Artificial intelligence (AI) in healthcare is assumed to introduce risks that are not easily addressed by dominant philosophical models for thinking about responsibility. When an AI tool makes an error that results in patient harm, the question of who is responsible is rarely straightforward. Dominant models of responsibility work when harm can be traced to a single actor, but they fail in socio-technical systems where decisions and actions are distributed across multiple human and technological agents. Iris Marion Young's social connection model of responsibility offers a systematic way to rethink responsibility in these contexts. Rather than locating responsibility solely after harms occur, Young proposes a forward-looking account that attaches responsibility to those who participate in and benefit from the structural processes that produce harm. Young's framework organised around parameters of reasoning-power, privilege, interest, collective ability, and personal connection- provides an alternative way for understanding differentiated responsibilities across core actors in AI-driven healthcare.
The ontological status of health and disease remains a central problem in medical philosophy, commonly framed through tensions between naturalistic and normativist accounts. While useful for acute classification, static conceptions of disease contribute to "diagnostic fixation"-the persistence of clinical labels long after active pathological processes have stabilised. This article proposes a dynamic, five-dimensional framework that reconceptualises health not as categorical restoration, but as longitudinal viability. Drawing on Canguilhem's biological normativity and Ian Hacking's theory of looping effects, it argues that diagnostic revisability is a core ethical requirement in contemporary healthcare. By shifting the clinical focus from categorical restoration to longitudinal viability, the framework offers a pathway to mitigate biographical surveillance. The article concludes with practical guidelines for the ethical retirement of diagnostic labels while addressing clinical concerns related to liability and institutional inertia.
This paper critically reviews Sparrow et al.’s notion of the “hermeneutic burden” placed upon clinicians by the demand for explainable artificial intelligence (XAI) in the context of adaptive machine learning (ML) systems. While Sparrow et al. highlight important additional labour that may be required of clinicians, this response argues that framing explanation primarily in terms of such a burden obscures its overall ethical significance. This paper therefore offers a supplementary account of the interpretive work associated with XAI in medicine that places it within existing models of the patient–clinician relationship. In particular, Emanuel and Emanuel’s influential typology consisting of four models of the patient–physician relationship is used to extract possible justifications for the responsibility to grasp and explain not only patients’ values and conditions but also ML outputs. This allows us to distinguish between ‘hermeneutic burden’ and ‘hermeneutic responsibility’ and emphasise that explanation in medicine is not an incidental task but part of a clinician’s professional role, particularly on ‘interpretive’ and ‘deliberative’ models. The paper thus argues that viewing explanation as a hermeneutic responsibility linked to patient autonomy clarifies the ethical significance of XAI in terms of both the grounds and scope of clinicians’ responsibilities. At its core, the ethical challenge raised by XAI in clinical practice concerns not only the burdens it may impose on clinicians but also the evolution of clinicians’ traditional interpretive duties in the novel context of ML-mediated care.
A controlled human infection study is the deliberate exposure of a healthy volunteer to an infectious pathogen under a strict controlled environment. Although there has been noticeable contribution of such studies to the biomedical research involving understanding of disease pathogen interaction, vaccine development, etc, they are in direct contradiction of core ethical principles such as non-maleficence. The major ethical dilemma lies in the deliberate exposure without certain direct benefits. This narrative review discusses the ethical challenges and need for robust ethical framework taking in account recent international guidelines, debates on trial design and placebo use, and evidence-based analyses of trial conduct and reporting. Analysis of ethical principles such as proportionality, respect for persons' decision, and social value has been done through this article with emphasis on challenge strain selection, participant selection, control group design and adverse event monitoring. Special attention was paid to CHIS in low-and middle-income countries, where potential direct benefits, and issues like justice and capacity building complicate standard ethical convention. We further examined the CHIS status in India despite its substantial infectious disease burden, placing this gap within the country's evolving ethical and regulatory landscape. We argue that CHIS can be morally acceptable with stringent context-sensitive ethical standards, and transparency in reporting, thereby prioritising public trust and equitable benefit sharing.
The classical model of informed consent presupposes a competent patient capable of making an autonomous decision on the basis of adequate information. In clinical practice, decisional incapacity, prognostic uncertainty, and time pressure frequently undermine these conditions, making surrogate decision-making both unavoidable and ethically fraught. This paper examines a structural vulnerability within the substituted judgment standard that has received comparatively limited attention in the philosophical literature: the possibility that surrogate authority may be exercised by proxies whose motives are shaped by financial or personal self-interest. Through conceptual analysis and a paradigmatic clinical case from interventional radiology, the paper argues that substituted judgment may become structurally unstable when the motivational integrity of the surrogate cannot be presumed, and that the procedure designed to preserve patient autonomy risks in such conditions becoming a mechanism for its simulation. The paper develops three criteria for reconstructing autonomy under uncertainty: critical evaluation of surrogate testimony, a graduated rather than binary understanding of residual decisional capacity, and an advocacy-oriented conception of the physician’s role. The broader argument is that autonomy under conditions of incapacity should not be treated as a pre-existing fact to be recovered but as a normative task requiring active institutional reconstruction — one that calls for calibrated safeguards rather than either default trust or default suspicion.
The idea that thoraco-abdominal normothermic regional perfusion (TA-NRP) violates s33 of the Human Tissue Act and standard organ donation practices inherently does not address current systemic gaps already existing within the Australian legislation concerning death determination. Prevailing controversies surrounding TA-NRP reflect historical social prejudices, a necessity for better training to educate and communicate information about organ donation, as well as the ambiguous Australian legislative definition of death. The debate around TA-NRP is not about the future of organ donation, but centers around its very foundation. After culminating various perspectives on circulatory and neurological death from James Bernat to Robert Truog, comparing Australian, United Kingdom, Canadian and American definitions of death (including the interpretations of the word ‘irreversible’), as well as providing contemporary perspectives from medical practitioners on the physical and social effects of TA-NRP, this comprehensive review aims to provide an objective account of what TA-NRP exposes to be vulnerabilities in Australian organ donation today.
Clinical ethical issues in paediatric practice are relatively common due to the nature of the doctor-parent-patient relationship, as these patients run the spectrum from newborns, infants, children and adolescents. The Clinical Ethics Consultation Service (CECS) was established at Hospital Al-Sultan Abdullah (HASA) in 2020. It has played a crucial role in addressing the ethical issues and dilemmas faced by healthcare professionals in their clinical practice. This study aimed to identify common ethical issues encountered in paediatric practice at HASA to provide recommendations on improving clinical ethics support. A qualitative approach employing key informant interviews (KIIs) was utilised. Five HASA paediatricians were interviewed. The results were divided into three sections. Section one focused on common ethical issues encountered by paediatricians. The issues were related to clinical decision-making, refusal of treatment by parents, end-of-life issues and resource allocation. Section two focused on the paediatrician’s understanding and experience of clinical ethics which yielded mixed responses. Section three looked at input regarding the development of paediatric clinical ethics support. Recommendations include promoting the CECS and its services through awareness and educational programmes at HASA. It also recommends enhancing case consultations through participation during grand rounds, providing ethics education and training, as well as guidelines and policy development in paediatric practice at HASA. This study provided meaningful insights into common ethical issues faced by paediatricians at HASA and recommendations on how clinical ethics can support their practice. It also adds to the limited literature on clinical ethics in Malaysia.
During the COVID-19 pandemic, a large number of people became infected, hospitals were overwhelmed and the healthcare system was under extreme pressure. In order to overcome any pandemic, society must stay united. Therefore, the German government repeatedly urged all citizens to show solidarity and cooperate in overcoming the pandemic. However, considering the similarity conditions necessary to realize solidarity, it is questionable whether people with and without a migration background demonstrated solidarity with each other. Germany has a long history of immigration and has Europe's highest immigration rate. Nevertheless, little research has been conducted on the sense of solidarity within people with a migration background during the pandemic. This paper aims to highlight the lack of mutual solidarity between people with and without a migration background. This provides critical insights into how culturally diverse societies could unite in solidarity and overcome future pandemics.
Contemporary societies face pressing ethical and policy challenges that require politically legitimate decision-making processes. This paper comparatively assesses how two public decision-making procedures - referendums and the empirical bioethical method of Collective Reflective Equilibrium in Practice (CREP) - perform in generating politically legitimate policymaking, using personal responsibility for health in healthcare resource allocation as a case study. While referendums appear to ensure political legitimacy through direct public voting, they often produce merely coarse-grained outcomes that fail to capture the nuanced reasoning underlying public preferences, risking oversimplification and 'tyranny of the majority'. By contrast, CREP integrates lay and expert judgments, elicited through empirical methods such as surveys, focus groups, and citizen juries, with ethical theories, principles, and guidelines in an effort to arrive at ethically justifiable and publicly defensible policy recommendations. The paper argues that political legitimacy requires not only procedural participation but also alignment with nuanced, reason-sensitive, and bias-filtered public views that constructively accommodate disagreement. Against this background, the analysis concludes that by examining conditional and context-specific opinions, eliciting justificatory reasons behind judgments, screening for bias and prejudice, and constructively incorporating disagreement into policy synthesis, CREP can provide stronger substantive political legitimacy than referendums, something of particular importance especially in ethically contentious domains like healthcare.
This article offers an original theoretical basis for the claim that public engagement and bioethics are natural allies. It draws on Walker's expressive-collaborative model, which conceptualises morality as a social reality in which differently situated individuals continuously negotiate moral understandings and shared responsibilities to sustain social equilibrium. By highlighting the collective, dialogic, and interpretative nature of moral reasoning-and the epistemic partiality of all actors, including experts-it underscores the necessity of intersubjective processes for achieving legitimate and inclusive governance in bioethics. Deliberative forms of engagement materialise this approach by fostering moral knowledge co-production among individuals with unequally distributed authority over moral claims, thereby helping mitigate epistemic power imbalances between laypeople and experts. Realising this democratic ideal, however, requires rethinking engagement practices that are often expert-driven and work in silos (i.e., engaging citizens and experts separately). This limits the potential for mutual learning and the reconfiguration of moral knowledge to reflect the societal values, needs, and concerns. Instead, engagement practices should stress the interdependence and complementarity of laypeople and experts in solving complex ethical issues.
In vitro gametogenesis (IVG) has attracted growing attention as a transformative reproductive technology, despite its remaining largely at the stage of basic research. This paper analyzes how IVG is represented across academic and media discourse, with a particular focus on expectations surrounding its clinical applications and the ethical implications of such expectations. Drawing on a qualitative review of bioethical literature, selected media reports, and discussions with IVG researchers, the study identifies a shared tendency to frame IVG in terms of its potential use in human reproduction, often presuming near-term feasibility. This forward-looking framing contrasts with the current scientific reality, in which significant technical and safety challenges remain unresolved. The paper argues that this discrepancy contributes to a form of "hype," wherein speculative applications prematurely shape public understanding and ethical debate. Such hype may distort discussions on ethics and policy, amplify unrealistic expectations, and obscure the value of basic research. By clarifying the gap between scientific practice and societal perception, this study highlights the need for responsible communication and ethically grounded discourse. It concludes that fostering accurate public understanding is essential for the governance of emerging biotechnologies such as IVG.
Short-term medical missions have become a common response to global health needs in resource-limited countries, yet concerns persist about their ethical implications and sustainability. This study aimed to explore the ethical challenges of short-term medical missions and volunteer health initiatives in low- and middle-income countries, with a particular focus on their impact on local health professionals and systems, using Ethiopia as a contextual example. The study adopted a narrative review of literature published between 2010 and 2024. A comprehensive search of MEDLINE, CINAHL Complete, Dentistry & Oral Sciences Source, and Scopus, supplemented by Google Scholar, was undertaken. After screening titles, abstracts, and full texts, along with reference lists of included sources, 61 sources were included. Findings were narratively synthesised to identify major ethical themes and structural contributors. Three recurring themes emerged: violations of clinical scope of practice and inconsistent regulatory oversight; structural power imbalances between foreign volunteers and local professionals; and psychological strain and moral distress among local health professionals. Weak credential verification, dependency on external funding, and limited institutional accountability were identified as contributing factors. Ethical reform in global health volunteering requires a shift from episodic charity to partnership-centred practice that prioritises local leadership, accountability, and sustainability. Key strategies include transparent credential verification, pre-departure ethics and cultural competency training, equitable supervision frameworks, and alignment with international guidelines. By implementing these measures, global health volunteering can strengthen local health services and professionals, build more resilient systems and ensure the benefits endure beyond the mission period.
Managing the perceived or actual risks of vaccine policy remains a challenge for public health. Vaccines are among the most significant public health achievements; however, current public and political discourse focuses on the risk of harm they purportedly produce. While the vaccine-related bioethics literature often centres on risk, it has largely overlooked the growing normative scholarship on ethical risk imposition and just distribution. We undertook an analytic scoping review to understand how risk is applied in the bioethics literature, primarily to take stock of where we stand as a bioethics community to advance discussions on ethical vaccination policy. Sixty-two papers were included. Most of the literature adopts an agent-relative rather than agent-neutral account of risk, prioritising duties and rights related to avoiding harm, respecting autonomy and ensuring fairness over simplistic consequentialist reasoning. While individual papers often convey risk as flowing in a single direction - falling into either agent-centred or patient-centred perspectives - the literature as a whole reveals risk to be multidirectional. We are simultaneously both vector and victim, and with regard to risk imposition and distribution, also, morally, both agent and patient. Recognising this is critical for clearer ethical reasoning and more effective discourse and policymaking.
Uterine transplantation (UTx) is an innovative and exciting development that is aimed at making available the experience of gestation to those for whom it may otherwise be out of reach. Given the personal and social importance of this experience to many people, this is a laudable goal. Outside of at least one historic outlier, this practice has primarily been discussed in the context of resolving uterine factor infertility (UFI) for cisgender women. The guidelines and protocols that have been established around UTx understand Uterine Factor Infertility (UFI) as the indication for UTx. This article critically evaluates the Montreal Criteria (2012, 2013) as the primary ethical guidelines regarding UTx. This evaluation focuses on and challenges the way the Criteria structure the discussion around UFI as indication for UTx and the requirement for female genetics. I argue that, outside of the initial experimental design of UTx, there are prima facie grounds for making UTx available outside of the indication of UFI, and that for reasons both internal and external to the Montreal Criteria’s analysis of UTx, there are no overwriting ethical reasons to limit UTx to cis-gender women.
Opposition to vaccination by some people may not be unethical. If so, vaccine mandates must trade off the costs imposed on these people against the benefits that result from vaccine mandates, most particularly the reduced risk of covid-19 deaths. This paper applies these principles to the covid-19 vaccine mandates applied to the 12 + population of New Zealand in 2021–22. It concludes that opposition to covid-19 vaccines was not unethical for people under 50 without comorbidities, that the costs of the vaccine mandates borne by those opposing vaccination were in excess of the mandate benefits, and therefore they were unjustified. Even in respect of mandates for health workers, the costs of the mandates borne by those workers who opposed vaccination still exceeded the mandate benefits, and therefore even they were not justified.
Gabriel Andrade’s recent article, published in Monash Bioethics Review, employs a modus tollens argument to claim that abortion cannot be murder by contending that, if it were, violent resistance (e.g. bombing abortion clinics) would be justified under Just War theory. Because such violence is widely condemned, he concludes that abortion is not murder. This paper critically examines the underlying ethical and legal assumptions of that argument. By interrogating the premises related to Just War theory, and supplementing the critique with counter-modus tollens arguments derived from contemporary foetal homicide statutes and the concept of conditional moral status, this paper demonstrates that reducing the moral status of abortion to the permissibility or impermissibility of violence is both conceptually and practically flawed. This paper calls for an ethical framework that respects legal consistency, competing rights claims, and the importance of procedural restraint in resolving bioethical challenges.
Since the COVID-19 pandemic, attention to elective (or planned) surgery waiting lists has been increasingly urgent and sustained. While the ethical challenge of prioritising patients for planned surgeries is extensively discussed at a policy or system level, little attention has been paid to ethical practice at the individual clinician level. We argue that surgical resource allocation should be reconceptualised as an ethical issue that spans the macro and the micro, to acknowledge and begin to address the experiences of individual clinicians working in this area. This project explored the ethical challenges faced by surgeons, surgical liaison nurses and surgical leadership practising in one network of hospitals in metropolitan Melbourne, Australia. The project was conducted by one hospital’s clinical ethics unit and involved qualitative ethicist-led conversations with eighteen key staff members. These revealed that clinicians experience ethical challenges throughout the surgical patient journey, from referral to the scheduling of the procedure, many of which centre on perceived inequities. The map of challenges includes some patients bypassing public outpatient clinics via the private system, inconsistencies in use of urgency categories, and managing patient deterioration between consent for surgery and the procedure itself. Mapping clinicians’ ethical challenges shows that clinicians administer “the system” and bear witness to its failings; they navigate their moral obligations to individual patients in personal, but quite variable, ways with acute awareness of the broader resource-constrained system. Making these on-the-ground ethical challenges visible is important for clinicians’ and teams’ own reflective practice at the micro level and for informing systemic change at the macro level.
In an ageing society, reducing the number of people with dementia is one of the most important health policies. In the recent years, many studies have focused on dementia prevention, with technologies, such as smartphone apps, attracting considerable attention. These apps help people to manage their lifestyle habits and support them in maintaining an optimal lifestyle to prevent dementia. However, people with migration backgrounds are often excluded from these technologies for various reasons, including digital literacy, language proficiency, socio-economic situation, and educational attainment. To successfully implement health policies, it is essential to address the social structures that prevent people with migration backgrounds from accessing these technologies. Fostering solidarity could be an effective way in achieving this goal given its significant role in movements such as the women’s liberation movement, the Black liberation movement and the disability rights movement. However, the problem is that people with and without migration backgrounds often find it difficult to recognize their similarities. People with a migration background have experienced various forms of discrimination because of their migration experience. Those without a migration background have not had such experiences. This makes it difficult to form solidarity because, by definition, solidarity requires a shared sense of similarity between the sender and receiver. This paper aims to demonstrate how people with and without migration backgrounds can identify these similarities in order to foster a sense of solidarity.
