Spurred by a severe shortage of cadaveric organs, there has been a marked growth in living organ donation over the past several years. This has stimulated renewed interest in the ethics of this practice. The major concern has always been the possibility that a physician may seriously harm one person while trying to improve the well-being of another. As Carl Elliott points out, this puts the donor's physician in a difficult predicament: when evaluating a person who volunteers to donate an (...) organ, “a doctor is in the position of deciding not simply whether a subject's choice is reasonable … but whether he [the doctor] is morally justified in helping the subject accomplish it.”1 This question has become even more difficult since the introduction of living donor operations that are more risky than living kidney donation and the suggestion that volunteers at added risk may sometimes be acceptable.2 So, how can we decide when the risk is too much? (shrink)

Walter Glannon argues that our proposal for routine recovery of transplantable cadaveric organs is unacceptable After carefully reviewing his counterarguments, we conclude that, although some of them have merit, none are sufficiently strong to warrant abandoning this plan. Below we respond to each of Glannon's concerns.

The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur’s Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide (...) useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place. (shrink)

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and (...) evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. (shrink)

Transplantation is now the best therapy for eligible patients with end-stage organ disease. For patients with failed kidneys, successful renal transplantation improves the quality and increases the quantity of their lives. For people with other types of organ failure, transplantation offers the only hope for long-term survival. a.

: The March 2003 issue of the Kennedy Institute of Ethics Journal was devoted to cadaveric organ procurement. All the discussed proposals for solving the severe organ shortage place a higher value on respecting individual and/or family autonomy than on maximizing recovery of organs. Because of this emphasis on autonomy and historically high refusal rates, I believe that none of the proposals is likely to achieve the goal of ensuring an adequate supply of transplantable organs. An alternative approach, conscription of (...) cadaveric organs for transplantation, reverses the rank order of these priorities by placing greater value on maximizing recovery of organs than on respect for autonomy. Although conscription of organs initially may appear to be a radical and even ridiculous proposal, careful consideration reveals that it might well solve the organ shortage in an ethically acceptable way. (shrink)

In their recent article, Glannon and Ross remind us that family members have obligations to help each other that strangers do not have. They argue, I believe correctly, that what creates moral obligations within families is not genetic relationship but rather a sharing of intimacy. For no one are these obligations stronger than they are for parents of young children. This observation leads the authors to the logical conclusion that organ donation by a parent to her child is not optional (...) but rather a prima facie duty. However, Glannon and Ross go a step further by suggesting that because parent-to-child organ donation is a duty, it cannot be altruistic. They assert that “altruistic acts are optional, nonobligatory…supererogatory…. Given that altruism consists in purely optional actions presupposing no duty to aid others, any parental act that counts as meeting a child's needs cannot be altruistic.” Here I think the authors go too far. (shrink)

The advent of deep sequencing technology has unexpectedly advanced our structural understanding of molecules composed of nucleic acids. A significant amount of progress has been made recently extrapolating the chemical methods to probe RNA structure into sequencing methods. Herein we review some of the canonical methods to analyze RNA structure, and then we outline how these have been used to probe the structure of many RNAs in parallel. The key is the transformation of structural biology problems into sequencing problems, whereby (...) sequencing power can be interpreted to understand nucleic acid proximity, nucleic acid conformation, or nucleic acid‐protein interactions. Utilizing such technologies in this way has the promise to provide novel structural insights into the mechanisms that control normal cellular physiology and provide insight into how structure could be perturbed in disease. (shrink)

According to Glannon and Ross, for an act to be considered altruistic, it cannot be obligatory nor motivated by expectation of self-reward. Given that parents are obligated to help their children and stand to benefit greatly from donating, the authors conclude that parent to child organ donation is not altruistic. Are they correct? I am not sure. In my view, this is a semantic question and the answer depends upon how one defines altruism. Altruism is a complex subject that means (...) different things to different people. If we say that an altruistic act is one that is performed voluntarily, is risky or costly to the actor, and is designed only to benefit others with no expectation of self-reward, then it may be difficult or impossible to identify any such acts. When one risks her own life to save a stranger, others may ask: “Did she really act solely to benefit another or was she motivated, at least in part, by a need to satisfy her conscience or a desire to feel good about herself?” This question is relevant to the motivation of living organ donors. In contrast to the authors' answer that strangers who donate organs do so only out of concern for other people, Carl Fellner argued that many living organ donors, even those who are not related to their recipients, act to benefit themselves. If Fellner is correct, and if organ donation by parents is not altruistic because of the possibility of self-reward, perhaps the same is true of organ donation by strangers. (shrink)

During the last decade, children have shown an increasing need for mental wellbeing interventions due to their anxiety and depression issues, which the COVID-19 pandemic has exacerbated. Socially Assistive Robotics have been shown to have a great potential to support children with mental wellbeing-related issues. However, understanding how robots can be used to aid the measurement of these issues is still an open challenge. This paper presents a narrative review of child-robot interaction (cHRI) papers (IEEE ROMAN proceedings from 2016–2021 and (...) keyword-based article search using Google Scholar) to investigate the open challenges and potential knowledge gaps in the evaluation of mental wellbeing or the assessment of factors affecting mental wellbeing in children. We exploited the SPIDER framework to search for the key elements for the inclusion of relevant studies. Findings from this work (10 screened papers in total) investigate the challenges in cHRI studies about mental wellbeing by categorising the current research in terms of robot-related factors (robot autonomy and type of robot), protocol-related factors (experiment purpose, tasks, participants and user sensing) and data related factors (analysis and findings). The main contribution of this work is to highlight the potential opportunities for cHRI researchers to carry out measurements concerning children’s mental wellbeing. (shrink)

This paper addresses the critiques based on trade-offs and normativity presented in response to our target article proposing the Public Health Emergency Risk and Crisis Communication (PHERCC) framework. These critiques highlight the ethical dilemmas in crisis communication, particularly the balance between promoting public autonomy through transparent information and the potential stigmatization of specific population groups, as illustrated by the discussion of the mpox outbreak among men who have sex with men. This critique underscores the inherent tension between communication effectiveness and (...) autonomy versus fairness and equity. In response, our paper reiterates the adaptability of the PHERCC framework, emphasizing its capacity to tailor messages to diverse audiences, thereby reducing potential stigmatization and misinformation. Through community engagement and feedback integration, the PHERCC framework aims to optimize the effectiveness of communication strategies while addressing ethical concerns. Furthermore, by involving affected communities in the communication strategy from the onset, the framework seeks to minimize ethical trade-offs and enhance the acceptance and effectiveness of public health messages. (shrink)

Background Prenatal genetic testing, in particular non-invasive prenatal testing (NIPT), as well as screening for risks associated with pregnancy, and counseling, play pivotal roles in reproductive healthcare, offering valuable information about the health of the fetus to expectant parents. This study aims to delve into the perspectives and experiences of women considering genetic testing and screening during pregnancy, focusing on their decision-making processes and the implications for informed consent. Methods A nationwide qualitative study was conducted in Switzerland, involving in-depth interviews (...) with women who were 1 to 2 years post-partum, covered by basic compulsory Swiss insurance, including women with a migration background. Thematic analysis was employed to identify key themes and patterns in the data. Results The findings underscore the significance of effective communication during prenatal counseling, suggesting that healthcare providers could not only convey technical information but also support women in their decision-making processes. Women need comprehensive information about genetic testing and its implications, as well as the reasons for screening during pregnancy, as there might be a need to bridge knowledge gaps and clarify misconceptions. Furthermore, the study highlights the multifaceted nature of decision-making, with women considering factors such as uncertainty, values, emotional responses, and societal support systems. The concept of acceptance emerged as a crucial theme, with some women expressing their readiness to love and accept their child, regardless of genetic anomalies or disabilities. Conclusion This study offers valuable insights into the perspectives and needs of women regarding prenatal genetic testing, screening, and counseling in Switzerland. It underscores the importance of enhancing the clinical interaction and informed consent process by providing comprehensive information, addressing misconceptions, and supporting women in decision-making about pregnancy management and the management of the child’s health, following prenatal genetic testing, including NIPT. These findings can inform healthcare providers and policymakers in improving the quality of prenatal counseling, ensuring informed consent, and supporting women in making well-informed and meaningful decisions about genetic testing, and on the use of screening during pregnancy. (shrink)

Name der Zeitschrift: Der Islam Jahrgang: 93 Heft: 2 Seiten: 614-617.

In a recent article in this journal, we argued that living organ donation from a parent to a child should be described as a beneficent rather than an altruistic act. Emotional relationships can generate an obligation of beneficence to help those with whom we have these relationships. This may involve an obligation for a parent to donate an organ to a child, even though it entails some risk to the parent. The parent's donation is not altruistic because altruistic acts are (...) not obligatory but optional, and they are motivated solely or primarily by other-regarding concerns. In contrast, donor parents' other-regarding concerns are inseparable from their own self-regarding concerns. An individual who donates to a stranger is acting altruistically. She may choose to help others to whom she is not emotionally related for a variety of reasons—sympathy, compassion, generosity, or a desire to give something back to humanity. But she does not have an obligation to do so. Although she may benefit as a consequence of donating, this is not her reason for donating. Instead, her action is motivated by a concern for the recipient's own sake. This is what makes the donation altruistic, and it can be justified without any expectation of benefit to the donor. However, although the potential competent donor decides whether the donation is in her best interests, physicians have the right to refuse to perform a transplant if the risks to the donor are too great or the potential benefits to the recipient are too small. (shrink)

Spitale et al. (2024) address a public health ethics question of great importance: How should governments communicate with the public during public health emergencies? The article highlights severa...

Spitale, Germani, and Biller-Andorno’s (2024) PHERCC matrix sets out a useful and systematic framework for risk and crisis communication in public health emergencies. A problem in ensuring effective messaging is the extent to which the messaging environment is *quiet* or *noisy*: in other words, whether or not a message has to *compete with other messages* at the same time. I use the example of the UK’s experience during COVID-19, which was marked by tensions between the devolved regional governments—and consequently divergent (...) policy responses—which sowed confusion among the populace. More generally, if policymakers try to account for the needs of competing publics simultaneously (in order to meet the inclusivity and understandability principles), this may increase the noise problem and so actually undermine effective public health messaging. The issue of noisy messaging environments reveals a tradeoff between inclusivity and understandability versus effectiveness in risk and crisis communication. (shrink)

Spitale, Germani, and Biller-Andorno (2024) have proposed a comprehensive framework for navigating the ethical dilemmas associated with risk and crisis communication (RCC) during public health emer...

Spitale, Germani, and Biller-Andorno (2024) presented an ethical framework for managing risk and crisis communication (RCC) during public health emergencies (PHE) in their recent paper. They advoca...

The ethical restatement of the “risk and crisis communication in public health emergency” (PHERCC) matrix by Spitale et al. (2024) is a step up from mainstream approaches like the Crisis and Emerge...

In a recent set of papers, Aaron Spital has proposed conscription or routine recovery of cadaveric organs without consent as a way of ameliorating the severe shortage of organs for transplantation. Under the existing consent requirement, organs can be taken from the bodies of the deceased if they expressed a wish and intention to donate while alive. Organs may also be taken when families or other substitute decisionmakers decide on behalf of the deceased to allow organ procurement for the purpose (...) of transplantation. When patients or families do not consent to organ procurement, many transplantable organs are lost. This is a tragic yet avoidable situation. The dead are beyond any benefit or harm, and their organs could be used to prevent harm by saving and improving the lives of many people suffering and dying from end-stage organ failure. (shrink)

Als wir bei Sonnenuntergang gerade durch die Herde Nilpferde hindurchfuhren, stand urplötzlich, von mir nicht gesucht, das Wort »Ehrfurcht vor dem Leben« vor mir. Der Pfad im Dickicht war sichtbar geworden. Nun war ich zu der Idee vorgedrungen, in der Welt- und Lebensbejahung und Ethik miteinander enthalten sind. Albert Schweitzer Seit fast 100 Jahren steht der Name Albert Schweitzer für aktives humanitäres Engagement. Dank seiner Philosophie der »Ehrfurcht vor dem Leben«, die er gemeinsam mit seiner Frau Helene Bresslau im Urwaldhospital (...) in Lambarene verwirklichte, gehört er zu den am meisten bewunderten Menschen der Welt. Mit dreißig Jahren ein geachteter Theologe und gefeierter Interpret der Orgelwerke Johann Sebastian Bachs entschloss er sich, noch ein Medizinstudium zu absolvieren, um den Ärmsten der Armen zu helfen. Ernst Luther nähert sich diesem Humanisten mit philosophisch-kritischen Betrachtungen, ordnet dessen Leben und Werk in die Umbrüche seiner Zeit ein und resümiert, was von Schweitzers Gedankengut bewahrt werden sollte. Ernst Luther, Jg. 1932, Studium der Pädagogik, Geschichte/Germanistik, extern Philosophie, Gasthörer Medizin an der Universität Halle; Promotion Dr. phil. 1961 zur medizinischen Anthropologie Viktor von Weizsäckers an der Universität Greifswald; Dr. sc. phil. 1970 Universität Halle mit einer Arbeit über Ethik in der Medizin. Herausgeber und Mitautor zahlreicher Arbeiten zur Ethik in der Medizin. Mitglied im Albert-Schweitzer-Komitee e. V. Weimar, im Deutschen Hilfsverein für das Albert-Schweitzer-Spital Lambarene, Frankfurt a. M., in der Internationalen Albert-Schweitzer-Vereinigung. Von 2000 bis 2002 Mitglied der Enquete-Kommission des Deutschen Bundestages Recht und Ethik in der Medizin. Inhalt: Vorwort Albert Schweitzer - der friedlichen Menschheit zugehörig Das »Bergwerk der Ethik« Das Menschenbild aus Schweitzers philosophischer und religiöser Sicht Albert Schweitzer und Karl Marx Albert Schweitzers Gedanken zu Kultur und Ethik in den Weltreligionen Albert Schweitzer und die Ethik in der Medizin Ethik und Völkerfrieden Sozialethik gegen Kolonialpolitik und Rassenhass. (shrink)

Hospitals are traditional sites, not only of care, but of knowledge production. The word ‘hospital’ is derived from ‘hospitality’, and is also associated with ‘spital’, ‘hotel’ and ‘hospice’. In medieval society, the hospice was a place of rest, security and entertainment. The Knights Hospitallers were an order of military monks that took its historical origin from a hospital founded in Jerusalem in 1048. Before the rise of the modern research hospital, these spitals had a more general function as charitable institutions (...) for the care and maintenance of the aged, infirm and impoverished. Hospitals were important in the historical emergence of the university, but with the dominance of bio-medical sciences medical faculties have become increasingly separated geographically and administratively from other faculties. Medical research is dominated by private corporations and increasingly medical knowledge exists outside the conventional procedures and norms of scientific research. (shrink)

Immer mehr Menschen in der Schweiz praktizieren Yoga, glauben an eine Wiedergeburt und lassen sich komplementärmedizinisch behandeln. Barbara Zeugin untersucht, wie sich dieser religiöse Wandel auf die Begleitung am Lebensende auswirkt. Insofern alternative Formen von Religion in der Schweiz zunehmen, ist es nicht erstaunlich, wenn in der Begleitung am Lebensende auch alternativ-religiöse Praktiken und alternative Heilverfahren sowie die entsprechenden Rationalisierungen immer mehr an Bedeutung gewinnen. Die Rekonstruktion einer solchen, als alternativ aufgefassten Sterbebegleitungspraxis führte die Religionswissenschaftlerin erstens in ein Hospiz für (...) schwer Kranke und Sterbende und zweitens in ein anthroposophisch-medizinisches Spital, wo sie beobachtend und fragend den folgenden Fragen nachging: Welche alternativ-religiösen Handlungsformen und Rationalisierungen spielen in der Begleitung am Lebensende eine Rolle? Welche Bedeutung wird alternativen Heilpraktiken zugeschrieben? Wie sieht die konkrete Begleitungspraxis aus? Und worin besteht letztlich die Alternativität dieser Praxis resp. wie verhält sich diese zum Selbstanspruch der Palliative Care, die schwer Kranken und Sterbenden auch spirituell zu begleiten?"-- Back cover. (shrink)

The risk and crisis communication process in public health emergencies (PHERCC, public health emergency risk and crisis communication) matrix, as proposed by Spitale, Germani, and Biller-Andorno (2...