeconomic disparities10 and sexual and racial discrimination in reproductive medicine.11 As such, the myriad functions, usage, and implementation of ART can be unpredictable, morally ambivalent, and unique to the social settings under which they are deployed. Uncertainties about the social construction of reproduction and family ties therefore gives rise to a need for continued scholarship in bioethics. Providing practitioners, third parties, and service users with actionable and up-to-date insights on how best to operationalize reproductive technologies in the name of family ties, while also promoting awareness about their current limitations, is an ethically important task.</p><p>Many of the open-ended questions one might ask in this field invite philosophical considerations. Who does ART","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 7","pages":"589-591"},"PeriodicalIF":1.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565190","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":"Can a human right to good mental health be justified?","authors":"Phil Bielby","doi":"10.1111/bioe.13329","DOIUrl":"10.1111/bioe.13329","url":null,"abstract":"<p>Can a human right to good mental health be justified? This is an under-explored question: until recently, rights in relation to mental health have been framed and debated primarily in terms of their relevance to psychosocial disability and mental ill-health/mental distress. By contrast, in this article, I propose the basis of a normative justification for a population-wide right to good mental health, focusing in particular on individuals who do not experience mental ill-health/distress or do not have (or may never have) a psychiatric diagnosis or a psychosocial disability. The article is structured into three parts. First, I will outline the emergence of a population-wide right to good mental health in mental health discourse, led by recent reports published by the former United Nations Special Rapporteur on the Right to Health, Danius Pūras. I will then go on to explore what we might understand by ‘good mental health’. Finally, I will explain how a right to good mental health may be justified, drawing on insights from compassion, ‘vulnerable agency’, and James Wilson's account of ‘a right to public health’. I then respond to feasibility and demandingness concerns about such a right, which together inform the basis of the qualified public health right to good mental health I propose.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 8","pages":"733-740"},"PeriodicalIF":1.7,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536066","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 ‘family’: A call for conceptual amelioration","authors":"Ryan Xia-Hui Lam","doi":"10.1111/bioe.13333","DOIUrl":"10.1111/bioe.13333","url":null,"abstract":"<p>The modern concept of ‘family’ in the United States recognizes many types of social groups as families, a conceptual shift which was largely helped along by advancements in assisted reproductive technologies enabling those formerly unable to biologically reproduce to have children, as well as by social movements aimed at garnering recognition for these emergent nonbiologically related social groups spearheaded by LGBTQ+ and adoption activists. That these social groups are now recognized as types of families is unquestionably an improvement to the concept, though there are still defects in the concept that preclude these nonnuclear families from achieving the same social–ontological status as nuclear families. Drawing from the nascent philosophical field of conceptual engineering, I analyze our current conception of ‘family’ and argue that it is tacitly exclusionary of nonnuclear families, which can be attributed to a combination of widespread genetic essentialism and linguistic practices that unduly cast the nuclear family as a more desirable type of family by emphasizing genetic relatedness as a valuable quality. I then offer proposals to ameliorate these defects, such as educational interventions to reduce genetic essentialism and the introduction of new terminology that does not connote one type of family as being superior to another. In doing so, my hope is to reveal and begin to resolve an overlooked defect in the concept of ‘family’ in order to bolster the movement to view all families as equal.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 7","pages":"650-658"},"PeriodicalIF":1.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472840","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":"Revealing misattributed parentage through the integration of genetic information into the electronic health record","authors":"Sivan Tamir,&nbsp;Sivan Gazit,&nbsp;Shiri Sivan,&nbsp;Tal Patalon","doi":"10.1111/bioe.13332","DOIUrl":"10.1111/bioe.13332","url":null,"abstract":"<p>The integration of genetic information (GI) into the electronic health record (EHR) seems inevitable as the mainstreaming of genomics continues. Such newly provided accessibility to GI could be beneficial for improving health care, as well as for supporting clinical decision-making and health management. Notwithstanding these promising benefits, the automatic integration of GI into the EHR, allowing unrestricted access to one's GI through patient portals, carries various knowledge-related risks for patients. This article is focused on the potential case of inadvertently revealing misattributed parentage through such practice. The article aims to identify key clinical and ethical implications of such revelation for adult patients. Clinical implications include, for example, altering the physician-patient interaction and the need to enhance physician's genetic literacy to improve genetic-information-specific communication skills. Ethical implications yield arguments supporting disclosure of MP, such as autonomy, individuals' right to know medical information pertaining to them, and the right to know one's genetic origins. Arguments opposing disclosure of MP centre on the right <i>not</i> to know GI and concerns for post-disclosure family relationships. Following the clinical and ethical analyses of these respective implications, we consider how such integration of GI into the EHR ought to be carried out, ethically. We therefore suggest a solution, featuring an autonomy-based approach, built around EHR users' right <i>not</i> to know. Our solution of nuanced consent options (including a ‘genetic ignorance option’) is designed to enable patients' informed exposure to GI through the EHR, allowing them some control over their self- and familial narrative.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 8","pages":"741-750"},"PeriodicalIF":1.7,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472841","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":"Best to possibly not be: A prudential argument for antinatalism","authors":"Marcus T. L. Teo","doi":"10.1111/bioe.13330","DOIUrl":"10.1111/bioe.13330","url":null,"abstract":"<p>This article starts by examining the present state of death ethics by attending to the euthanasia debate. Given that voluntary active euthanasia has seen strong support in the academic community, insights on the choiceworthiness of continued existence may be derived. Having derived cases of choiceworthy nonexistence (which I refer to as choiceworthy nonexistence [CNE] cases), I extend these intuitions to lives not worth starting, or choiceworthy nonexistence for potential people (which I refer to as foetal-CNE, or fCNE cases). Although I depart from Benatarian antinatalism by rejecting Benatar's claim that all existence is necessarily a harm, I posit a weaker argument that all existence is <i>likely</i> a harm since we cannot know until later in life if an existence is a harm. If I am right, then we have prudential reasons not to bear children, since they are more likely to suffer in lives not worth living than not.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 8","pages":"722-727"},"PeriodicalIF":1.7,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460890","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 prospects of longtermism","authors":"Ingmar Persson,&nbsp;Julian Savulescu","doi":"10.1111/bioe.13323","DOIUrl":"10.1111/bioe.13323","url":null,"abstract":"<p>This article objects to two arguments that William MacAskill gives in <i>What We Owe the Future</i> in support of optimism about the prospects of longtermism, that is, the prospects of positively influencing the longterm future. First, it grants that he is right that, whereas humans sometimes benefit others as an end, they rarely harm them as an end, but argues that this bias towards positive motivation is counteracted by the fact that it is practically easier to harm than to benefit. For this greater easiness makes it likely both that accidental effects will be harmful rather than beneficial and that the means or side-effects of the actions people perform with the aim of benefiting themselves and those close to them will tend to be harmful to others. Secondly, while our article agrees with him that values could lock-in, it contends that the value of longtermism is unlikely to lock in as long as human beings have not been morally enhanced but remain partial in favor of themselves and those near and dear.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 8","pages":"709-712"},"PeriodicalIF":1.7,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421996","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":"Virtue ethics and the unsettled ethical questions in controlled human infection studies","authors":"Jeffrey T. Poomkudy,&nbsp;Seema K. Shah","doi":"10.1111/bioe.13326","DOIUrl":"10.1111/bioe.13326","url":null,"abstract":"<p>Controlled human infection studies (CHIs) involve the intentional infection of human subjects for a scientific aim. Though some past challenge trials have involved serious ethical abuses, in the last few decades, CHIs have had a strong track record of safety. Despite increased attention to the ethics of CHIs during the COVID-19 pandemic, CHIs remain controversial, and there has been no in-depth treatment of CHIs through the lens of virtue ethics. In this article, we argue that virtue theory can be helpful for addressing CHIs that present a constellation of controversial, unresolved, and/or under-regulated ethical issues. We begin with some brief background on virtue ethics. We then substantiate our claim that some CHIs raise a constellation of ethical issues that are unresolved in the ethics literature and/or lack adequate regulatory guidance by demonstrating that CHIs can present indeterminate social value, risks to third parties, limitations on the right to withdraw from research, and questions about the upper limit of allowable risk. We argue that the presence of a virtuous investigator, with virtues such as prudence, compassion, and integrity, is especially important when these unresolved research ethics issues arise, which is the case for certain types of controlled human infection studies. We use the historical example of Walter Reed and the Yellow Fever Commission to illustrate this claim, and we also highlight some contemporary examples. We end by sketching some practical implications of our view, such as ensuring that investigators with experience running CHIs are involved in novel CHI models.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 8","pages":"692-701"},"PeriodicalIF":1.7,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332592","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":"Another “turn” in bioethics? A plea for methodological continuity","authors":"Michiel De Proost,&nbsp;Veerle Provoost","doi":"10.1111/bioe.13324","DOIUrl":"10.1111/bioe.13324","url":null,"abstract":"<p>A growing trend in bioethics highlights the importance of using big data science methods to advance normative insight. This has been called the “digital turn” in bioethics by Salloch and Ursin. Automated data processing can, for example, detect significant patterns of correlation that have escaped the attention of human scholars. Although we agree that such technological innovations could bolster existing methods in empirical bioethics (EB), we argue that it should not be conceptualized as a new turn but rather as a revivification, and possibly an amplification of entrenched debates in EB. We begin by highlighting some convergences between EB and digital bioethics that Salloch and Ursin seem to categorize as fundamental differences and end up with elaborating on some risks related to the integration of empirical findings with normative (philosophical) analysis in the digitalization trend.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 8","pages":"728-732"},"PeriodicalIF":1.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321969","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":"Euthanasia in detention and the ethics of caring solidarity: A case study of the ‘Tarragona Gunman’","authors":"Luis Espericueta","doi":"10.1111/bioe.13325","DOIUrl":"10.1111/bioe.13325","url":null,"abstract":"<p>Almost a year after the enactment of the law regulating euthanasia in Spain, public opinion was shocked to learn that a defendant in criminal proceedings obtained medical assistance in dying following injuries sustained in an exchange of gunfire with the police after having committed a series of severe crimes. Although there are very few cases in the world where prisoners have received euthanasia, the one we will discuss in this article is the only known case where both the public prosecutor's office and the private prosecutors judicially opposed the defendant's euthanasia. This article aims to offer a new perspective on the ethical legitimacy of detainees' access to euthanasia: the ethics of caring solidarity. To do this, we will first place the case in its legal context. Subsequently, we will address the two main arguments proposed in the literature to justify euthanasia in detention: respect for the autonomy of the detainee and the principle of equivalence of care. Finally, after having identified serious shortcomings in both arguments, we will argue that the perspective of caring solidarity offers a better ethical basis for people in detention's access to euthanasia.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 8","pages":"713-721"},"PeriodicalIF":1.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/bioe.13325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321970","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":"Age-related hearing loss and “hearables”: An agenda for moral considerations","authors":"Michiel De Proost,&nbsp;Seppe Segers,&nbsp;Heidi Mertes","doi":"10.1111/bioe.13327","DOIUrl":"10.1111/bioe.13327","url":null,"abstract":"<p>Rapid advances in digital hearing technologies, also known as hearables, are expected to disrupt the direct-to-consumer health market. For older adults with higher incidence of hearing loss, such disruption could reduce hearing problems, increase accessibility to hearing aids, and mitigate related stigmas. This paper delves into the intersection of disruptive innovation and hearables within the realm of biomedical ethics. Through a comprehensive exploration, we shed light on the ethical implications surrounding hearables. By critically evaluating the key ethical advantages and drawbacks, we find that no single concern presents an insurmountable a priori objection to hearables. We conclude with some ideas to maximize the benefits of hearables and further promote opportunities for equitable hearing health.</p>","PeriodicalId":55379,"journal":{"name":"Bioethics","volume":"38 9","pages":"778-786"},"PeriodicalIF":1.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321968","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}