This paper attends to a claim that is commonly made in the pro-life literature: that certain secondary mechanisms of action that some forms of contraception may have are abortifacient. Examination of the matter suggests that the relevant mechanism of action—termed contragestion—differs from contraception. However, it is also distinct from what is entailed by an abortion (the termination of a pregnancy). It is therefore inaccurate to label contragestive mechanisms of action abortifacient. Having sketched this view—and having also acknowledged that those who claim contragestive interventions are abortifacient will likely maintain their moral opposition to this mechanism of action regardless—the ethical significance of contragestion is considered in the light of two analogies proposed by Judith Jarvis Thomson, the commonly discussed violinist and the less commonly discussed people-seeds . I conclude that rather than seek to pre-empt discussion by using the term abortifacient, those who consider contragestive interventions morally impermissible should articulate their claims more clearly.
Routine prenatal screening programmes are often heralded as ways to empower women's autonomous decision-making around pregnancy. The introduction of non-invasive prenatal testing (NIPT) is seen as enhancing the aim of empowering women by making screening and testing easier, more accurate, and safer. However, the possibility of a systematic (routine) offer of NIPT has been linked with risk to women's autonomous decision-making as the method's ease is feared to impair deliberate and voluntary choice. In this landscape of conflicting views, NIPT is increasingly adopted globally. Technological advancements in the field increase the likelihood of systematically offering NIPT to all pregnant women and expanding its use to include more foetal conditions alongside common aneuploidies. In this paper, I argue that autonomous decision-making amidst the challenges of new screening and testing methods requires more than providing accurate, balanced, and non-directive information. To truly empower pregnant women with choice in this era, we need to move away from entrenched ideas of routinised screening and take a new approach. My suggestion is that only by routinely offering high-quality perinatal counselling followed by an option to choose to test for genetic conditions are we likely to come anywhere near our goal of enhancing women's choice.
The ‘medical brain drain’ phenomenon demonstrates a tension point between the rights of health care workers to move freely, and seek to live and work where they choose, and the needs of the countries which trained them. Often, this extensive, heated, and long running debate focuses on the impacts that medical brain drain has on exit countries, which are often left with inadequate healthcare staffing levels due to the active recruitment of health care workers by destination countries. In this paper, rather than re-examine the extensive debate surrounding the impacts of health worker migration on exit countries, we focus instead on an under theorised aspect of medical brain drain – the injustices perpetrated against migrant health workers in destination countries. Healthcare workers leave their homes for better pay and opportunities but often experience declining health and discrimination. We argue that while destination countries such as the UK are often highly reliant on migrant health care workers, they regularly fail to adequately respond to their needs or address systemic forms of oppression which cause significant harm to those recruited internationally. Our analysis develops a case for more equitable and sustainable approaches to global health workforce planning.
George Orwell coined the term "doublethink" to describe the concept of "holding two contradictory beliefs in one's mind simultaneously, and accepting both of them." Patients at end-of-life may be using “Therapeutic Doublethink” as a psychological mechanism to cope with the cognitive dissonance resulting from accepting a terminal diagnosis and desiring curative therapy. To develop the concept of Therapeutic Doublethink, we explored the literature on Unrealistic Optimism and decision-making, then grounded them in existing psychological and neurobiological concepts. Functional neuroimaging studies can help to explain the biological mechanisms that permit Unrealistic Optimism and Therapeutic Doublethink to exist, including a failure to track less desirable information and a focus on outcomes without considering the actions required to achieve them. These findings help us appreciate the challenges patients face when trying to make “rational” treatment decisions. They also raise questions about the effectiveness and potential harm of truth-telling, which is a common approach used by physicians who are confronted by Unrealistic Optimism. In some cases, physicians may be able to use Therapeutic Doublethink to harness the beneficial aspects of Unrealistic Optimism while simultaneously helping patients accept the terminal nature of their condition. This approach may be conceptually and ethically challenging for many physicians, but has important implications for improving patient care.
What is the role of the medical profession when the government is promoting lies about vaccines? An understanding of what it means to be a profession—and a profession’s authority to set standards of care—shows that it is both appropriate and necessary for the medical profession to do what it can to defend the standard of care.
The coronavirus disease 2019 (COVID-19) pandemic placed Switzerland's healthcare system into an extraordinary situation, creating a profound ethical challenge of deciding which patients to treat. While in-hospital triage received much attention, little is known about pre-hospital triage and its ethical implications. The purpose of our study was to explore the perceptions of stakeholders involved in Swiss healthcare regarding pre-hospital triage during the COVID-19 pandemic in Switzerland, with a particular focus on how it affected the treatment and care of older people during times of resource scarcity. We conducted 57 qualitative interviews with such stakeholders and analysed them with reflexive thematic analysis. We identified three main themes (1) ‘Tracing pre-hospital triage’ captures participants’ reflections on how hospital access may have been restricted before patient arrival; (2) ‘Exploring pre-hospital Silent Triage’ outlines, based on participants’ assumptions and explanations, the occurrence of Silent Triage; (3) In ‘Examining concrete mechanisms of pre-hospital triage’ we refer to explicit actions taken to avoid hospitalization. Although many participants believed urgent hospitalization was always available, our study highlights signs of Silent Triage. These were mainly based on our participants’ descriptions about the persistent concern over the potential to overload the healthcare system and their suspicions of self-triage among older adults. To prevent future Silent Triage, it is imperative to make real-time hospital data on capacity available and to ensure public communication that affirms equal access to care.
This article examines how the concept of explainability must be fundamentally reconceptualised when applied to digital phenotyping in adolescent mental health contexts. After a short overview of digital phenotyping, the ethical challenges connected to it are sketched, which mostly come from the use of AI and include the well-known problems of bias, distortion, black box models and missing transparency. These aspects must be considered even more carefully when it comes to adolescents. After that, it is proposed that explainability should be the central ethical demand that must be fulfilled before such technologies are allowed to be used, and the connection between explainability and other important normative concepts like trust and informed consent is explained. While existing debates about AI transparency in healthcare often assume universal standards of explainability, this analysis demonstrates that the developmental, relational, and epistemic particularities of adolescence demand a qualitatively different understanding of what it means for algorithmic systems to be ‘explainable’. The paper argues that explainability in this context cannot be reduced to technical transparency or procedural information disclosure, but must be reimagined as a multidimensional, developmentally sensitive concept that encompasses relational dynamics, identity formation processes, and the cultivation of epistemic autonomy. This reconceptualisation reveals that traditional approaches to explainable AI – developed primarily for adult populations and clinical professionals – fail to address the specific ways in which adolescents engage with, understand, and are shaped by algorithmic categorisations of their mental states.
We examine the ethical and legal challenges of continuing inpatient treatment for individuals with longstanding anorexia nervosa (AN), particularly where treatment effectiveness is uncertain. This legally and ethically contentious issue has been explored in a number of cases, which can be divided into two cohorts. We analysed the first cohort in 2017, identifying three key criticisms and offering corresponding recommendations. We assess a second, ongoing set of cases in light of those recommendations, while also considering new issues, including emergent treatment approaches and the debate surrounding the controversial ‘terminal eating disorder’ framework. Although judges in the Court of Protection do not adopt this framework, they do recognise that prolonged, compulsory life-sustaining treatment may – under certain circumstances – conflict with the patient's best interests. We argue that recent approaches to both mental capacity assessments and determination of best interests indicate a meaningful shift towards a more individualised and ethically responsive approach and suggest ways to augment this approach.
Moral distress contributes to serious consequences, and cultivating individual moral resilience has been proposed as a promising approach to mitigating the detrimental impact of moral distress, despite its varying definitions. A scoping review of the literature was conducted to analyse the concept of moral resilience in health, following the principles recommended by the Joanna Briggs Institute and the Walker and Avant conceptual analysis method. From the 39 articles included in this review, six key attributes, nine antecedents and six consequences were identified. A definition of moral resilience is described based on the literature. Moral resilience is the inherent ability or process to sustain, restore, or deepen one's moral integrity when confronted with moral adversity situations and moral distress. This ability can be challenged or degraded but not extinguished. Understanding the antecedents of moral resilience is crucial for developing effective strategies to promote it. Identifying the consequences of moral resilience can emphasise its importance.
Historically, EMTs and clinicians intervened to resuscitate patients and provide lifesaving treatment following a suicide attempt. Despite this, the literature describes a range of cases following an attempted suicide where some physicians and ethicists assert that clinicians should not resuscitate the patient or provide lifesaving interventions, and instead allow the patient to die. Building upon a recent clinical ethics consultation case, this article provides a taxonomy of cases in the literature of patients who refuse lifesaving treatment following a suicide attempt. Often, these cases occur rapidly in emergency settings, offering little time for deliberation or discussion. While adults with decision-making capacity do have a right to refuse lifesaving treatment, this right does not extend to patients whose capacity is compromised or absent. This article outlines key legal points to guide clinician actions, including considerations for capacity assessments, duties under the Emergency Medical Treatment and Labor Act, the doctrine of presumed consent, and emergency psychiatric hold laws. Integrating legal duties along with ethical principles of autonomy, nonmaleficence, and beneficence, this article provides a model recommendation to guide future cases.
Monitoring technologies to aid communication in long-term patient care may enhance safety but infringe on privacy. While autonomy is a primary value in bioethics, definitions of autonomy often take for granted a minimum level of communicative ability. This paper explores how contemporary philosophical arguments for using long-term preventative monitoring apply to individuals without the ability to consent to such technologies. Specifically, how do the ethical principles of autonomy, justice, safety, and privacy manifest when implementing technologies such as long-term heart rate monitoring for individuals with severe communication difficulties? While monitoring someone without their consent is ethically problematic, providing heart rate monitoring for individuals with severe communication difficulties may be morally imperative as a necessary means of interaction. Heart rate monitoring enhances their autonomy by offering a form of communication, and it shows promise as safety -inducing through quicker detection of distress. Simultaneously, heart rate monitoring is a form of surveillance, thus potentially violating privacy ; and misinterpretation or over-reliance on such data might undermine the patient's autonomy , lead to unnecessary interventions or result in reduced human interaction. Restricting monitoring based on consent capacity may deepen care disparities and violate the justice principle but so does selectively applying it to disabled individuals. We conclude that heart rate monitoring might greatly benefit this population, but we need to balance potential benefits for the individual with the risks, trained caregivers must integrate data with other cues, and we need data encryption, collaborative decision-making, and regular reassessment.
Currently, there is a gap in clinical ethics discussions regarding the responsibility of medical interpreters and their responsibility in attaining informed consent. The responsibility of the interpreter in a medical setting for Deaf persons, or those who are deaf, hard of hearing, or deaf-blind, could easily become paternalistic. However, in many cases, Deaf persons may not experience diminished autonomy, but rather language barriers. This case study focuses on the responsibility of the interpreter for Deaf patients who primarily use American Sign Language to communicate in an emergency medical setting. This case study uses popular views of informed consent and identifies an additional way in which medical interpreters can help ensure that a patient is adequately informed to make decisions about their own health care through a relational autonomy approach. This case study expands the normative framework to include an account of relational autonomy. First, I identify barriers that obstruct informed consent. Second, I consider what types of interventions are problematically paternalistic. Third, I consider the interpreter’s role in making the conditions for informed consent possible. I argue that the expanded scope of moral responsibility for the medical interpreter can be used to support the disclosure and understanding requirements of informed consent through a shared cultural understanding and support the responsibility of the interpreter as understood as a complex system of social relationships that impact the decision-making process. Additionally, I argue that medical interpreters must aid the clinical team in better supporting patient's needs.
It is widely assumed in the bioethical literature that the existence of any absolute moral principle depends on the ability of moral intuition to be in line with metaphysical reality. It is further assumed by many that we have shared access to (at least some) core moral intuitions and shared knowledge by which we can easily identify most (or even all) humans as possessing incontestable moral status. According to these assumptions, debate over moral status only needs to address the status of entities such as non-human animals and human embryos. We have previously argued that Gewirth's Principle of Generic Consistency (PGC) is the supreme principle of morality (indeed, of all practical reasoning) and requires no such assumptions, but its application requires a particular type of moral precaution when identifying whom/what beyond oneself is to be granted moral status. John Coggon argues that our ‘moral precautionary thesis’ is incapable of dealing with the ‘metaphysical and epistemological’ challenges that underpin the problem of other minds, which he therefore dismisses as a ‘mistaken starting point’. In this article, we argue that Coggon has not fully appreciated his own assumptions and what is implied by recognition of the PGC as the categorical imperative.
Vulnerability is frequently conceptualized as a group attribute, with all members of that group automatically receiving additional safeguards, including denial of access. There has, however, been a move to recognize more nuanced, context-driven concepts of vulnerability. In the research setting, this has taken the form of a taxonomy that identifies eight types of vulnerability (cognitive, juridic, deferential, social, medical, situational, allocational, and infrastructural) that can lead a potential research subject to make choices against their own best interests. In the consumer context, vulnerability is conceptualized as a lack of control arising from the interaction of personal states, personal characteristics, and external conditions that hinder marketplace navigation. This study examines both the research and consumer conceptualizations of vulnerability for candidates for uterus transplantation (UTx)—a procedure that is transitioning out of the context of clinical trials, and into a consumer marketplace. It identifies the potential for most types of vulnerability defined in the research taxonomy, as well as the strategies, such as a psychosocial evaluation during the screening process, that can be carried forward from UTx clinical trial protocols to manage these vulnerabilities. Likewise, the consumer-driven model for vulnerability indicates similar risks for UTx as have been identified for in vitro fertilization: specifically, a willingness among women with low chances of success to repeatedly incur physical, financial, and emotional risks in the pursuit of pregnancy, and the need to support a sense of control through managing expectations and validating decisions about appropriate treatment endpoints.
Decisions at the end of life often result in conflicting opinions between medical and nursing professionals and the people concerned themselves. Especially when different beliefs and values clash, it can be difficult to understand each other's situation. Appropriate communication, with the necessary respect for the opinions and interests of other individuals, seems to be crucial here. However, if the person concerned is no longer able to express their own views on further treatment or possible withdrawal, support is often needed in the form of a surrogate decision maker, which poses specific challenges. This article deals with the ethically relevant difference between conscience and conscientiousness in the context of surrogate decision making. In the first step, due to the multitude of different views, it is shown what can be understood by conscience. By differentiating between building conscience, formation of conscience, and conscience conformity, a distinction is made between conscience and conscientiousness. In the second step, representatives are placed in relation to the concept established so far, and ethical implications are pointed out. The final step attempts not only to bring together the previous considerations and present suggestions for action but also to clarify common misunderstandings regarding the two terms. The ethical relevance of conscientiousness and the willingness of representatives to be open to other views on the one hand and to remain true to their own values on the other appear to be essential.
Within hospital settings, chaplains offer emotional support, spiritual counseling, and healing services to patients and simultaneously address ethical considerations by upholding confidentiality and impartiality. This study examines the impact of chaplains in hospital settings on patients, families, and healthcare teams by analyzing diverse case studies and personal anecdotes. Further, it highlights the significant spiritual and pastoral roles of chaplains, which potentially contribute to ethical decision-making in end-of-life situations. Results reveal that chaplains play a crucial and dynamic role in providing ethical support to patients, families, and healthcare personnel. Additionally, the traits possessed by chaplains can help ensure the continuous provision of care and adherence to best practices. This study further examines the various ethical conflicts of interest that may occur when chaplains participate in and discuss effective conflict management strategies. Finally, it contributes to the ongoing academic discussion on chaplains’ role in and impact on patient-centered care and ethical decision-making within healthcare organizations.
A recent thematic issue of Clinical Ethics contains a number of papers on bodily integrity in paediatric populations. The papers assume that defining ‘bodily integrity’ is a simple matter, and that the main ethical and legal issue is to define when breaches of bodily integrity in pre-autonomous children can be justified. This paper will argue that defining bodily integrity raises specific problems in the paediatric context because the child has a body that is continually developing. The problems will be illustrated by analysing one of the commonly used definitions in the literature, and by considering the developing brain as a body part. Keywords Bodily integrity , brain integrity , child , paediatrics
The bioethical literature demonstrates both substantive contest over the moral status of entities such as human embryos, and approaches that aim to find morally sound prescriptions in light of fundamental disagreement and uncertainty about identification of their moral status. Amongst such latter approaches, we find Shaun Pattinson's moral precautionary thesis, for which he provides a renewed defence in his recent book Law at the Frontiers of Biomedicine. Pattinson's overarching moral theory centres on the rights of moral agents. In relation to the question of that theory's application, the moral precautionary thesis addresses how, and with what degree of certainty, one moral agent may identify or recognise another. Pattinson roots his precautionary thesis in the problem of other minds. In this article, I argue that that is a mistaken starting point when held against the consequent epistemic claims that Pattinson makes. Furthermore, in examining Pattinson's reasoning, including against earlier objections that have been levelled, I argue that he generates additional problems for accepting the cogency of his thesis.
Most rare diseases are poorly understood, affected individuals struggle tobe timely diagnosed and to access tailored, appropriate, and affordablecare. Following pragmatist theory, individuals living with rare diseasesmay experience these obstacles as morally problematic situations, wherethey struggle with actualizing their cherished values amid their lifecircumstances. These embedded and contextualized lived episodes aredistinct from moral challenges and moral issues, which are more abstract,decontextualized, and speculative moral matters. We sought to uncoverthe moral matters of adults living with rare diseases in the qualitativeliterature while elucidating the moral dimensions of morally problematicsituations. Moral matters were extracted from 25 qualitative studies andsubjected to thematic and interpretive analyses. The uncovered moralissues addressed abstract considerations relating to accessibility, limitedknowledge, and unpredictability of illness manifestations. Moralchallenges and morally problematic situations spanned across the fourphases of the medical trajectory: the diagnostic odyssey, the diagnosis,clinical care and treatment, and medical follow-up. Moral challengesnamely pertained to poor communication of diagnoses, lack of shareddecision-making, and lack of holistic support. Morally problematicsituations featured moral dimensions, namely (1) internal tensions (e.g.,being misunderstood), (2) constraints to agency (e.g., powerlessness anddisempowerment), in addition to (3) empowerment and selfadvocacystrategies (e.g., being assertive and demanding), notably in episodeswhere support from clinicians lacked. This study highlights the usefulnessof distinguishing these three types of moral matters in ethical analysis. Italso shows how moral dimensions of morally problematic situations carryexistential importance for affected individuals.
