Among the contemporary challenges to liberal political philosophy are those that arise from feminist concerns about relationships of dependence and care. If liberalism is committed to supporting each individual's pursuit of a good life, and if a good society is one that establishes institutions to address the complex coordination of competing vital interests, then why hasn't liberalism paid more attention to the social allocation of caring responsibilities and the vulnerability of some individuals to the conscientiousness of others willing and able to provide care for those who may be dependent? In this chapter, I address this in two steps. The first is to demonstrate the resources of an ethics of care or care orientation to ethics for informing normative political philosophy. I then consider how these resources can be used to reconsider what the proper scope of politics or the political might be in light of the vulnerabilities of those who are dependent on the care of others, and what is owed to those who provide care to dependants. In my view, the relative silence of political philosophy to address the problems of dependence and care arises in part from a conception of the subject of politics as paradigmatically an independent autonomous agent and of care provision as being beyond the realm of politics.

Human brain organoids provide a remarkable opportunity to model prenatal human brain biology in vitro by recapitulating features of in utero molecular, cellular and systems biology. An ethical concern peculiar to human brain organoids is whether they are or could become capable of supporting sentience through the experience of pain or pleasure and/or consciousness, including higher cognitive abilities such as self-awareness. Identifying the presence of these traits is complicated by several factors, beginning with consciousness—which is a highly contested concept among neuroscientists, cognitive scientists, and philosophers and so there is no agreed definition. Secondly, given human brain organoids are disembodied, there is no practical way to identify evidence of consciousness as we might in humans or animals. What would count as evidence of organoid consciousness is an emerging area of research. To address concerns about consciousness and human brain organoids, in this paper we clarify the morally relevant aspects of human consciousness, phenomenal experience and embodied development and explore the empirical basis of consciousness to develop a defensible framework for informed decision-making on the moral significance and utility of brain organoids, which can also guide regulation and future research of these novel biological systems.

In the 1980s Contact Precautions were introduced as a precautionary measure to control the emerging threat of antimicrobial resistance in hospitals, particularly methicillin resistant Staphylococcus aureus (MRSA). Today, antimicrobial resistance remains a concerning global public health threat, and a focus for hospital patient safety priorities. In late 2019 a novel respiratory virus described as SARS-CoV-2, was reported. Just as MRSA had prompted control measures developed in the context of limited information and understanding of the pathogen, public health control measures against SARS-CoV-2 were promptly and strictly implemented. Whilst SARS-CoV-2 control measures were successful at containing the virus, numerous detrimental socio-economic and health impacts have led to a rebalancing of harms versus benefits and loosening of restrictions. Conversely, evidence collated over the past 50 years, suggests that Contact Precautions are not superior to well-applied standard infection prevention and control precautions in controlling MRSA acquisition in hospitals. Several harms associated with Contact Precautions, affecting patient safety, financial costs, and organisational culture, are described. However, rebalancing of hospital MRSA control policies has been slow to materialise. This commentary invites infection prevention and control policy makers to reflect and revise policies for the control of MRSA in hospitals so that harms do not outweigh benefits.

Neurodevices that collect neural (or brain activity) data have been characterised as having the ability to register the inner workings of human mentality. There are concerns that the proliferation of such devices in the consumer-directed realm may result in the mass processing and commercialisation of neural data (as has been the case with social media data) and even threaten the mental privacy of individuals. To prevent this, some argue that all raw neural data should be conceptualised and regulated as “medical data” even if it is collected from consumer-directed devices in obviously non-clinical settings. In this paper, we argue that without a clearer formulation of what does and does not count as medical data, this approach might also uncritically enlarge the scope for medical influence and an unwarranted medicalisation of everyday aspects of mental life. Indeed, if we were to accept the position that all neural data is medical data because it offers insights into personally sensitive information (such a person’s thoughts, emotions, or intentions) then this could even unnecessarily expand the boundaries of medical data to other forms of data that otherwise seem to be non-clinical. If all brain data (neural activity data) is considered to be medical data even when collected from consumer-directed devices then we might unintentionally reduce meaningful distinctions between what is and what is not rightfully in the purview of medicine.

Background: Contact Precautions (CP) were developed to control multi-resistant organisms (MROs) in hospitals. However, MROs persist and harms are associated with CP. Research objectives were to understand the bioethical impact of CP on patients and health-professionals, and make recommendations for ethicallyimproved management of MRO-colonized patients. Methods: Interpretive description methodology scaffolded upon bioethical principles framed this qualitative study. Findings were explored alongside contemporary published reports to make recommendations for practice and research. Results: Nine patients and 24 health professionals participated. Four themes were found: Powerlessness moving to acceptance; You feel a bit of a pariah; Others need protection, but I need looking after too; Doing Contact Precautions is not easy. Discussion: CP conflict with the principle of respect for autonomy due to non-adherence to informed consent, and sub-optimal communication. Patients experience health care inequality, and discriminatory practices breaching the principle of justice. CP elicit stigma for patients, and moral distress and inter-personal conflict for staff, breaching the principle of non-maleficence. Under the principle of beneficence, pluralistic cost-benefit assessment situates CP as low-value practice. Conclusions: CP challenge organizational culture, professional well-being, and person-centered ethical care. Ethical costs of CP outweigh benefits, obliging policy-makers to reconsider CP in managing MRO-colonized patients. Crown Copyright (c) 2022 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Janna Thompson is best known internationally for her contributions to social and political philosophy, with important books on intergenerational justice (2009), international justice (1992), and reparations for historic injustice (2002a, 2018).Her research also extended to a range of applied philosophical issues including environmental ethics (2000), terrorism (2002b), gene technology (2008), and feminist philosophy (2006).Her work is informed by her political commitments to socialism (she had been a member of the Australian Communist Party); however, it is not overtly Marxist in its theoretical approach or conceptualisation.Rather, her philosophical works address some of the shortcomings of individualistic liberal political philosophy, using an analytic approach to address questions about justice from the perspective of a collectivist ethics (1998).As a feminist philosopher, Janna was concerned with failures of liberalism to account for relations of care and dependence and the effects of these failures on social institutions that expose to harm those who are dependent or vulnerable, and place unreasonable burdens on those who provide care to others (2006, 2014).

Introduction: Health policymakers are committed to controlling multi-resistant organisms (MROs) in hospitals. Infection prevention and control (IPC) measures known as Contact Precautions (CP) were developed in the 1980’s however MROs persist. Research objectives were to understand the impact of CP on patients and health-professionals, to discuss study findings from a bioethical perspective, and make recommendations for ethically sound management of MRO-colonised hospital patients.

The increasing dementia prevalence worldwide is driving the testing of novel therapeutic approaches, such as invasive brain technologies, despite limited clinical evidence and the risk of accelerating cognitive decline. Our manuscript (a) reviews the NIH Clinicaltrials.gov database for deep brain stimulation, stem cell implantation, and gene therapy trials on people with dementia; (b) discusses issues on beneficence, nonmaleficence, and autonomy associated with these trials; and (c) proposes nine recommendations that build on elements from the Declaration of Helsinki. We found 49 preregistered high-risk trials from nine countries planning to or involving 11,801 people with Alzheimer's or Lewy body dementia or dementia secondary to Parkinson's or Huntington's disease. Most of the people with Alzheimer's who are in these trials are from North America and East Asia. There is substantial heterogeneity in the enrolment criteria, even for trials recruiting only those with Alzheimer's disease. Although most trials enrol people in mild to moderate stages of Alzheimer's disease, trials in China enrol people who have severe Alzheimer's. Our findings highlight a pressing need to review and refine the enrolment criteria for invasive neural trials in people with dementia, considering risks, potential benefits, and capacity for informed consent. As a multidisciplinary team from Australia, the USA, Canada, and Germany with expertise in neurology, neuroscience, and ethics, we examine how it is essential to balance the risks of invasive neural research in a vulnerable population with limited capacity to provide informed consent to help advance the body of knowledge regarding a disease with limited therapeutic options.

ZusammenfassungWendy Rogers ist Professorin für klinische Ethik und Catriona Mackenzie ist Professorin für Philosophie. Beide lehren an der Macquarie University in Sydney, Australien. Susan Dodds ist Professorin für Philosophie an der La Trobe University in Melbourne, Australien. Alle drei befassen sich seit Jahren intensiv mit feministischer Theorie, angewandter und biomedizinischer Ethik sowie mit Moralphilosophie.

Antimicrobial resistance (AMR) is now recognised as a social, cultural, economic and political phenomenon, positioning the social sciences as central in responding to this global health threat. Yet efforts to address AMR within hospital settings, for example through antimicrobial stewardship (AMS) programs, continue to focus primarily on the prescribing practices of individual clinicians, often with little effect. There has been less attention to the role of healthcare administration, and managerialism therein, in explaining the limited progress to date in reining in antimicrobial misuse. To explore this, drawing on interviews with senior executives and managers from two Australian hospitals, we examine how these stakeholders navigate between management practice and AMR solutions, revealing that antimicrobial optimisation is frequently obscured by accountability structures attuned to other agendas. This has led, we argue, to the institutionalisation of micro-improvements that frequently ‘tick the box’ of having an AMS program, yet do little to effectively counteract rising AMR. Our analysis illustrates how sociological attention to the structural and ideological settings within which prescribing behaviour is carried out will be crucial to any attempts to successfully rein in AMR.

BackgroundNurses face challenges when providing information about multi-resistant organisms (MROs), and related hospital policies, to patients found to be colonised, and may be concerned for their own safety when caring for MRO-colonised people. Resultant emotional responses may influence behaviours of staff caring for these patients. This study aimed to identify the feelings experienced by nurses when talking about MROs with patients. Secondary objectives were to learn about staff behaviours towards MRO-colonised patients, and to explore the utility of Emotional Touchpoints methodology in this context.MethodsA qualitative study using an adapted Emotional Touchpoints method delivered as a paper survey tool for data collection. Content analysis and inductive coding of responses was used to identify key themes.Results53 nurses participated. ‘Nervous’, ‘Concerned’ and ‘Knowledgeable’ were the most commonly selected adjectives chosen to describe their feelings. Reasons for these choices were themed as ‘Empowerment through knowledge’, ‘Performance anxiety’, ‘Concern for the patient’ and ‘Concern for professional reputation’. Social or temporal distancing, and the need for staff and other patients to be protected from contagion were key themes for the behaviours these nurses had witnessed towards patients.ConclusionTalking about MROs with patients can elicit strong emotional responses in nurses, and MRO-colonised patients may be treated and spoken about in a discriminatory fashion. Infection prevention and control teams should recognise this and focus on the person rather than the pathogen when educating and supporting nurses. Recommendations for practice are made to support improved wellbeing of nurses as well as MRO colonised patients.

The world’s first clinical trial using advisory brain implant operated by artificial intelligence (AI) has been completed with significant success. The tested devices predict a specific neuronal event (epileptic seizure), allowing people implanted with the device to be forewarned and to take steps to reduce or avoid the impact of the event. In principle, these kinds of artificially intelligent devices could be used to predict other neuronal events and allow those implanted with the device to take precautionary steps or to automate drug delivery so as to avoid unwanted outcomes. This chapter examines moral issues arising from the hypothetical situation where such devices controlled by AI are used to ensure that convicted criminal offenders are safe for release into society. We distinguish two types of predictive technologies controlled by AI: advisory systems and automated therapeutic response systems. The purpose of this chapter is to determine which of these two technologies would generate fewer ethical concerns. While there are moral similarities between the two technologies, the latter raises more concerns. In particular, it raises the possibility that individual moral decision-making and moral autonomy can be threatened by the use of automated implants.

3D bioprinting involves engineering live cells into a 3D structure, using a 3D printer to print cells, often together with a compatible 3D scaffold. 3D-printed cells and tissues may be used for a range of purposes including medical research, in vitro drug testing, and in vivo transplantation. The inclusion of living cells and biomaterials in the 3D printing process raises ethical, policy, and regulatory issues at each stage of the bioprinting process that include the source of cells and materials, stability and biocompatibility of cells and materials, disposal of 3D-printed materials, intended use, and long-termeffects. This chapter focuses on the ethical issues that arise from 3D bioprinting in the lab-from consideration of the source of cells and materials, ensuring their quality and safety, through to testing of bioprinted materials in animal and human trials. It also provides guidance on where to seek information concerning appropriate regulatory frameworks and guidelines, including on classification and patenting of 3D-bioprinted materials, and identifies regulatory gaps that deserve attention.

Public policy decisions about patients' access to limited healthcare resources must be defensible and responsive to the interests of those affected. Decision-makers should articulate their reasoning and recommendations so that citizens can judge them. While the context of policy decisions will differ, their legitimacy depends upon the transparency of the reasoning, the accountability of the decision-makers, the testability of the evidence used to inform the decision-making and the inclusive recognition of those the decision affects. An example of applying this framework to resource allocation is that of approving effective high-cost anticancer drugs in a timely fashion.

Hospital infection control practices known as Contact Precautions are recommended for the management of people with pathogens such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococci. Background: The patient is isolated, and staff are required to wear gloves, and a gown or apron when providing care. A notice is displayed to remind staff of these requirements and an 'alert' message is placed in the patient's medical record. Objective: The aim of this article is to discuss and explore whether practices used in hospitals to reduce the transmission of endemic antibiotic-resistant organisms are ethically justified in today's healthcare environment in the developed world. In order to do this, the history of the development of these practices is summarised, and the evidence base for their effectiveness is reviewed. Key bioethics principles are then discussed and contextualised from the perspective of hospital infection prevention and control, and an ethically superior model for the prevention and control of healthcare associated infection is proposed.

There has been a surge in mass media reports extolling the potential for using three-dimensional printing of biomaterials (3D bioprinting) to treat a wide range of clinical conditions. Given that mass media is recognized as one of the most important sources of health and medical information for the general public, especially prospective patients, we report and discuss the ethical consequences of coverage of 3D bioprinting in the media. First, we illustrate how positive mass media narratives of a similar biofabricated technology, namely the Macchiarini scaffold tracheas, which was involved in lethal experimental human trials, influenced potential patient perceptions. Second, we report and analyze the positively biased and enthusiastic portrayal of 3D bioprinting in mass media. Third, we examine the lack of regulation and absence of discussion about risks associated with bioprinting technology. Fourth, we explore how media misunderstanding is dangerously misleading the narrative about the technology.

Recent developments of three-dimensional printing of biomaterials (3D bioprinting) in medicine have been portrayed as demonstrating the potential to transform some medical treatments, including providing new responses to organ damage or organ failure. However, beyond the hype and before 3D bioprinted organs are ready to be transplanted into humans, several important ethical concerns and regulatory questions need to be addressed. This article starts by raising general ethical concerns associated with the use of bioprinting in medicine, then it focuses on more particular ethical issues related to experimental testing on humans, and the lack of current international regulatory directives to guide these experiments. Accordingly, this article (1) considers whether there is a limit as to what should be bioprinted in medicine; (2) examines key risks of significant harm associated with testing 3D bioprinting for humans; (3) investigates the clinical trial paradigm used to test 3D bioprinting; (4) analyses ethical questions of irreversibility, loss of treatment opportunity and replicability; (5) explores the current lack of a specific framework for the regulation and testing of 3D bioprinting treatments.