This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and (...) medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

The development of bioethics primarily at the cognitive level further perpetuates the tendency to construe all aspects of our lives, including our bodies, as technical systems. For example, if we consider the moral issue of organ sales without taking our embodiment into account, there appear to be no sound arguments for opposing such sales. However, it is important to consider the aspects of the phenomenal body that challenge rational deliberation by exploring an embodied approach to the ethical dilemma produced by (...) a proposed kidney exchange as presented in one of Krzysztof Kieslowski's Dekalog films. What is sought is a description of a body-measure that would serve as a critique of strictly cognitive bioethical deliberations. (shrink)

Heart disease is the leading cause of death amongst adult Americans and has recently become a top killer worldwide. The direct costs of cardiovascular disease are projected to triple in the next 20 years, from $272.5 billion to $818.1 billion (Heidenreich et al. 2011). Although there has been a decreased incidence and prevalence of ischemic heart disease over the past several decades in the United States, heart failure remains a major cause of morbidity and mortality. In the United States, approximately (...) 500,000 to 700,000 new cases are identified each year (Lloyd-Jones et al. 2009). Heart failure is now the number one diagnosis leading to hospitalization. As such, it is an increasingly heavy economic burden on .. (shrink)

Population health has recently grown from a series of loosely connected critiques of twentieth-century public health and medicine into a theoretical framework with a corresponding field of research—population health science. Its approach is to promote the public’s health through improving everyday human life: affordable nutritious food, clean air, safe places where children can play, living wages, etc. It recognizes that addressing contemporary health challenges such as the prevalence of type 2 diabetes will take much more than good (...) hospitals and public health departments. -/- Blending philosophy of science/medicine, public health ethics and history, this book offers a framework that explains, analyses and largely endorses the features that define this relatively new field. Presenting a philosophical perspective, Valles helps to clarify what these features are and why they matter, including: searching for health’s “upstream” causes in social life, embracing a professional commitment to studying and ameliorating the staggering health inequities in and between populations; and reforming scientific practices to foster humility and respect among the many scientists and non- scientists who must work collaboratively to promote health. -/- Featuring illustrative case studies from around the globe at the end of all main chapters, this radical monograph is written to be accessible to all scholars and advanced students who have an interest in health—from public health students to professional philosophers. (shrink)

Population-based research is enhanced by biological measures, but biological sampling raises complex ethical issues. The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) will estimate the population prevalence of five sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus (HPV), HIV and Mycoplasma genitalium) in a probability sample aged 16–44 years. The present work describes the development of an ethical approach to urine testing for STIs, including the process of reaching consensus on whether to return (...) results. The following issues were considered: (1) testing for some STIs that are treatable and for which appropriate settings to obtain free testing and advice are widely available (Natsal-3 provides all respondents with STI and healthcare access information), (2) limits on test accuracy and timeliness imposed by survey conditions and sample type, (3) testing for some STIs with unknown clinical and public health implications, (4) how a uniform approach is easier to explain and understand, (5) practical difficulties in returning results and cost efficiency, such as enabling wider STI testing by not returning results. The agreed approach, to perform voluntary anonymous testing with specific consent for five STIs without returning results, was approved by stakeholders and a research ethics committee. Overall, this was acceptable to respondents in developmental piloting; 61% (68 of 111) of respondents agreed to provide a sample. The experiences reported here may inform the ethical decision making of researchers, research ethics committees and funders considering population-based biological sampling. (shrink)

In recent years, scholars have begun to lay the groundwork to justify a distinct application of ethics to the field of public health. They have highlighted important features that differentiate public health ethics from bioethics, especially public health’s emphasis on population health rather than issues of individual health. Articulations of public health ethics also tend to emphasize the role of social justice compared to the predominance of autonomy in the bioethical literature. Now that the field of public (...) health ethics is developing a unique focus and a language of its own, including a code of ethics disseminated by the American Public Health Association, the future of public health ethics may well be global health ethics, focusing on issues of global justice. As public health ethics evolves from its nascent stage of reflection to a place of action and application in the national and global arenas, two interrelated developments will need to occur: public health professionals, including practitioners, policymakers, and scholars, will need a richer understanding of the ethical challenges practitioners face on a daily basis and scholars will need to develop useful tools that practitioners may employ for identifying and tackling these ethical challenges. (shrink)

What are the ethical, political and cultural consequences of forgetting how to trust our senses? How can artworks help us see, sense, think, and interact in ways that are outside of the systems of convention and order that frame so much of our lives? In Cultivating Perception through Artworks, Helen Fielding challenges us to think alongside and according to artworks, cultivating a perception of what is really there and being expressed by them. Drawing from and expanding on the work of (...) philosophers such as Luce Irigaray and Maurice Merleau-Ponty, Fielding urges us to trust our senses and engage relationally with works of art in the here and now rather than distancing and systematizing them as aesthetic objects. Cultivating Perception through Artworks examines examples as diverse as a Rembrandt painting, M. NourbeSe Philip's poetry, and Louise Bourgeois' public sculpture, to demonstrate how artworks enact ethics, politics, or culture. By engaging with different art forms and discovering the unique way that each opens us to the world in a new and unexpected ways, Fielding reveals the importance of our moral, political, and cultural lives. (shrink)

A number of philosophers :171–187, 2011; Arnold 2011, in Ethics Politics XV:101–138, 2013) have argued that agent-based, evolutionary game theory models of the evolution of cooperation fail to provide satisfying explanations of cooperation because they are too disconnected from actual biology. I show how these criticisms can be answered by employing modeling approaches from the situated cognition research program that allow for more biologically detailed models. Using cases drawn from recent situated cognition modeling research, I show how agent-based models of (...) the evolution of cooperation can become more empirically-informed and relevant to explaining the evolution of cooperation in real populations. I argue that because situated cognition models allow for more detailed representations of not just agents’ brains but bodies and environments as well, they can be informed by a much wider breadth of empirical research than traditional agent-based models. Moreover, because the simulated bodies of these agents exhibit particular behaviors, they can be more readily compared to the behaviors of actual organisms. I conclude that employing situated cognition approaches to modeling the evolution of cooperation is a more promising way to investigate the evolution of cooperation than more traditional agent-based evolutionary game theory models. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of artifact relationships. It (...) is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of artifact relationships. It (...) is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of artifact relationships. It (...) is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

Through qualitative surveys, a team of law students, law professors, physicians, and residents explored the perceptions of neurology residents towards referral to appropriate legal resources in an academic training program. Respondents reported feeling uncomfortable screening their patients for health-harming legal needs, which many attributed to a lack of training in this area. These findings indicate that neurology residents would benefit from training on screening for social factors that may be impacting their patients’ health.

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of (...) the society. Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of (...) the society. Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The primary aim of this article is to identify ethical challenges relating to authorship in engineering fields. Professional organizations and journals do provide crucial guidance in this realm, but this cannot replace the need for frequent and diligent discussions in engineering research communities about what constitutes appropriate authorship practice. Engineering researchers should seek to identify and address issues such as who is entitled to be an author and whether publishing their research could potentially harm the public.

Over the last decade, public health and bioethics have been courting each other, trying to figure out a way to inform and assist one another. Ethics in public health began in epidemiology and public health in ethics began in health law. Attempts have been made to create both an ethics of and in public health. Although many edited volumes and even model curriculums have been created for the teaching of public health ethics, most efforts are mired in medical ethics and (...) do not take the unique population perspective of public health. Several challenges to the development and teaching of public health ethics remain, including the issue of ethics being a required public health competency and the questions: what should be in a public health ethics curriculum, where will instructors be trained and how wi;l such faculty be paid? A true public health ethics will help professionals address issues of values, critical thinking and decision making. (shrink)

This article provides an analysis of the issues and ethical challenges faced in a study with LGBTIQ student participants concerning their experiences of violence, harassment and bullying in tertiary settings. The authors detail the ethical challenges behind the development of the project, and around conducting research with a minority and vulnerable population. The article illustrates how the utilization of feminist and queer theory has impacted the process of conducting ethical research, including approaches to recruitment and participant autonomy. The dilemmas (...) of confidentiality within a self-labelled and easily identifiable population are resolved. Further, unexpected challenges and risks to participant safety created through adherence to institutional ethical research frameworks are rectified. Importantly, the authors seek to avoid revictimization of participants and to instead empower students in their responses to violence, harassment and bullying that they may have experienced. The authors point to utilization of theoretical foundations and continual reflexive improvement as elements of best practice for those seeking to research minority populations, and in projects marked by the participation of those deemed vulnerable and high-risk. (shrink)

In 2014, the editorial board of BMC Medical Ethics came together to devise sections for the journal that would give structure to the journal help ensure that authors’ research is matched to the most appropriate editors and help readers to find the research most relevant to them. The editorial board decided to take a practical approach to devising sections that dealt with the challenges of content management. After that, we started thinking more theoretically about how one could go about classifying (...) the field of medical ethics. This editorial elaborates and reflects on the practical approach that we took at the journal, then considers an alternative theoretically derived approach, and reflects on the possibilities, challenges and value of classifying the field more broadly. (shrink)

This is a review of contemporary philosophical discussions of population policies. The focus is on normative justification, and the main question is whether population policies can be ethically justified. Although few analytical philosophers have directly addressed this question – it has been discussed more in other academic fields – many arguments and considerations can be placed in the analytical philosophical discourse. This article offers a comprehensive review and analysis of ethically relevant aspects of population policies evaluated on (...) the basis of the main ethical theories. This analysis is preceded by a brief historical contextualisation of when and how population policies became ethically contentious and how this relates to philosophical debates in environmental ethics, population ethics and political philosophy. The article also includes a conceptual analysis of population policies in which the empirical intricacies around individual fertility decisions are sorted out and the different ways in which they can be affected are categorised in a taxonomy which highlight the most relevant ethical aspects of population policies. The ethical analysis shows that while population policies can be justified on the basis of most ethical theories, it all depends on what prior assumptions are made about what is at stake. (shrink)

Background Issues of the aging population and disability of older persons have been rapidly developing in China over the past 20 years. Since 2016, the Chinese government has been exploring remedies to alleviate social and family burdens and ensure the dignity of the disabled old persons by implementing long-term care insurance systems in a few pilot cities across the country. Purpose The purpose of this study is to present the current challenges faced by China’s long-term care insurance system and (...) put forth suggestions for the future, based on literature research and the feedback obtained from its implementation in pilot areas. Research Design This paper conducts a theoretical study based on the principles of public health ethics. Study Sample Since 2016, China has launched two batches of pilot cities for long-term care insurance. The analysis object of this study is the feedback on the policy implementation of the existing 29 pilot cities that participated. The relevant data involved in the analysis are from the authors' field research and published literature on the analysis of pilot cities. Analysis The ethical value and importance of long-term care insurance policies in China are evaluated from the perspectives of policy philosophy and social individual interests. Results The results of this evaluation show that the core ethical values were not met in the development of China’s current long-term care insurance system. Moreover, distributive justice norms were neglected, and access to the system between different social groups and within the groups covered by it was unequal. Conclusions This paper argues that long-term care insurance should not differentiate between urban and rural areas in allocating nursing resources. Additionally, it would be essential to build democratic supervision and manage public opinions by adopting open and transparent information-sharing policies. Standards of disability assessments and treatment payment should be at par to ensure a balance between the rights and obligations of policyholders. (shrink)

Background The broad topic of research ethics is one which has been relatively well-investigated and discussed. Unique ethical issues have been identified for such populations as pediatrics, where the issues of consent and assent have received much attention, and obstetrics, with concerns such as the potential for research to cause harm to the fetus. However, little has been written about ethical concerns which are relatively unique to the population of patients seen by the practitioner of rehabilitation medicine. Discussion This (...) paper reviews unique ethical concerns in conducting research in this population, including decision-making capacity, communication, the potential for subject overuse, the timing of recruitment, hope for a cure and therapeutic misconception and the nature of the health care provider-research subject relationship. Summary Researchers in the area of rehabilitation medicine should be aware of some of the unique ethical challenges posed by this patient population and should take steps to address any potential concerns in order to optimize subject safety and ensure that studies meet current ethical guidelines and standards. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers and (...) practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers and (...) practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism. (shrink)

Nanotechnologies and nanoscience have generated an unprecedented global research and development race involving dozens of countries. The understanding of associated environmental, ethical, and societal implications lags far behind the science and technology. Consequently, it is critical to consider both what is known and what is unknown to offer a kernel that future work can be added to. The challenges presented by nanotechnologies are discussed. Some initial solutions such as self-regulation and borrowing techniques and tools from other fields are accompanied by (...) a call for further research. (shrink)

Population axiology concerns how to evaluate populations in terms of their moral goodness, that is, how to order populations by the relations “is better than” and “is as good as”. The task has been to find an adequate theory about the moral value of states of affairs where the number of people, the quality of their lives, and their identities may vary. So far, this field has largely ignored issues about uncertainty and the conditions that have been discussed (...) mostly pertain to the ranking of risk-free outcomes. Most public policy choices, however, are decisions under uncertainty, including policy choices that affect the size of a population. Here, we shall address the question of how to rank population prospects—that is, alternatives that contain uncertainty as to which population they will bring about—by the relations “is better than” and “is as good as”. We start by illustrating how well-known population axiologies can be extended to population prospect axiologies. And we show that new problems arise when extending population axiologies to prospects. In particular, traditional population axiologies lead to prospect-versions of the problems that they praised for avoiding in the risk-free settings. Finally, we identify an intuitive adequacy condition that, we contend, should be satisfied by any population prospect axiology, and show how given this condition, the impossibility theorems in population axiology can be extended to (non-trivial) impossibility theorems for population prospect axiology. (shrink)

There has been a spurt in both fundamental and translational research that examines the underlying mechanisms of the human microbiome in psychiatric disorders. The personalized and dynamic features of the human microbiome suggest the potential of its manipulation for precision psychiatry in ways to improve mental health and avoid disease. However, findings in the field of microbiome also raise philosophical and ethical questions. From a philosophical point of view, they may yet be another attempt at providing a biological cause (...) for phenomena that ultimately cannot be so easily localized. From an ethical point of view, it is relevant that the human gut microbiome comprises data on the individual’s lifestyle, disease history, previous medications, and mental health. Massive datasets of microbiome sequences are collected to facilitate comparative studies to identify specific links between the microbiome and mental health. Although this emerging research domain may show promise for psychiatric patients, it is surrounded by ethical challenges regarding patient privacy, health risks, effects on personal identity, and concerns about responsibility. This narrative overview displays the roles and advances of microbiome research in psychiatry and discusses the philosophical and ethical implications of microbiome big data and microbiome-based interventions for psychiatric patients. We also investigate whether these issues are really “new,” or “old wine in new bottles.”. (shrink)

Ethical challenges in genomic epidemiology are the direct result of novel tools used to confront scientific challenges in the field. An orders-of-magnitude increase in scale of genetic data collection has created the need for establishing diffuse international partnerships, sometimes across developed- and developing-world countries, with ramifications for assigning research ownership, distributing intellectual property rights, and encouraging capacity-building. Meanwhile, the fact that genomic epidemiological research is so far upstream in the pipeline of therapy development has implications for the privacy rights (...) of research participants and for a rigorous definition of valid informed consent, particularly in resource-poor settings. From these scientific underpinnings, we distill out two main categories of ethical issues: (1) How should researchers ensure that the subjects of research are appropriately protected? and (2) What is the structure of an equitable and fair system for distributing the financial and scientific rewards of research? We attempt to delineate the contours of specific problems in each category and propose steps toward solutions with reference to a particular project, known as gMap.net, that focuses on genomic epidemiological studies of malaria. (shrink)

Community Engagement (CE) has been presented by bio-ethicists and scientists as a straightforward and unequivocal good which can minimize the risks of exploitation and ensure a fair distribution of research benefits in developing countries. By means of ethnographic fieldwork undertaken in Kenya between 2007 and 2009 we explored how CE is understood and enacted in paediatric vaccine trials conducted by the Kenyan Medical Research Institute and the US Centers for Disease Control (KEMRI/CDC). In this paper we focus on the role (...) of paid volunteers who act as an interface between villagers KEMRI/CDC. Village Reporters’ (VRs) position of being both with the community and with KEMRI/CDC is advantageous for the conduct of trials. However it is also problematic in terms of exercising trust, balancing allegiances and representing community views. VRs role is shaped by ambiguities related to their employment status and their dual accountability to researchers and their villages. VRs are understandably careful to stress their commitment to self-less community service since it augments their respectability at community level and opens up opportunities for financial gain and self-development. Simultaneously VRs association with KEMRI/CDC and proximity to trial participants requires them to negotiate implicit and explicit expectations for material and medical assistance in a cultural setting in which much importance is placed on sharing and mutuality. To ensure continuity of productive interactions between VRs, and similar community intermediaries, and researchers, open discussion is needed about the problematic aspects of relational ethics, issues concerning undue influence, power relations and negotiating expectations. (shrink)

This collection of essays emphasizes society s increasingly responsible engagement with ethical challenges in emerging medical technology. Expansion of technological capacity and attention to patient safety have long been integral to improving healthcare delivery but only relatively recently have concepts like respect, distributive justice, privacy, and autonomy gained some power to shape the development, use, and refinement of medical tools and techniques. Medical ethics goes beyond making better medicine to thinking about how to make the field of medicine better. (...) These essays showcase several ways in which modern ethical thinking is improving safety, efficacy and efficiency of medical technology, increasing access to medical care, and empowering patients to choose care that comports with their desires and beliefs. Included are complimentary ethical approaches as well as compelling counter-arguments. Together, the articles demonstrate how improving the quality of medical technology relies on every stakeholder -- not just medical researchers and scientists -- to assess each given technology s strengths and pitfalls. This collection also portends one of the next major issues in the ethics of medical technology: developing the requisite moral framework to accompany shifts toward patient-centred personalized healthcare.". (shrink)

Populations around the world are aging at a very fast rate, so much so that care for the elderly will soon rupture even the most carefully planned, enlightened care provisions societies can offer. The demographics in advanced countries demonstrate this dilemma, even without projections based on antiaging medications that may be possible in the near future, and a healthier lifestyle that has preoccupied the yuppies for about 10 years.

Individual research results from population-based genetic and genomic research are traditionally not disclosed to research participants. Current practices of non-disclosure are, however, being challenged by an increasing number of scientists, ethicists and policy-makers who make arguments in favour of disclosing at least individual results of potential health or lifestyle significance to research participants. Simultaneously, research participants are expressing greater interest in accessing their results. This article first provides an overview of main arguments for and against the disclosure of individual (...) research results to research participants. Next, it discusses the need for a move from the current ethical framework under which researchers operate, which is rather protective of research participants and does not encourage disclosure, to a new ethical framework that would better cope with current developments within the field. Comparative analysis of existing and potential ethical frameworks favours implementation of an ethical framework aimed at enhancing the autonomy of research participants through the disclosure of individual research results. Finally, this article explores practical models of disclosure that could be used under such a new framework. A model of disclosure that takes into account the two key criteria of communicability of research results and the research participant’s preferences to determine which results to disclose is found to comply best with the selected ethical framework. (shrink)

This paper develops a largely neglected parallel between prudence and population ethics. Prudence is generally understood to be concerned with the balancing of well-being over time. How, precisely, well-being ought to be balanced over time, however, is a fervently debated question. I argue that developing a standard guiding such evaluations is exceedingly challenging. This is due to an often overlooked fact about prudence, namely that it shares a structural similarity with population ethics: In both contexts, we assess (...) the comparative value of populations of personstages/people, which may vary in number and level of well-being. Based on this analogy, I show that the development of an adequate theory of prudence runs into very similar impossibility results as obtain in population ethics. In particular, I prove that Arrhenius’ fifth impossibility theorem can be applied to prudence. I develop and compare four possible answers to this challenge. First, I discuss the possibility of accepting the very repugnant conclusion intrapersonally. Second, I present and further develop Donald Bruckner’s Minimax Regret approach, which gives up Transitivity. Third, I apply Jacob Nebel’s Lexical Threshold View to prudence and critically evaluate it. Lastly, I introduce what I call the Negative Lexicality View, which is based on Lexical Threshold View but overcomes some of its problems. (shrink)

Bioethics in the twenty‐first century is confronting what one might call “collective‐impact problems.” The ethics guidance and policies that are developed to address these kinds of problems will affect not only individuals but everyone living and future generations too. With many collective‐impact problems, all parties will eventually be worse off if there is a failure to develop solutions to head off damage to the shared environment. However, the effects are not felt equally throughout and across societies; some groups are hit (...) far worse. To address collective‐impact problems, bioethics needs to recalibrate. Our field, and especially American bioethics, should find a better balance between individual rights and the best interests of the group, develop more robust tools for examining structural inequities that damage people's health and well‐being, and study how to engage the public in learning about and shaping ethics guidance for these complex problems. (shrink)

BackgroundBurn patients are among the most vulnerable groups of patients requiring principled ethical care. Caring for these patients often brings various ethical challenges for the members of the health care teams, especially nurses, which affect the clinical decisions made for these patients. A limited number of studies have addressed the ethical challenges of caring for burn patients for the responsible caregivers, so the present study attempted to identify these challenges. The present study aimed to explore the health professionals' experiences of (...) the ethical challenges during caring for burn patients.MethodsThis was a qualitative study with a descriptive, phenomenological design. 22 health professional practiced in public burn centers in Iran who met the inclusion criteria of the study were selected via purposeful sampling to participate in the study from June to August 2019. Data were collected using semi-structured, in-depth interviews with the individuals as well as field notes. Sampling was continued up to the data saturation. Thereafter, the collected data were analyzed using Colaizzi's method.ResultsThe findings of the study yielded 3 themes, including respect for the patient's privacy, respect for the patient's personal identity, and care challenges, as well as 9 categories.ConclusionThe findings of this study showed that the burn patients’ caregivers face some challenges in the domains of maintaining the patient's privacy, respecting the patient’s personal identity, and making the best clinical decision. Thus, providing the cultural, professional, and organizational requirements of meeting the challenges of caring for burn patients can consequently result in the caregivers’ inner peace and the improved performance. (shrink)

The Alzheimer field is in desperate need for an effective treatment. After decades of research, the available drugs treat only symptoms, and even their effectiveness is disputed. Because brain changes precede the clinical symptoms by years to decades, disease-modifying treatments should probably be started early, when the first symptoms occur—or even before. But how to determine who to treat? In this issue, Erik Gustavsson c.s. approach this question by addressing the benefits, harms and ethical issues encountered when using different (...) modes of screening for ‘preclinical’ or early symptomatic Alzheimer disease.1 Their overall conclusion is clear—screening for high risk of developing AD dementia to select those who are eligible for treatment is ethically problematic, unless extremely effective treatment becomes available. An additional major challenge is that diagnostic test accuracy is generally poor, with a particularly high risk of false-positive results, that is, biological evidence of Alzheimer pathology in persons who will never develop dementia. The risk of overmedicalisation is serious, and the potential harms of screening for AD should not be ignored, as Le Couteur c.s. previously argued.2 In short, there is no evidence base for any form of screening for AD whether in a preclinical stage (an …. (shrink)

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate ethical obligations to family (...) caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy. (shrink)

The multiverse theodicy proposes to reconcile the existence of God and evil by supposing that God created all and only the creation-worthy universes and that some universes like ours are, despite their evils, creation-worthy. Drawing on work in population ethics, this paper develops a novel challenge to the multiverse theodicy. Roughly, the challenge contends that the axiological underpinnings of the multiverse theodicy harbor a ‘mere addition paradox’: the assumption that creating creation-worthy universes would always make the world better turns (...) out to have morally repugnant consequences akin to those of the assumption that adding worthwhile lives to a population would always make the overall welfare of the population better. Further, the challenge leverages this difficulty into an argument against God’s having created all and only the creation-worthy universes, and hence against the multiverse theodicy. Responses to this challenge are considered but found wanting, largely because of commitments of the multiverse theodicy that have no analogs in population ethics. (shrink)

Recently, in his Rolf Schock Prize Lecture, Derek Parfit has suggested a novel way of avoiding the Repugnant Conclusion by introducing what he calls “imprecision” in value comparisons. He suggests that in a range of important cases, populations of different sizes are only imprecisely comparable. Parfit suggests that this feature of value comparisons opens up a way of avoiding the Repugnant Conclusion without implying other counterintuitive conclusions, and thus solves one of the major challenges in ethics. In this article, I (...) try to clarify Parfit's proposal and evaluate whether it will help us with the paradoxes in population ethics. (shrink)

The effective provision of psychotherapy services to individuals with intellectual disability requires consideration of ethical issues related to clinical competence, access to services, obligations to multiple parties, guardianship, and appropriate assessment practices. This article provides an overview of major ethical considerations with guidance for clarifying and resolving common ethical concerns. Psychologists are encouraged to expand access to psychotherapy services for this population while maintaining awareness of potential modifications, training needs, and boundaries of professional competence. The authors provide recommendations and (...) resources for effective and ethical treatment of psychotherapy clients with intellectual disabilities. (shrink)

Aims To examine the understanding of the ethical dilemmas associated with Big Data and artificial intelligence (AI) among Jordanian medical students, physicians in training, and senior practitioners. Methods We implemented a literature-validated questionnaire to examine the knowledge, attitudes, and practices of the target population during the period between April and August 2023. Themes of ethical debate included privacy breaches, consent, ownership, augmented biases, epistemology, and accountability. Participants’ responses were showcased using descriptive statistics and compared between groups using t-test or (...) ANOVA. Results We included 466 participants. The greater majority of respondents were interns and residents (50.2%), followed by medical students (38.0%). Most participants were affiliated with university institutions (62.4%). In terms of privacy, participants acknowledged that Big Data and AI were susceptible to privacy breaches (39.3%); however, 59.0% found such breaches justifiable under certain conditions. For ethical debacles involving informed consent, 41.6% and 44.6% were aware that obtaining informed consent posed an ethical limitation in Big Data and AI applications and denounced the concept of “broad consent”, respectively. In terms of ownership, 49.6% acknowledged that data cannot be owned yet accepted that institutions could hold a quasi-control of such data (59.0%). Less than 50% of participants were aware of Big Data and AI’s abilities to augment or create new biases in healthcare. Furthermore, participants agreed that researchers, institutions, and legislative bodies were responsible for ensuring the ethical implementation of Big Data and AI. Finally, while demonstrating limited experience with using such technology, participants generally had positive views of the role of Big Data and AI in complementing healthcare. Conclusion Jordanian medical students, physicians in training and senior practitioners have limited awareness of the ethical risks associated with Big Data and AI. Institutions are responsible for raising awareness, especially with the upsurge of such technology. (shrink)

This paper will first introduce the development of professional ethics of counseling and psychotherapy in mainland China. Ethical awareness is often limited due to variations in training experiences. Aligning with ethics codes can also bring challenges due to nuances within Chinese culture. Furthermore, the authors discuss the ethical challenges regarding the principles of multiple relationships, informed consent, and confidentiality in the context of Chinese culture. These ethical issues are often discussed within an individualistic cultural frame and presentation from a collectivist (...) culture offers a unique perspective in the ethics literature. (shrink)

_This article presents the main ethical challenges faced by social work professionals in Spain during the "first wave" of COVID-19 in 2020. The pandemic had a serious impact not only on the health sector, but also in the field of social work. During this time, social workers had to address serious ethical questions regarding issues such as confidentiality breaches, how to fairly distribute available resources, the lack of personal contact and emotional connection with the service users, the difficulties of (...) working in isolation and online, doubts about the reliability of the information they were handling and the difficulty of making proper diagnoses. An international research group led by Dr. Sara Banks conducted a broader research project in collaboration with the International Federation of Social Workers, which collected information through an online questionnaire aimed at social workers from various countries. In this article we analyse the results related to the main ethical challenges faced by social workers in Spain. The research group identified two types of ethical challenges that they have separated into two sections: the first section is related to direct intervention with users, which includes topics such as the lack of emotional support, reliability, use of technology, the appropriate care, compliance with the highest professional standards, confidentiality, vulnerability, and the fair distribu-tion of resources. The other section is related to the ethical challenges around the daily work within social entities, which involved dealing with issues such as the e-social work and coordination difficulties, the management of pressure in social bodies and changes in the intervention methodology__._ _Keywords_: Social work ethics, pandemic, international research, COVID. (shrink)

Recently, in his Rolf Schock Prize Lecture, Derek Parfit has suggested a novel way of avoiding the Repugnant Conclusion by introducing what he calls “imprecision” in value comparisons. He suggests that in a range of important cases, populations of different sizes are only imprecisely comparable. Parfit suggests that this feature of value comparisons opens up a way of avoiding the Repugnant Conclusion without implying other counterintuitive conclusions, and thus solves one of the major challenges in ethics. In this article, I (...) try to clarify Parfit’s proposal and evaluate whether it will help us with the paradoxes in population ethics. (shrink)

This article addresses some critical aspects of the relationship between aesthetic medicine (AM) and ethics and proposes a possible deontological ethical line to pursue based on current practices. The role of AM has always been controversial and suffers from unclear practical and moral boundaries, even within academic settings, since it aims to improve the appearance of individuals, not to cure a disease. Today, it is essential and pertinent to discuss these issues, as AM specialists are dealing with a growing and (...) increasingly demanding patient population that has undergone profound evolution in recent years. Current challenges within the field of AM include a lack of global uniformity concerning the education of AM specialists, an increasing number of physicians practicing AM with diverse training backgrounds, the spread of AM being practiced outside of medical practice or hospital settings, and the influence of social media where the success is modelled and dictated by the identification of a youthful appearance). By the field of action enriched by technologies that aim not only at enhancement per se but also at the preservation and regeneration of tissues, it is necessary to establish an active multidisciplinary discussion on the definition of shared ethical limits. This discussion would allow AM to fully reclaim its identity as a specialty that aims to improve patient well-being whilst maintaining respect for patient aesthetic harmony, the expertise of specialists who practice AM, the essential role of safety, and awareness of the importance of a confidential doctor−patient relationship. (shrink)

At the 2022 Clinical Ethics Unconference, the authors perceived a significant lack of racial and ethnic diversity, which was consistent with their experiences in other clinical ethics settings. As a result, they convened a working group to address the pervasive lack of diversity present in the field of clinical ethics and to propose strategies to increase the representation of people from racial and ethnic minority populations. This article identifies the harms associated with the lack of diversity in the healthcare (...) setting and translates these to the field of clinical ethics. The article then proposes a framework that may be used to help diversify the field of clinical ethics. Specifically, the authors identify existing barriers to appropriate diversity, actionable steps to increase diversity, and tools the field can utilize to systematically assess its progress with respect to achieving diversity. (shrink)