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Journal of Medical Ethics

Daniel W Tigard
Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would serve the medical community well to retain notions of individual responsibility and blame in healthcare settings...
November 9, 2018: Journal of Medical Ethics
Derick T Wade
No abstract text is available yet for this article.
October 31, 2018: Journal of Medical Ethics
Emmanuelle Bélanger, Anna Towers, David Kenneth Wright, Yuexi Chen, Golda Tradounsky, Mary Ellen Macdonald
OBJECTIVES: In 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia (VAE). Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation? METHODS: We used interpretive description, an inductive methodology to answer research questions about clinical practice...
October 30, 2018: Journal of Medical Ethics
Timothy M Wilkinson
Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose we distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem)...
October 30, 2018: Journal of Medical Ethics
Sarah N Boers, Johannes J M van Delden, Annelien L Bredenoord
Recent developments in biotechnology allow for the generation of increasingly complex products out of human tissues, for example, human stem cell lines, synthetic embryo-like structures and organoids. These developments are coupled with growing commercial interests. Although commercialisation can spark the scientific and clinical promises, profit-making out of human tissues is ethically contentious and known to raise public concern. The traditional bioethical frames of gift versus market are inapt to capture the resulting practical and ethical complexities...
October 26, 2018: Journal of Medical Ethics
Zoë Fritz, Richard Holton
As many studies around the theme of 'too much medicine' attest, investigations are being ordered with increasing frequency; similarly the threshold for providing treatment has lowered. Our contention is that trust (or lack of it) is a significant factor in influencing this, and that understanding the relationship between trust and investigations and treatments will help clinicians and policymakers ensure ethical decisions are more consistently made. Drawing on the philosophical literature, we investigate the nature of trust in the patient-doctor relationship, arguing that at its core it involves a transfer of discretion...
October 26, 2018: Journal of Medical Ethics
David Avitzour, Rani Barnea, Eliana Avitzour, Haim Cohen, Ittay Nissan-Rozen
There is an extensive ethical debate regarding the justifiability of doctors nudging towards healthy behaviour and better health-related choices. One line of argument in favour of nudging is based on empirical findings, according to which a healthy majority among the public support nudges. In this paper, we show, based on an experiment we conducted, that, in health-related choices, people's ethical attitudes to nudging are strongly affected by the point of view from which the nudge is considered. Significant differences have been found between doctors' ethical attitude to clinical nudging and that of patients...
October 25, 2018: Journal of Medical Ethics
Thomas David Riisfeldt
Opioid and sedative use are common 'active' practices in the provision of mainstream palliative care services, and are typically distinguished from euthanasia on the basis that they do not shorten survival time. Even supposing that they did, it is often argued that they are justified and distinguished from euthanasia via appeal to Aquinas' Doctrine of Double Effect. In this essay, I will appraise the empirical evidence regarding opioid/sedative use and survival time, and argue for a position of agnosticism...
October 23, 2018: Journal of Medical Ethics
Ben Saunders
In a recent article, Fiona Woollard draws attention to a number of problems, both theoretical and pragmatic, with current discourse around infant feeding. References both to the 'benefits of breastfeeding' and 'harms of formula' are problematic, since there is no obvious baseline of comparison against which to make these evaluations. Further, she highlights the pragmatic consequences of these linguistic choices. Saying that formula feeding harms babies, for instance, is likely to exacerbate feelings of guilt and shame felt by many mothers who use formula, for various reasons...
October 20, 2018: Journal of Medical Ethics
Matthew S McCoy, Karin Rolanda Jongsma, Phoebe Friesen, Michael Dunn, Carolyn Plunkett Neuhaus, Leah Rand, Mark Sheehan
Biomedical research funding bodies across Europe and North America increasingly encourage-and, in some cases, require-investigators to involve members of the public in funded research. Yet there remains a striking lack of clarity about what 'good' or 'successful' public involvement looks like. In an effort to provide guidance to investigators and research organisations, representatives of several key research funding bodies in the UK recently came together to develop the National Standards for Public Involvement in Research...
October 18, 2018: Journal of Medical Ethics
Alex James Miller Tate
I explain the notion of contributory injustice, a kind of epistemic injustice, and argue that it occurs within psychiatric services, affecting (at least) those who hear voices. I argue that individual effort on the part of clinicians to avoid perpetrating this injustice is an insufficient response to the problem; mitigating the injustice will require open and meaningful dialogue between clinicians and service user organisations, as well as individuals. I suggest that clinicians must become familiar with and take seriously concepts and frameworks for understanding mental distress developed in service user communities, such as Hearing Voices Network, and by individual service users...
October 18, 2018: Journal of Medical Ethics
Charles Foster
Over the last quarter of a century, English medical law has taken an increasingly firm stand against medical paternalism. This is exemplified by cases such as Bolitho v City and Hackney Health Authority, Chester v Afshar, and Montgomery v Lanarkshire Health Board. In relation to decision-making on behalf of incapacitous adults, the actuating principle of the Mental Capacity Act 2005 is respect for patient autonomy. The only lawful acts in relation to an incapacitous person are acts which are in the best interests of that person...
October 9, 2018: Journal of Medical Ethics
Vincent Couture, Régen Drouin, Jean-Marie Moutquin, Patricia Monnier, Chantal Bouffard
Cross-border reproductive care (CBRC) can be defined as the movement from one jurisdiction to another for medically assisted reproduction (MAR). CBRC raises many ethical concerns that have been addressed extensively. However, the conclusions are still based on scarce evidence even considering the global scale of CBRC. Empirical ethics appears as a way to foster this ethical reflection on CBRC while attuning it with the experiences of its main actors. To better understand the 'in and out' situation of CBRC in Canada, we conducted an ethnographic study taking a 'critically applied ethics' approach...
October 9, 2018: Journal of Medical Ethics
Neil C Manson
Over the past couple of decades, there has been an ongoing, often fierce, debate about the ethics of biobank participation. One central element of that debate has concerned the nature of informed consent, must specific reconsent be gained for each new use, or user, or is broad consent ethically adequate? Recently, Thomas Ploug and Søren Holm have developed an alternative to both specific and broad consent: what they call a meta-consent framework. On a meta-consent framework, participants can choose the type of consent framework they require, for different kinds of use, different types of user and so on...
October 1, 2018: Journal of Medical Ethics
Anna Lindblad, Gert Helgesson, Manne Sjöstrand
Psychiatry today is mainly practised within a curative framework. However, many mental disorders are persistent and negatively affect quality of life as well as life expectancy. This tension between treatment goals and the actual illness trajectory has evoked a growing academic interest in 'palliative psychiatry', namely the application of a palliative care approach in patients with severe persistent mental illness. Recently, Trachsel et al presented a working definition of palliative psychiatry. This first official attempt to capture the concept is based on WHO's widely accepted definition of palliative care but modified and limited to include only severe persistent psychiatric illness...
September 28, 2018: Journal of Medical Ethics
Carey DeMichelis, Randi Zlotnik Shaul, Adam Rapoport
This article explores the ethical challenges of providing Medical Assistance in Dying (MAID) in a paediatric setting. More specifically, we focus on the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution. We illuminate a central point of conceptual confusion about the nature of MAID that emerges at the level of practice, and explore the various entailments for clinicians and patients that would flow from different understandings...
September 21, 2018: Journal of Medical Ethics
Johan Christiaan Bester
This work clarifies the role of the best interest standard (BIS) as ethical principle in the medical care of children. It relates the BIS to the ethical framework of medical practice. The BIS is shown to be a general principle in medical ethics, providing grounding to prima facie obligations. The foundational BIS of Kopelman and Buchanan and Brock are reviewed and shown to be in agreement with the BIS here defended. Critics describe the BIS as being too demanding, narrow, opaque, not taking the family into account and not suitable as limiting principle...
September 21, 2018: Journal of Medical Ethics
Thomas Finegan
Christopher Cowley1 has recently put forward three arguments against the legal accommodation of a general practitioner's conscientious objection (CO) to abortion referrals.i He claims that the adoption of these arguments does not undermine a more general right to CO to involvement in abortion. I argue that Cowley is seriously mistaken. His three arguments, especially the second and third, proceed on a path directed towards the outright rejection of a right to CO in healthcare contexts. A common problem with Cowley's three arguments is that they overlook the peremptory significance for CO analysis of both the internal, deliberating perspective of those with a CO and the good of moral integrity...
September 21, 2018: Journal of Medical Ethics
Laura Frances Callahan
Woollard and Porter argue that mothers have no moral duty to breastfeed their babies. Rather, mothers simply have moral reason(s) to breastfeed, stemming from the benefits of breast feeding for babies. According to Woollard and Porter, doing what one has moral reason to do is often supererogatory, not obligatory. I agree that mothers have no moral duty to breastfeed. However, it is misleading to suggest that mothers in general have moral reason to breastfeed and to liken not breastfeeding to not performing some supererogatory action...
September 19, 2018: Journal of Medical Ethics
Mike King, Angela Ballantyne
Donor-funded research is research funded by private donors in exchange for research-related benefits, such as trial participation or access to the trial intervention. This has been pejoratively referred to as 'pay to play' research, and criticised as unethical. We outline three models of donor-funded research, and argue for their permissibility on the grounds of personal liberty, their capacity to facilitate otherwise unfunded health research and their consistency with current ethical standards for research...
September 18, 2018: Journal of Medical Ethics
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