Although most theorists of healthcare rationing argue that rationing, including rationing that takes place in the physician–patient relationship is unavoidable, some health professionals strongly disagree. In a recent essay, Vegard Bruun Wyller argues that bedside rationing is immoral and thoroughly at odds with a sound view of the physician–patient relationship. We take Wyller to be an articulate exponent of the reluctance to participate in rationing found among some clinicians. Our essay attempts to refute the five crucial premises of his argument (...) yet build on his genuine insights. In our analysis, Wyller’s critique of bedside rationing is instructive both for harbouring some very common misconceptions that must be exposed and refuted, but also for offering important words of caution. In particular, bedside rationing must be performed in ways that do not harm the physician–patient relationship. Read irenically, Wyller’s critique is a reminder of what must not be lost in our painful endeavour to update the ethics of medicine to encompass the unavoidability of rationing. (shrink)

The Covid-19 pandemic creates an unprecedented threatening situation worldwide with an urgent need for critical reflection and new knowledge production, but also a need for imminent action despite prevailing knowledge gaps and multilevel uncertainty. With regard to the role of research ethics in these pandemic times some argue in favor of exceptionalism, others, including the authors of this paper, emphasize the urgent need to remain committed to core ethical principles and fundamental human rights obligations all reflected in research regulations and (...) guidelines carefully crafted over time. In this paper we disentangle some of the arguments put forward in the ongoing debate about Covid-19 human challenge studies and the concomitant role of health-related research ethics in pandemic times. We suggest it might be helpful to think through a lens differentiating between risk, strict uncertainty and ignorance. We provide some examples of lessons learned by harm done in the name of research in the past and discuss the relevance of this legacy in the current situation. (shrink)

The ongoing legal and bioethics debates on consent requirements for collecting, storing, and utilizing human biological material for purposes of basic and applied research—that is, genomic research biobanking—have already managed to pass through three ostensibly dissimilar stages.

How are we individually and as a society to handle new and emerging technologies? This challenging question underlies much of the bioethical debates of modern times. To address this question we need suitable conceptions of the new technology and ways of identifying its proper management and regulation. To establish conceptions and to find ways to handle emerging technologies we tend to use analogies extensively. The aim of this article is to investigate the role that analogies play or may play in (...) the processes of understanding and managing new technology. More precisely we aim to unveil the role of analogies as analytical devices in exploring the "being" of the new technology as well the normative function of analogies in conceptualizing the characteristics and applications of new technology. Umbilical cord blood biobanking will be used as a case to investigate these roles and functions. (shrink)

New medical technologies provide us with new possibilities in health care and health care research. Depending on their degree of novelty, they may as well present us with a whole range of unforeseen normative challenges. Partly, this is due to a lack of appropriate norms to perceive and handle new technologies. This article investigates our ways of establishing such norms. We argue that in this respect analogies have at least two normative functions: they inform both our understanding and our conduct. (...) Furthermore, as these functions are intertwined and can blur moral debates, a functional investigation of analogies can be a fruitful part of ethical analysis. We argue that although analogies can be conservative; because they bring old concepts to bear upon new ones, there are at least three ways in which they can be creative. First, understandings of new technologies are quite different from the analogies that established them, and come to be analogies themselves. That is, the concepts may turn out to be quite different from the analogies that established them. Second, analogies transpose similarities from one area into another, where they previously had no bearing. Third, analogies tend to have a figurative function, bringing in something new and different from the content of the analogies. We use research-biobanking as a practical example in our investigations. (shrink)

BackgroundThe Ethiopian law on abortion was liberalized in 2005. However, as a strongly religious country, the new law has remained controversial from the outset. Many abortion providers have religious allegiances, which begs the question how to negotiate the conflicting demands of their jobs and their commitment to their patients on the one hand, and their religious convictions and moral values on the other.MethodA qualitative study based on in-depth interviews with 30 healthcare professionals involved in abortion services in either private/non-governmental clinics (...) or in public hospitals in Addis Ababa, Ethiopia. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework.ResultsFor the participants, religious norms and the view that the early fetus has a moral right to life count against providing abortion; while the interests and needs of the pregnant woman supports providing abortion services. The professionals weighed these value considerations differently and reached different conclusions. One group appears to have experienced genuine conflicts of conscience, while another group attempted to reconcile religious norms and values with their work, especially through framing provision of abortion as helping and preventing harm and suffering. The professionals handle this moral balancing act on their own. In general, participants working in the private sector reported less moral dilemma with abortion than did their colleagues from public hospitals.ConclusionsThis study highlights the difficulties in reconciling tensions between religious convictions and moral norms and values, and professional duties. Such insights might inform guidelines and healthcare ethics education. (shrink)

In 1997 a debate broke out about the ethical acceptability of using placebo as a comparative alternative to establishe effective treatment in trials conducted in developing countries for the purpose of preventing perinatal HIV-transmission. The debate has now been going on for more than five years. In spite of extensive and numerous attempts at resolving the controversy, the case seems far from being settled. The aim of this paper is to provide an updated account of the debate, by identifying empirical (...) arguments employed in the controversy and by critically assessing their use in the debate. A notion of resolution of moral conflicts will be introduced that makes it possible to give a more positive verdict on the moral results of this controversy. Finally, the procedural problem of safe-guarding the selection of empirical arguments against undue forms of normative bias will be addressed. (shrink)

This paper aims at analysing the problem of remainder and regret in moral conflicts. Four different approaches are subject of investigation: a moral-theoretical strategy aimed at consistency; a narrative approach of moral coherence and open consensus; Plato's moral methodology of dialogue and aporetic resolution of moral conflicts and finally, an approach deduced from Greek tragedy of emotional resolution of moral conflicts. A central argument is that since there exists no theoretically convincing way of solving the problem of remainder and regret, (...) the attention should instead be directed towards finding alternative ways of coping with this problem. The three last approaches subject of investigation attempt - each in their own way - to do this. Teaching medical ethics to medical students and the burning issue of medical fallibility is used to demonstrate the relevance of these forms of resolution in a medical context. (shrink)

The aim of this paper is to investigate Plato’s conception of the whole in the Phaedrus and the theory of medical dialectic underlying this conception. Through this analysis Plato’s conception of kairos will also be adressed. It will be argued that the epistemological holism developed in the dialogue and the patient-typology emerging from it provides us with a way of perceiving individual situations of medical discourse and decision-making that makes it possible to bridge the gap between observations of a professional (...) nature, i.e. of diagnostics and therapy—of whom to treat and in what magnitude—and individual patients’ perceptions of their situation. Besides, it will be argued that such a patient-typology represents a conceptual framework to assess and deal normatively with patients’ ailments and needs that is more robust than the current standards in use, i.e. the Subjective Standard, the Reasonable Person Standard and the Professional Practice Standard. Finally, it will be argued that the possession of kairos, which according to Plato is the hallmark of a true physician, represents a normative conception of time that today’s medicine is in need of revisiting. (shrink)

This paper aims at analysing the ancient Greek notions of catharsis, to holon and therapeia to assess whether they may be of help in addressing a set of questions concerning the didactics of medical ethics: What do medical students actually experience and learn when they attend classes of medical ethics? How should teachers of medical ethics proceed didactically to make students benefit morally from their teaching? And finally, to what extent and in what forms and formats can the kind of (...) cathartic treatment envisaged by Plato still be considered a necessary preliminary to moral learning? The three questions will be addressed by means of a reconstructive analysis and assessment of the Platonic notions of catharsis and holistic therapy present in the Charmides and the Sophist. Besides, the didactic potential of Plato’s dialogue form and moral regimen will be tried out. The ultimate aim is to investigate the possibilities of developing a therapeutic conception of medical ethics. (shrink)

This article aims at analysing Aristotle’s poetic conception of catharsis to assess whether it may be of help in enlightening the particular didactic challenges involved when training medical students to cope morally with complex or tragic situations of medical decision-making. A further aim of this investigation is to show that Aristotle’s criteria for distinguishing between history and tragedy may be employed to reshape authentic stories of sickness into tragic stories of sickness. Furthermore, the didactic potentials of tragic stories of sickness (...) will be tried out. The ultimate aim is to investigate whether the possibilities of developing a therapeutic conception of medical ethics researched in a previous article on catharsis and moral therapy in Plato may be strengthened through the hermeneutics of the Aristotelian conception of tragic catharsis. (shrink)

From my flat on the eighth floor, I enjoy the panoramic view of the bay and beaches of Montevideo. Except for days of rain and stormy weather—which happen often in these months of winter—the beach is frequented by dogs and their masters and mistresses. I have a passion for dogs, and every morning and afternoon I take short breaks to watch from my window the playfulness of my four-feeted soulmates. They differ in race, color, and size, but from a bird’s-eye (...) view, these differences are negligible, as are the differences in their behavior: they all stop to sniff and deposit their “biological fingerprints” at exactly the same places, they leap and jump around, they move back and forward in different directions, always close to water—a few of them even risk brief visits into the water—and always ahead of their guardians, though not too far away from them. Only occasionally do I observe barking confrontations. Often, however, I see them joined in ceremonial acts aimed at repeatedly outshining each other with regard to “depositional” pace and outreach. (shrink)

At the end of a paper on international research ethics published in the July-August 2010 issue of the Hastings Center Report, London and Zollman argue the need for grounding our duties in international medical and health-related research within a broader normative framework of social, distributive, and rectificatory justice. The same goes for Thomas Pogge, who, in a whole range of publications during the past years, has argued for a human-rights-based approach to international research. In a thought-provoking paper in the June (...) 2010 issue of the American Journal of Bioethics, Angela J. Ballantyne argues that “the global bioethics priority” in medical and health-related research ethics today is how to do research fairly in an unjust world. (shrink)

This paper aims at analysing the ancient Greek notions of catharsis (clearing up, cleaning), to holon (the whole) and therapeia (therapy, treatment, healing) to assess whether they may be of help in addressing a set of questions concerning the didactics of medical ethics: What do medical students actually experience and learn when they attend classes of medical ethics? How should teachers of medical ethics proceed didactically to make students benefit morally from their teaching? And finally, to what extent and in (...) what forms and formats can the kind of cathartic treatment envisaged by Plato still be considered a necessary preliminary to moral learning? The three questions will be addressed by means of a reconstructive analysis and assessment of the Platonic notions of catharsis and holistic therapy present in the Charmides and the Sophist. Besides, the didactic potential of Plato’s dialogue form and moral regimen will be tried out. The ultimate aim is to investigate the possibilities of developing a therapeutic conception of medical ethics. (shrink)

This paper seeks to find different ways of addressing illness as an experience essential to the understanding of being a human being. As a conceptual point of departure, we suggest the notion of ‘pathic existence’ as developed by the German physician and philosopher Viktor von Weizsäcker (1886–1957). Through an analysis of his conceptualisation of the pathic and of pathic categories, we demonstrate how this auxiliary typology may be of help in unveiling different modes of ill-being, or Kranksein. Furthermore, we show (...) how illness plays a paradigmatic role in this type of existence. We discuss how von Weizsäcker's claim of illness as “a way of being human” indicates how such a view of the illness existence both differs from and touches upon other streams of thought within the philosophy of medicine and medical ethics. Finally, we highlight some of the normative implications emerging from this perspective of relevance in today's medicine. (shrink)

It has been hypothesised that the reimbursement system pertaining to radiotherapy is influencing prescription practices for patients with cancer with bone metastases. In this paper, we present and discuss the results of an empirical study that was undertaken on patient records, referred to radiotherapy for the treatment of bone metastases, in a medium-size city, in southern Brazil, during the period of March 2006 to March 2014. Our findings seem to confirm this hypothesis: after a change in the reimbursement method, radiation (...) prescriptions were adapted accordingly, in order to maximise profits. Once such patients become highly vulnerable due to their diagnoses, they also become susceptible to a subtle form of exploitation; physicians let patients believe that more radiation will be better for their health, and they do so despite knowing otherwise, and as it seems, out of pecuniary interests. (shrink)

In two articles about the controversy surrounding stem cell research, Søren Holm claims that no argument has so far been advanced in the debate to justify the necessity of destructive research on human embryos for the therapeutic potential of stem cell research to be achieved, and that it is up to the scientists themselves to produce “convincing arguments” for their case. This seemingly defeatist statement on behalf of bioethics originates from the viewpoint that neither a reiteration of old arguments about (...) the moral status of the human embryo nor the generation of new arguments of the same kind are likely to have any positive bearing on the controversy; on the other hand, the impact of science on the current debate is unquestionable, due to three “partially independent” developments. (shrink)

BackgroundEthiopia’s 2005 abortion law improved access to legal abortion. In this study we examine the experiences of abortion providers with the revised abortion law, including how they view and resolve perceived moral challenges.MethodsThirty healthcare professionals involved in abortion provisions in Addis Ababa were interviewed. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework.ResultsMost participants considered the 2005 abortion law a clear improvement—yet it does not solve all problems and has led to new dilemmas. As a main finding, the (...) law appears to have opened a large space for professionals’ individual interpretation and discretion concerning whether criteria for abortion are met or not. Regarding abortion for fetal abnormalities, participants support the woman’s authority in deciding whether to choose abortion or not, although several saw these decisions as moral dilemmas. All thought that abortion was a justified choice when a diagnosis of fetal abnormality had been made.ConclusionEthiopian practitioners experience moral dilemmas in connection with abortion. The law places significant authority, burden and responsibility on each practitioner. (shrink)