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Journal of Medical Ethics

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https://www.readbyqxmd.com/read/29217615/identity-personhood-and-the-law-a-response-to-ashcroft-and-mcgee
#1
Charles Foster, Jonathan Herring
No abstract text is available yet for this article.
December 7, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29175968/learning-health-systems-clinical-equipoise-and-the-ethics-of-response-adaptive-randomisation
#2
Alex John London
To give substance to the rhetoric of 'learning health systems', a variety of novel trial designs are being explored to more seamlessly integrate research with medical practice, reduce study duration and reduce the number of participants allocated to ineffective interventions. Many of these designs rely on response adaptive randomisation (RAR). However, critics charge that RAR is unethical on the grounds that it violates the principle of equipoise. In this paper, I reconstruct critiques of RAR as holding that it is inconsistent with five important ethical principles...
November 24, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29175967/dangers-of-neglecting-non-financial-conflicts-of-interest-in-health-and-medicine
#3
Miriam Wiersma, Ian Kerridge, Wendy Lipworth
Non-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration...
November 24, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29151058/nudging-informed-consent-and-bullshit
#4
William Simkulet
Some philosophers have argued that during the process of obtaining informed consent, physicians should try to nudge their patients towards consenting to the option the physician believes best, where a nudge is any influence that is expected to predictably alter a person's behaviour without (substantively) restricting her options. Some proponents of nudging even argue that it is a necessary and unavoidable part of securing informed consent. Here I argue that nudging is incompatible with obtaining informed consent...
November 18, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29151057/nudges-to-reason-not-guilty
#5
Neil Levy
No abstract text is available yet for this article.
November 18, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29151056/between-professional-values-social-regulations-and-patient-preferences-medical-doctors-perceptions-of-ethical-dilemmas
#6
Berit Bringedal, Karin Isaksson Rø, Morten Magelssen, Reidun Førde, Olaf Gjerløv Aasland
BACKGROUND: We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. METHODS: The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded (78%). We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so...
November 18, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29146714/reasons-causes-and-identity
#7
Andrew McGee
No abstract text is available yet for this article.
November 16, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29146713/autonomy-nudging-and-post-truth-politics
#8
Geoff Keeling
In his excellent essay, 'Nudges in a post-truth world', Neil Levy argues that 'nudges to reason', or nudges which aim to make us more receptive to evidence, are morally permissible. A strong argument against the moral permissibility of nudging is that nudges fail to respect the autonomy of the individuals affected by them. Levy argues that nudges to reason do respect individual autonomy, such that the standard autonomy objection fails against nudges to reason. In this paper, I argue that Levy fails to show that nudges to reason respect individual autonomy...
November 16, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29146712/golden-opportunity-reasonable-risk-and-personal-responsibility-for-health
#9
EDITORIAL
Julian Savulescu
No abstract text is available yet for this article.
November 16, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29146711/ethics-health-policy-and-zika-from-emergency-to-global-epidemic
#10
Euzebiusz Jamrozik, Michael J Selgelid
Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation (PAHO), with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics guidance and the role of ethics in emergency responses, before turning to ethical issues that are yet to be resolved...
November 16, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29127137/ethics-of-treatment-interruption-trials-in-hiv-cure-research-addressing-the-conundrum-of-risk-benefit-assessment
#11
Gail E Henderson, Holly L Peay, Eugene Kroon, Rosemary Jean Cadigan, Karen Meagher, Thidarat Jupimai, Adam Gilbertson, Jill Fisher, Nuchanart Q Ormsby, Nitiya Chomchey, Nittaya Phanuphak, Jintanat Ananworanich, Stuart Rennie
Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption (ATI), involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally...
November 10, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29102919/choice-pressure-and-markets-in-kidneys
#12
Julian Koplin
We do not always benefit from the expansion of our choice sets. This is because some options change the context in which we must make decisions in ways that render us worse off than we would have been otherwise. One promising argument against paid living kidney donation holds that having the option of selling a 'spare' kidney would impact people facing financial pressures in precisely this way. I defend this argument from two related criticisms: first, that having the option to sell one's kidney would only be harmful if one is pressured or coerced to take this specific course of action; and second, that such forms of pressure are unlikely to feature in a legal market...
November 4, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29101302/disability-sex-rights-and-the-scope-of-sexual-exclusion
#13
Alida Liberman
In response to three papers about sex and disability published in this journal, I offer a critique of existing arguments and a suggestion about how the debate should be reframed going forward. Jacob M. Appel argues that disabled individuals have a right to sex and should receive a special exemption to the general prohibition of prostitution. Ezio Di Nucci and Frej Klem Thomsen separately argue contra Appel that an appeal to sex rights cannot justify such an exemption. I argue that Appel's argument fails, but not (solely) for the reasons Di Nucci and Thomsen propose, as they have missed the most pressing objection to Appel's argument: Appel falsely presumes that we never have good reasons to restrict someone's sexual liberty rights...
November 3, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29101301/do-not-attempt-resuscitation-dnar-orders-understanding-and-interpretation-of-their-use-in-the-hospitalised-patient-in-ireland-a-brief-report
#14
Helen O'Brien, Siobhan Scarlett, Anne Brady, Kieran Harkin, Rose Anne Kenny, Jeanne Moriarty
Following the introduction of do-not-resuscitate (DNR) orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate (DNAR), decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from July to December 2014...
November 3, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29084865/ethics-of-fertility-preservation-for-prepubertal-children-should-clinicians-offer-procedures-where-efficacy-is-largely-unproven
#15
Rosalind J McDougall, Lynn Gillam, Clare Delany, Yasmin Jayasinghe
Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. 'Fertility preservation' for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group...
October 30, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29079558/life-extending-enhancements-and-the-narrative-approach-to-personal-identity
#16
Andrea Sauchelli
Various debates on the desirability and rationality of life-extending enhancements have been pursued under the presupposition that a generic psychological theory of personal identity is correct. I here discuss how the narrative approach to personal identity can contribute to these debates. In particular, I argue that two versions of the narrative approach offer good reasons to reject an argument against the rationality of (certain forms of) life-extending enhancements.
October 27, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29079557/bringing-science-and-advocacy-together-to-address-health-needs-of-people-who-inject-drugs
#17
EDITORIAL
Liza Dawson, Steffanie A Strathdee, Alex John London, Kathryn E Lancaster, Robert Klitzman, Irving Hoffman, Scott Rose, Jeremy Sugarman
No abstract text is available yet for this article.
October 27, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29079556/the-disvalue-of-death-in-the-global-burden-of-disease
#18
Carl Tollef Solberg, Ole Frithjof Norheim, Mathias Barra
In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something that happens to an individual, loss of life itself (YLL) occurs when that individual's life has ended. YLLs quantify something that involves no experience and does not take place among living individuals...
October 27, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29070707/adverse-consequences-of-article-12-of-the-un-convention-on-the-rights-of-persons-with-disabilities-for-persons-with-mental-disabilities-and-an-alternative-way-forward
#19
Matthé Scholten, Jakov Gather
It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. According to a recent report of the United Nations (UN) High Commissioner for Human Rights, article 12 of the UN Convention on the Rights of Persons with Disabilities (CRPD) presents a wholesale rejection of the competence model...
October 25, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29070706/does-egg-donation-for-mitochondrial-replacement-techniques-generate-parental-responsibilities
#20
César Palacios-González
Children created through mitochondrial replacement techniques (MRTs) are commonly presented as possessing 50% of their mother's nuclear DNA, 50% of their father's nuclear DNA and the mitochondrial DNA of an egg donor. This lab-engineered genetic composition has prompted two questions: Do children who are the product of an MRT procedure have three genetic parents? And, do MRT egg donors have parental responsibilities for the children created? In this paper, I address the second question and in doing so I also address the first one...
October 25, 2017: Journal of Medical Ethics
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