This book offers a unique and comprehensive outline of the ethos, the bioethics and the sexual ethics of the renowned anatomist and founder of modern geology, Niels Stensen. It tells the story of a student who is forced to defend himself against his professor who tries to plagiarize his first discovery, the “Ductus Stenonis”: the first performance test for the young researcher. The focal points are questions of bioethics, especially with regard to human reproduction, sexual ethics, (...) the beginning of life and the ensoulment of the embryo, together with frontiers of pastoral care. The book delineates Stensen’s ethos as well as its medico-ethical and theological implications and reception by researchers and physicians from the 17th century until today, and asks about his lasting significance. Despite dating back more than 300 years, Stensen’s character and his work offer up surprisingly topical answers to current questions on the nature of professional ethics in medical science and practice. Furthermore, “Ethos, Bioethics, and Sexual Ethics in Work and Reception of the Anatomist Niels Stensen : Circulation of Love” is the first academic book on bioethics and sexual ethics with a foreword by the Prefect of the Congregation for the Doctrine of the Faith. A fascinating book for bioethicists, physicians, members of health professions, scientists, and theologians. (shrink)

In response to the many changes currently going on in health care, this book offers the combined insight and wisdom of a stellar group of scholars and professionals with extensive experience in the health care field. The book opens with a look at people's actual experience of health care today, from four different perspectives. It then addresses foundational questions, including the nature of medicine, nursing, and justice. Surveyed next are the changing economics of health care as well as the impact (...) of these changes on such areas as mental health care, long-term care, health care for minorities, and legal malpractice. The closing section of the book assesses from a Christian perspective available constructive alternatives, including creative funding strategies with special attention to the needs of poor persons, physician unions, and the use of "alternative medicine" therapies. (shrink)

In 2006, I was diagnosed with cancer. This began a crash course in real-world medical ethics. Having cancer was awful, but it was instructive, too. The experience gave me a new understanding of what my profession is about. Individuals in the bioethics field often address topics related to cancer, such as medical decision-making, the patient-physician relationship, clinical trials, and access to health care. Yet few engaged in this work have lived with cancer themselves. Experience as a cancer patient (...) or family caregiver extends and deepens one’s thinking about serious illness and bioethics. During my time as a cancer patient, I kept in touch with several colleagues immersed in their own cancer .. (shrink)

Health care is provided in many contexts—not just hospitals, clinics, and community health settings. Different institutional settings may significantly influence the design and delivery of health care and the ethical obligations and practices of health care practitioners working within them. This is particularly true in institutions that are established to constrain freedom, ensure security and authority, and restrict movement and choice. We describe the results of a qualitative study of the experiences of doctors and nurses working within two women’s prisons (...) in the state of New South Wales (NSW), Australia. Their accounts make clear how the provision and ethics of health care may be compromised by the physical design of the prison, the institutional policies and practices restricting movement of prisoners and practitioners, the focus on maintaining control and security, and the very purpose of the prison and prison system itself. The results of this study make clear the impact that context has on professional practice and illustrate the importance of sociology and anthropology to bioethics and to the development of a more nuanced account of professional ethics. (shrink)

A significant number of asylum seekers who largely survived torture live in the United States. Asylum seekers have complex social and medical problems with significant barriers to health care access. When evaluating and providing care for survivors, health providers face important challenges regarding medical ethics and professional codes. We review ethical concerns in regard to accountability, the patient–physician relationship, and moral responsibilities to offer health care irrespective of patient legal status; competing professional responsibility toward society and the (...) judiciary system; concerns about the consistency of asylum seekers’ claims; ethical concerns surrounding involving trainees and researching within the evaluation setting; and the implication of broader societal views towards rights and social justice. We discuss contributing factors, including inadequate and insufficient provider training, varying and inadequate institutional commitment, asylum seekers’ significant medical and social problems, and the broader health and social system issues. We review existing resources to address these concerns and offer suggestions. (shrink)

Jecker et al. (2024) propose seven ethical principles to guide international bioethics conferencing, applying them to the selection of Qatar as the location for the 2024 World Congress of Bioethics...

The article examines reasons and features of the Italian bioethics movement in itself and in relationship to that in the U.S.A. Research, consultation, teaching are the most requested professional activities. Ethics committees are now established in several places and at different level: national (National Italian Committee for Bioethics), regional (Italy has about twenty regions with some political power), and institutional (research centers, university, main hospitals).

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care (...) class='Hi'>Ethics Consultants, the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

The moral status of professional boundaries and the ethical nature of dual and multiple overlapping human relationships in contemporary clinical practice remain enduring problems in all health care disciplines. In this paper I explore the ethics of dual or multiple overlapping relationship and apply a virtue ethics framework to the case of psychotherapy.After clarifying the context and meaning of commonly used terminology, and considering what some of the key Australian codes of ethics relevant to psychotherapy advise (...) about dual relationships, I identify some commonly occurring situations where overlapping relationships are unavoidable. A case study from a rural context where size, isolation, and community expectations profoundly impact on the capacity of a psychotherapist to maintain clearly defined professional therapeutic relationship boundaries is analysed. The rural example is pertinent. A virtue ethics approach goes some way toward alleviating perceptions about the nature of dual relationships that contribute to an enduring reticence amongst psychotherapists (and other professionals) to practice in rural settings.Clearly, if a dual relationship involves exploitation then that relationship is a boundary crossing that should rightly be categorised as a boundary violation. Boundary violations are exploitative and unethical. However, some dual relationships may involve boundary crossings that are not necessarily boundary violations. Despite their general prohibition by Australian (and many other countries’) codes of ethics relevant to psychotherapy, I argue that in certain situations, if a psychotherapist (who crosses a professional relationship boundary) acts with professional integrity from the distinct professional role-related virtues and/or regulative ideals that ensure the goals of psychotherapy (to increase autonomy and psychological wellbeing) are met, then a dual or multiple overlapping relationship in psychotherapy will be ethical. (shrink)

Neonatal professionals encounter many ethical challenges especially when it comes to interventions at the limit of viability (weeks 22–25 of gestation). At times, these challenges make the moral dilemmas in neonatology tragic and they require a particular set of intellectual and moral virtues. Intellectual virtues of episteme and phronesis, together with moral virtues of courage, compassion, keeping fidelity to trust, and integrity were highlighted as key virtues of the neonatal professional. Recognition of the role of ethics requires a (...) recognition that answering the obvious question (what shall we do?) does not always suffice. Acknowledging the tragic question (is any of the alternatives open to us free from serious moral wrongdoing) and recognizing the ethical dilemmas, where the lines between right and wrong are blurred, leads to actions taken towards establishing ethics frameworks to support decision-making. In neonatology units, such organizational support can help in allowing the team members to recognize the ethical dilemmas, avoid moral distress, and improve team cohesion and the quality of care provided. Only when the organizational structure allows ethical dilemmas to be recognized, adequate decisions can be made. (shrink)

The complexities of professional ethics are best understood and interpreted within their sociohistorical context. This paper focuses on the experience of 20 rural psychologists from across Canada, a context rife with demographic and practice characteristics that may instigate ethical issues. Employing hermeneutic phenomenology, these qualitative research results are indicative of professional struggles that impacted the participants’ experience of professional ethics and raised key questions about policy and practise. Concerns regarding competition highlight potential professional vulnerability, (...) beget the idea of fostering general psychological practice, and question the role of professional bodies in addressing rural shortages. Dependency on government funding models and decisions highlights the benefits and medical cost-offset effect of psychological services’ role in funded medical care. The controversial prescriptive authority debate for psychologists raises myriad concerns that are particularly salient to rural practitioners. These include changes to training and practice, with risks of psychopharmacology gaining prominence over behavioural health interventions. National inconsistencies in level of registration add to the growing shortage of practitioners. Finally, the results illuminate the need for advocacy to move beyond the literature and into public policy to increase public awareness, decrease the stigma of mental illness, and develop rural Canadian psychology. Although limited to this study, these results allowed for a fuller and more robust understanding of rural practice in consideration of professional ethics, which may inform policy, science, or ethical clinical practice. (shrink)

War has major health consequences and poses significant ethical dilemmas for health professionals. In caring for victims of armed conflicts, health providers are obliged to put medical ethics before military aims. While the normative framework of warfare is clear and accepted by almost all countries, in practice, restrictions on violence are continuously broken, and the safety and independence of health professionals are not ensured. In bioethics, the issue of war has not been treated as a major concern. The (...) field can do more to articulate the responsibilities of health practitioners and scientists, arguing that Red Cross founder Henri Dunant's principle of humanity and the principles of professional and global ethics reject the idea of military necessity. Bioethics should focus on strategies to prevent war, encouraging the collective action of health professionals. Bioethics should also stress—as, so far, one national medical association has—that war is a man‐made public health problem. (shrink)

_The Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants_ instructs clinical ethics consultants to preserve their professional integrity by “not engaging in activities that involve giving an ethical justification or stamp of approval to practices they believe are inconsistent with agreed-upon standards” (ASBH, 2014, p. 2). This instruction reflects a larger model of how to address value uncertainty and moral conflict in healthcare, and it brings up some intriguing and as yet unanswered questions—ones (...) that the drafters of the _Code_, and the profession more broadly, should seek to address in upcoming revisions. The objective of this article is to raise these questions as a way of urging greater clarification of the _Code’s_ overall approach to professional integrity, its meaning, and implications. (shrink)

BackgroundPrecision medicine development is driven by the possibilities of next generation sequencing, information technology and artificial intelligence and thus, raises a number of ethical questions. Empirical studies have investigated such issues from the perspectives of health care professionals, researchers and patients. We synthesize the results from these studies in this review.MethodsWe used a systematic strategy to search, screen and assess the literature for eligibility related to our research question. The initial search for empirical studies in five data bases provided 665 (...) different records and we selected 92 of these publications for inclusion in this review. Data were extracted in a spreadsheet and categorized into different topics representing the views on ethical issues in precision medicine.ResultsMany patients and professionals expect high benefits from precision medicine and have a positive attitude towards it. However, patients and professionals also perceive some risks. Commonly perceived risks include: lack of evidence for accuracy of tests and efficacy of treatments; limited knowledge of patients, which makes informed consent more difficult; possible unavailability of access to precision medicine for underprivileged people and ethnic minorities; misuse of data by insurance companies and employers, potential of racial stigmatization due to genetic information; unwanted communication of incidental findings; changes in doctor-patient-relationship through focusing on data; and the problem that patients could feel under pressure to optimize their health.ConclusionsNational legislation and guidelines already minimize many risks associated with precision medicine. However, from our perspective some problems require more attention. Should hopes for precision medicine’s benefits be fulfilled, then the ethical principle of justice would require an unlimited access to precision medicine for all people. The potential for autonomous patients’ decisions must be greatly enhanced by improvements in patient education. Harm from test results must be avoided in any case by the highest possible data security level and communication guidelines. Changes in the doctor-patient relationship and the impact of precision medicine on the quality of life should be further investigated. Additionally, the cost-effectiveness of precision medicine should be further examined, in order to avoid malinvestment. (shrink)

The edited volume presents new and unconventional views of many traditional moral values, such as humanity, human dignity, moral right (of life), justice and responsibility. The originality of the contributions contained in this book is to analyze these values and approaches from the point of view of non-utilitarian consequentialism and ethics of social consequences as one of its forms. The authors of the chapters present new ways of solving many of the contemporary ethical and moral issues, for example, in (...) bioethics, medical ethics, environmental ethics, teaching ethics, and cyber ethics, based on non-utilitarian consequentialism and ethics of social consequences. They also confront these approaches with other ethical theories and philosophical traditions, which serve them as further incentives for the development of non-utilitarian consequentialism and ethics of social consequences in philosophical, applied and professional ethics. (shrink)

Justifying the existence of professional ethics in medicine is usually connected with the traditions of a profession and with a humanistic dimension of these ethics, pointing at the same time to their culture-forming character. With such an attitude, professional ethics is treated as a part of all mankind’s output, and its teaching turns out to be an important element of preparation for taking part in culture. Taking into account the cultural meaning of professional (...) class='Hi'>ethics, one should notice that all discussions about the character of relations of medicine and ethics exceed the very health care system. The dilemma outlined in the article deals with the problem whether the existence of medical ethics requires external regulations or is this also a creation of the very representatives of medicine and only they can formulate it. If the latter is to be assumed, ethics in medicine would have to be independent of other detailed ethics and it would not need to be included in any other more general theory. In the first solution, medical ethics is becoming a part of general ethics and, therefore, it would be justified to include it in a more general theory – bioethics. The authors indicate that professional ethics does not limit freedom of the staff but gives a special opportunity to use it. Records constituting its contents are mostly standardized by a professional group which sets criteria of recruitment on its own and general duties resting on their members. (shrink)

Bioethicists have virtually assumed that Tarasoff generated a duty to warn the sexual partners of an HIV‐positive man that they risked infection. Yet given the views of sex and of AIDS that have evolved in the gay community, in many cases the parallels to Tarasoff do not hold. Bioethicists should at the least attend to the community's views, and indeed should go beyond doing mere “professional ethics” to participate in the moral self‐exploration in which these views are located.

Hunger strikes potentially present a serious challenge for attending physicians. Though rare, in certain cases, a conflict can occur between the obligations of beneficence and autonomy. On the one hand, physicians have a duty to preserve life, which entails intervening in a hunger strike before the hunger striker loses his life. On the other hand, physicians’ duty to respect autonomy implies that attending physicians have to respect hunger strikers’ decisions to refuse nutrition. International medical guidelines state that physicians should follow (...) the strikers’ unpressured advance directives. When physicians encounter an unconscious striker, in the absence of reliable advance directives, the guidelines advise physicians to make a decision on the basis of the patient’s values, previously expressed wishes, and best interests. I argue that if there are no advance directives and the striker has already lost his competence, the physician has the responsibility to resuscitate the striker. Once the striker regains his decision-making capacity, he should be asked about his decision. If he is determined to continue fasting and refuses treatment, the physician has a moral obligation to respect this decisions and follow his advance directives. (shrink)

I am not trying to present a full concept of professional ethics of an academic. I would like to focus on philosophical and ethical reflection of the specific area of an academic work in Slovakia. Almost two hundred years ago, the Slovak enlightenment philosopher Ján Feješ (1764 - 1823) responded to the situation of his era and he stated that a reviewer must, in the given area, be even better educated than the author himself. A different example can (...) be found in Honoré de Balzac’s great novel Lost Illusions where he also described journalistic practice of the first half of the 19th century. Part of the novel was based on his own experience with acrimonious critique. The situation concerning, for example academic reviewing in Slovakia in the present day is, possibly in some instances, even more critical than Feješ or Balzac suggested. This no longer concerns the quality of papers and book of essays but the number of works published; and evaluation of academics is partly dependant on whether they have published in a reviewed or a non-reviewed book, indexed journals, worldly known publishers, etc. There has to be a just requirement placed on critical reviews, as Feješ and others cautioned, and that is that they should not be informative reviews only for the sake of someone getting a reviewed work but truly critical reviews from people qualified in the given area of academic subjects and the aim of which should not lie in settling scores or expressing personal preferences but a constructive view of the issue. The problem in Slovak academic community (especially in humanities and social sciences), however, lies in the fact that critical reviews are not considered a challenge for discussion or polemics but are shifted to the personal level including settling scores with the critical reviewer. Quoting and referencing is another problematic area in Slovak academic life, which, in the present period, has almost become a fetish, as it is a criterion of qualification enhancement and evaluation of academics. That is why quotations and references are artificially made for colleagues, friends and acquaintances, or even already published works are faked to contain quotes and references for the needs of future qualification enhancement. To summarise, I would like to propose three aims which could become a part of professional ethics of the academics (in Slovakia). (shrink)

Author applies four models of professional ethics of politicians (Aristotle’s virtuous citizen, Machiavelli’s prince, Erasmus’ man of values and Weber’s responsible politician) to politics and politicians in Slovakia since the first half of the 20th century to the present. According to author, there is possible to identify Milan Hodža with Weber’s model, Alexander Dubek with Aristotle’s one, Vladimír Meiar and Robert Fico are identified with Machiavelli’s model and Iveta Radiová with Erasmus’ model of professional ethics of (...) politician in Slovakia. (shrink)

In the article I prove the separateness of professional medical ethics in three ways: 1. By showing differences between the normative rank of responsibilities within general and professional ethics. 2. By justifying affiliation of professional medical ethics within the appropriation model which is a type of applied ethics characterized by its unique properties. 3. By justifying historical professionalism as the ethics that is proper for the medical profession; for this kind of ethical (...) internalism the content of professional ethics is the sole work of medical professional organizations as well as individual doctors. In the final part of the article I reconstruct the actual and postulated relations between professional ethics and professionalism as well as between academic bioethics and public bioethics. The aim of this reconstruction is to indicate the optimal from the perspective of ethical education place of professional ethics within the ethics education system for professionalists. (shrink)

Pope St. John Paul II’s work on the Theology of the Body is well known among his many followers. Less well known is his conception of the human soul. Karol Wojtyla’s intricate philosophy of the soul fully endorses Aristotelian Thomistic psychology. Wojtyla’s main contribution is a phenomenological description of human action, which provides a credible basis for inferring the soul’s necessity. In the papal writings, John Paul II develops other resourceful doctrines, especially about the timing of ensoulment. His unelaborated notion (...) of the genealogy of the person has implications for ethics. Following in the tradition of St. Thomas Aquinas, John Paul II presents an integrated wisdom about the soul that weaves together Christian revelation, modern science, and different modes of philosophical reflection. (shrink)

We have two aims in this paper. The first is negative: to demonstrate the problems in Bernard Gert’s account of common morality, in particular as it applies to professional morality. The second is positive: to suggest a more satisfactory explanation of the moral basis of professional role morality, albeit one that is broadly consistent with Gert’s notion of common morality, but corrects and supplements Gert’s theory. The paper is in three sections. In the first, we sketch the main (...) features of Gert’s account of common morality in general. In the second, we outline Gert’s explanation of the source of professional moral rules and demonstrate its inadequacy. In the third section, we provide an account of our own collectivist needs-based view of the source of the role-moral obligations of many professional roles, including those of health care professionals. (shrink)

Catholic ethical teaching has increasingly relied on a concept of the common good for making and evaluating social decisions. The authors have argued that the common good is a maximal and ideal concept about which people and communities differ fundamentally. In practice, it does not resolve moral and social disagreements. The concept of the common harm is preferable because it is a minimal standard that can be more clearly identified and agreed for individuals and society, providing a basis for legislative (...) and social action. Bioethics and public health both have strong roots in doing no harm and preventing harm to both individuals and communities in society. The authors argue that the application of the concept of the common harm from these disciplines into wider use in the health professions and public policy would be beneficial. National Catholic Bioethics Quarterly 14.3 : 449–455. (shrink)

This essay examines the development of a liberation bioethics in Latin America with its focus on public health equity from the experience and knowledge of those who are at the margins, the poor and historically oppressed groups. An encounter between bioethics and liberation theology contributed to form a Latin American bioethics marked by a double aspect: bioethical scholarly focus on public health equity and social activism for universal healthcare coverage. Liberation theology has a role in this (...) class='Hi'>bioethics oriented to public health, and Pope Francis offers a new contribution for this perspective at the same time that he brings it to a global discussion. Considering the exchange between liberation theology and bioethics and Francis’s insights, this essay offers a new perspective grounded in the Brazilian experiment and the Catholic social tradition to dialogue with US bioethical accounts by challenging the Western epistemological framework of bioethical studies in the Global North. (shrink)

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to (...) be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay. (shrink)

Western society today is less unified by a set of core values than ever before. Undoubtedly, the concept of moral consensus is a difficult one in a liberal, democratic and pluralistic society. But it is imperative to avoid a rigid majoritarianism where sensitive personal values are at stake, as in bioethics. Bioethics has become an influential part of public and professional discussions of health care. It has helped frame issues of moral values and medicine as part of (...) a more general effort to find consensus about some of the most perplexing questions of our time. But why is it thought that a moral consensus is important or that it deserves respect? How does moral consensus acquire legitimacy in a society that includes diverse value systems? How is moral consensus possible and how do small groups help create or distort consensus processes? Written by a medical school professor trained in philosophy, this timely work tackles these questions from philosophical, historical, and social scientific standpoints. It begins by describing the traditional ambivalence about consensus in Western culture as well as the uncertain relationship in modernity between consensus and expertise. After outlining the current bioethical consensus, the book gives philosophical and political analyses of the idea of consensus, then assesses the role of consensus in national ethics commissions and in the ethics committee movement. Moreno constructs an original, naturalistic philosophy of moral consensus, referred to as "bioethical naturalism", and then applies sociology and social psychology to actual consensus processes. The book concludes with an account of bioethics as a consensus-oriented social reform movement. This insightful volume will be essential reading for bioethicists, philosophers, physicians, members of ethics committees, and all those concerned with ethical and social issues in health care. (shrink)

Who has more rights-the mother or the fetus? Interdisciplinary in scope and character, this latest volume of Humana's classic series, Biomedical Ethics Reviews, focuses on the complex moral and legal problems involving human fetal life. Each article in Bioethics and the Fetus provides an up-to-date review of the literature and advances bioethical discussion in its field. The authors have avoided much of the technical jargon of philosophy and medicine in order to speak directly to a broad and general (...) readership. Topics include: • maternal-fetal conflict • the disposition of aborted fetuses • frozen embryos • creating children to save sibling's lives • fetal tissue transplantation • moral implications of fetal brain integration • the embryo as patient • prenatal diagnosis. Probing deeply into these thorny issues, Bioethics and the Fetus offers thought-provoking reading-and paves the ground for new insight-for a host of healthcare and other professionals, as well as concerned laypersons. (shrink)

Background Studying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval (...) stage of the global research projects on health system responses to VAW. Methods We used the Network of Ethical Relationships model, framework method, and READ approach to analyse qualitative semi-structured interviews (n = 18) and policy documents (n = 27). In March-July 2021, we recruited a purposive sample of researchers and members of Research Ethics Committees (RECs) from the five partner countries. Interviewees signposted policies and guidelines on research ethics, including VAW. Results We developed three themes with eight subthemes summarising ethical challenges across three contextual factors. The global nature of the group contributed towards power and resource imbalance between HIC and LMICs and differing RECs’ rules. Location of the primary studies within health services highlighted differing rules between university RECs and health authorities. There were diverse conceptualisations of VAW and vulnerability of research participants between countries and limited methodological and topic expertise in some LMIC RECs. These factors threatened the timely delivery of studies and had a negative impact on researchers and their relationships with RECs and HIC funders. Most researchers felt frustrated and demotivated by the bureaucratised, uncoordinated, and lengthy approval process. Participants suggested redistributing power and resources between HICs and LMICs, involving LMIC representatives in developing funding agendas, better coordination between RECs and health authorities and capacity strengthening on ethics in VAW research. Conclusions The process of ethics approval for global research on health system responses to VAW should be more coordinated across partners, with equal power distribution between HICs and LMICs, researchers and RECs. While some of these objectives can be achieved through education for RECs and researchers, the power imbalance and differing rules should be addressed at the institutional, national, and international levels. Three of the authors were also research participants, which had potential to introduce bias into the findings. However, rigorous reflexivity practices mitigated against this. This insider perspective was also a strength, as it allowed us to access and contribute to more nuanced understandings to enhance the credibility of the findings. It also helped to mitigate against unequal power dynamics. (shrink)

Bringing expert knowledge to bear in an open and deliberative way to help solve pressing social problems is a major concern today, when technocratic and bureaucratic decision making often occurs with little or no input from the general public. Albert Dzur proposes an approach he calls “democratic professionalism” to build bridges between specialists in domains like law, medicine, and journalism and the lay public in such a way as to enable and enhance broader public engagement with and deliberation about major (...) social issues. Sparking a critical and constructive dialogue among social theories of the professions, professional ethics, and political theories of deliberative democracy, Dzur reveals interests, motivations, strengths, and vulnerabilities in conventional professional roles that provide guideposts for this new approach. He then applies it in examining three practical arenas in which experiments in collaboration and power-sharing between professionals and citizens have been undertaken: public journalism, restorative justice, and the bioethics movement. Finally, he draws lessons from these cases to refine this innovative theory and identify the kinds of challenges practitioners face in being both democratic and professional. (shrink)

Volume 20, Issue 9, September 2020, Page 26-28.

An example of illegal trade is presented in the context of hazardous waste movement across internaional borders. It highlights the fact that unethical conduct can have negative enviromental health consequences, especially for improverished countries. The example exposes how ethical principles are breached through illegal trade in hazardous waste, and points to the role that environmental epidemiology plays in the assessment of risk associated with trade in hazardous waste.

This paper explores why ethical issues associated with mental illness have been generally neglected in the literature and texts of the discipline of bioethics. I argue that the reasons for this are both philosophical and structural, involving the philosophical framework of principlism in bioethics, in particular the privileging of the principle of autonomy, and the institutional location and disciplinary boundaries of bioethics as a profession. Other contributing factors include developments outside of bioethics, in medicine and law (...) and in the delivery patterns and funding sources of mental health services, and above all the pervasive stigma that attaches to mental illness. My goal is to show both how the attention bioethics could bring would benefit this neglected area of health care, and why attending to the issues surrounding mental illness would benefit bioethics in meeting its professional obligations as the public voice on matters of ethical significance in health care. (shrink)

Background This analysis is about practical living bioethics and how law, ethics and sociology understand and respect children’s consent to, or refusal of, elective heart surgery. Analysis of underlying theories and influences will contrast legalistic bioethics with living bioethics. In-depth philosophical analysis compares social science traditions of positivism, interpretivism, critical theory and functionalism and applies them to bioethics and childhood, to examine how living bioethics may be encouraged or discouraged. Illustrative examples are drawn from (...) research interviews and observations in two London paediatric cardiac units. This paper is one of a series on how the multidisciplinary cardiac team members all contribute to the complex mosaic of care when preparing and supporting families’ informed consent to surgery. Results The living bioethics of justice, care and respect for children and their consent depends on theories and practices, contexts and relationships. These can all be undermined by unseen influences: the history of adult-centric ethics; developmental psychology theories; legal and financial pressures that require consent to be defined as an adult contract; management systems and daily routines in healthcare that can intimidate families and staff; social inequalities. Mainstream theories in the clinical ethics literature markedly differ from the living bioethics in clinical practices. Conclusion We aim to contribute to raising standards of respectful paediatric bioethics and to showing the relevance of virtue and feminist ethics, childhood studies and children’s rights. (shrink)

BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

In few other areas of bioethical inquiry exists as close a connection between bioethical professional advice and policy development as is the case with HIV and AIDS. Historically, the reasons for this have much to do with one of the groups initially affected most severely by HIV and AIDS, namely well-educated middle-class gay men in developed countries. This particular group of people, highly sophisticated and used to political activism in its pursuit of civil rights-related objectives, engaged the medical profession (...) as well as regulatory agencies such as the US Food and Drug Administration, and legislators (more so in the USA than in other countries) in a number of bioethically interesting policy areas. Many of the controversies of the times were framed as civil rights and/or ethical disputes. The initial areas of concern and inquiry focused on: informed consent to HIV testing and trial participation, the confidentiality of HIV test results, access to trials as a means of access to experimental drugs, the length of time it took to get an experimental drug to the market approval stage, and end-of-life decision-making. This line-up of issues explains why AIDS has become such an interesting topic for bioethicists. Bioethicists concerned about the traditional breadand- butter themes of medical ethics themes of the doctor - patient relationship (e.g., Daniels, 1991; Boyd, 1992), as well as bioethicists more concerned about policy and regulatory issues in the drug research and approval process (e.g., Edgar & Rothman, 1990; Salisbury & Schechter, 1990), found research topics worthy of vigorous pursuit. No surprise, then, that HIV/AIDS led to a probably unprecedented number of books and articles in professional journals (Manuel et al., 1990). HIV/AIDS has become a permanent fixture in all major mainstream bioethics textbooks (e.g., Kuhse & Singer, 1998; Arras & Steinbock, 1999). Reference series in medicine, ethics and law provide for dedicated volumes on AIDS.1 Even specialist bioethics textbooks, for instance those directed at dentistry students, carry chapters on HIV/AIDS (Ozar & Sokol, 2002). 128 Udo Schuklenk AIDS, designated by the medical profession a pandemic lives up to its classification. It did not stop at the borders of developed countries. As one would expect of a primarily sexually transmitted illness in the age of globalisation, it spread rapidly across the globe. Indeed, in many countries it has become one of the main causes of death, as in sub- Saharan Africa (Shisana & Simbayi, 2002). Dramatic increases in the number of AIDS cases are predicted for many Eastern European countries as well as for the two most populous nations on earth, India and China. Some of the HIV/AIDS-related bioethical and policy issues of concern to developed countries remain the same for developing countries. However, in ethically important ways they are dwarfed by concerns over drug prices, intellectual property rights, and affordable access to essential AIDS drugs for the impoverished masses of infected people in such countries. Of increasing importance have become ethical issues pertaining to the ever-growing research industry associated with clinical trials undertaken in developing countries. Indeed, major funding initiatives both in the USA and UK have brought clinical research in developing countries into focus. Some have questioned whether this attention is appropriate, considering other bioethical problems of arguably greater importance to developing countries (Chadwick & Schuklenk, 2003). Standards of clinical care in a study, and after a trial has concluded, as well as community benefits and access to the trial regime after the trial’s conclusion remain contentious issues. It is worth noting that more often than not it was an AIDS-related trial or policy decision that led to a great deal of bioethical analysis, yet the issues discussed almost always have ramifications far beyond AIDS. For instance, decisions about the question of what (if any) standards of care failures in preventive trials (of HIV vaccines or microbicides) ought to receive have important implications for non-AIDS prevention trials. (shrink)

This article presents the findings of qualitative research which explored, from the mothers’ perspective, the process of decision-making about mode of delivery for a subsequent birth after a previous Caesarean Section. In contradiction to the clinical literature, the majority of mothers in this study were strongly of the opinion that a vaginal birth after caesarean (VBAC) posed a higher risk than an elective caesarean (EC). From the mothers’ perspective, risk discussions were primarily valuable for gaining support for their pre-determined choice, (...) rather than obtaining information. The findings posit ethical concerns with regards to informed consent and professional obstetric practice at a time when there is a documented and worrying trend towards an increase in births by caesarean section (CS). (shrink)

The Handbook of Bioethical Decisions Volume II addresses and analyzes the most important ethical concerns and moral quandaries related to scientific integrity and institutional ethics. It counts on two parts, Part One: Research Ethics, which addresses issues related to Scientific Integrity, Research Misconduct and Conducting Ethical Research, and Part Two: Institutional Ethics and Bioethics Committees, which explores Institutional Ethics issues, Ethics and Bioethics Committees’ roles and scopes, and Bioethical Issues in Institutional Ethics. (...) Consequently, the Handbook, Vol. II, offers a remarkable collection of works by outstanding international experts on institutional and research ethics, in order for bioethics practitioners to obtain better elements to address key issues related to integrity in research as well as to decision-making processes. In this fashion, this volume is a valuable resource for professionals working on different bioethical and biomedical fields, such as, ethics and bioethics committees, health care institutions, biomedical and pharmacological companies, and academic settings, among others. Chapter 26 is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com. (shrink)

Volume 20, Issue 8, August 2020, Page 117-118.

Background The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Methods The GFBR is an annual meeting organized by the (...) World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022. Results We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships. Conclusions The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research. (shrink)

Background Despite the bourgeoning of digital tools for bioethics research, education, and engagement, little research has empirically investigated the impact of interactive visualizations as a way to translate ethical frameworks and guidelines. To date, most frameworks take the format of text-only documents that outline and offer ethical guidance on specific contexts. This study’s goal was to determine whether an interactive-visual format supports frameworks in transferring ethical knowledge by improving learning, deliberation, and user experience.Methods An experimental comparative study was conducted (...) with a pre-, mid-, and post-test design using the online survey platform Qualtrics. Participants were university based early-stage health researchers who were randomly assigned to either the control condition (text-only document) or the experimental condition (interactive-visual). The primary outcome variables were learning, (measured using a questionnaire), deliberation (using cases studies) and user experience (measured using the SED/UD Scale). Analysis was conducted using descriptive statistics and mixed-effects linear regression.Results Of the 80 participants, 44 (55%) used the text-only document and 36 (45%) used the interactive-visual. Results of the knowledge-test scores showed a statistically significant difference between participants’ post-test scores, indicating that the interactive-visual format better supported understanding, acquisition, and application of the framework’s knowledge. Findings from the case studies showed both formats supported ethical deliberation. Results further indicated the interactive-visual provided an overall better episodic and remembered user experience compared with the text-only document.Conclusions Our findings show that ethical frameworks formatted with interactive and visual qualities provide a more pleasing user experience and are effective formats for ethics learning and deliberation. These findings have implications for practitioners developing and deploying ethical frameworks and guidelines (e.g., in educational or employee-onboarding settings), in that the knowledge generated can lead to more effective dissemination practices of normative guidelines and health data ethics concepts. (shrink)

With the increased rate of the Turkish medical brain drain (MDB) in recent years, there is a need for more comprehensive studies to elucidate its vague migratory factors. The aim of this paper is to try to narrow that gap by analyzing present impacts of the MDB in Turkey and to evaluate if these aspects were driven by professional ethical values, and if so, what ethical principles they were based on. In-depth interviews were conducted with 19 doctors from various (...) backgrounds, followed by a thematic analysis. The MDB in Turkey demonstrated a multifactorial structure, with prominent push factors that are intertwined at macro-meso-micro levels. The effort to maintain the principles of beneficence, non-maleficence, and protecting professional autonomy were the most important in the context of professional ethics. Only deep-rooted regulations might ensure the prevention of the MDB in Turkey and the prospect of doctors returning in the future. Conclusively, the recent criticisms the MDB has been garnering may inspire improvements in deteriorating human and health rights in Turkey. (shrink)