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Journal of Medical Ethics

Misao Fujita, Keiichi Tabuchi
In the October edition of the Journal of Medical Ethics , Akabayashi and colleagues state that 'to establish a heterogeneous [induced pluripotent stem cell] iPSC bank covering roughly 80% of Japan's population…the Japanese government decided to invest JPY110 billion (US$ 1.1 billion) over 10 years in regenerative medicine research; a quarter of this was to be allocated to the iPSC stock project'. While they claim this amount of money to be an unfair distribution of state resources, we believe their assessment is based on a misunderstanding of the facts...
January 11, 2019: Journal of Medical Ethics
Jonathan Pugh
Deep brain stimulation (DBS) is frequently described as a 'reversible' medical treatment, and the reversibility of DBS is often cited as an important reason for preferring it to brain lesioning procedures as a last resort treatment modality for patients suffering from treatment-refractory conditions. Despite its widespread acceptance, the claim that DBS is reversible has recently come under attack. Critics have pointed out that data are beginning to suggest that there can be non-stimulation-dependent effects of DBS...
January 10, 2019: Journal of Medical Ethics
Ainar Miyata-Sturm
The realm of non-rational influence, which includes nudging, is home to many other morally interesting phenomena. In this paper, I introduce the term bumping, to discuss the category of unintentional non-rational influence. Bumping happens constantly, wherever people make choices in environments where they are affected by other people. For instance, doctors will often bump their patients as patients make choices about what treatments to pursue. In some cases, these bumps will systematically tend to make patients' decisions worse...
January 10, 2019: Journal of Medical Ethics
Laura Guidry-Grimes
The question of whether a patient has insight is among the first to be considered in psychiatric contexts. There are several competing conceptions of clinical insight, which broadly refers to a patient's awareness of their mental illness. When a patient is described as lacking insight, there are significant implications for patient care and to what extent the patient is trusted as a knower. Insight is currently viewed as a multidimensional and continuous construct, but competing conceptions of insight still lack consensus on the specifics...
January 10, 2019: Journal of Medical Ethics
Nilay Hepgul, Katherine E Sleeman, Alice M Firth, Anna Johnston, James T H Teo, William Bernal, Richard J B Dobson, Irene J Higginson
We welcome Ballantyne & Schaefer's discussion of the issues concerning consent and use of health data for research. In response to their acknowledgement of the need for public debate and discussion, we provide evidence from our own public consultation on this topic.
January 7, 2019: Journal of Medical Ethics
Robert F Card
Ancell and Sinnott-Armstrong argue that medical providers possess wide freedoms to determine the scope of their practice, and therefore, prohibiting almost any conscientious objections is a bad idea. They maintain that we could create an acceptable system on the whole which even grants accommodations to discriminatory refusals by healthcare professionals. Their argument is premised upon applying a free market mechanism to conscientious objections in medicine, yet I argue their Market View possesses a number of absurd and troubling implications...
January 7, 2019: Journal of Medical Ethics
Govind Persad
This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual's rights over that body can support the moral authority of advance directives...
December 22, 2018: Journal of Medical Ethics
Andrea Lavazza
In terms of ethical implications, Boers, van Delden and Bredenoord (2018) have made an interesting step forward with their model of organoids as hybrids, which seeks to find a balance between subject-like value and object-like value. Their framework aims to introduce effective procedures not to exploit donors and to increase their engagement, but it does not seem to take sufficient account of how organoids are used and how donors and society as a whole may want to act about such uses. I will concentrate my remarks on three points that I consider relevant...
December 22, 2018: Journal of Medical Ethics
Suzanne Ost
In the wake of two recent high-profile, controversial cases involving the prosecution and conviction of Drs Bramhall and Bawa-Garba, this article considers when it is socially desirable to criminalise doctors' behaviour, exploring how the matters of harm, public wrongs and the public interest can play out to justify-or not, as the case may be-the criminal law's intervention. Dr Bramhall branded his initials on patients' livers during transplant surgery, behaviour acknowledged not to have caused his patients any harm by way of injury to their organs...
December 22, 2018: Journal of Medical Ethics
Jenny Lindberg, Mats Johansson, Linus Broström
The principle of self-determination plays a crucial role in contemporary clinical ethics. Somewhat simplified, it states that it is ultimately the patient who should decide whether or not to accept suggested treatment or care. Although the principle is much discussed in the academic literature, one important aspect has been neglected, namely the fact that real-world decision making is temporally extended, in the sense that it generally takes some time from the point at which the physician (or other health care professional) determines that there is a decision to be made and that the patient is capable of making it, to the point at which the patient is actually asked for his or her view...
December 10, 2018: Journal of Medical Ethics
Hane Htut Maung
Assisted reproduction using donor gametes is a procedure that allows those who are unable to produce their own gametes to achieve gestational parenthood. Where conception is achieved using donor sperm, the child lacks a genetic link to the intended father. Where it is achieved using a donor egg, the child lacks a genetic link to the intended mother. To address this lack of genetic kinship, some fertility clinics engage in the practice of matching the ethnicity of the gamete donor to that of the recipient parent...
December 8, 2018: Journal of Medical Ethics
Paul Gosney, Paul Lomax, Carwyn Hooper, Aileen O'Brien
The approach to managing the involuntary detention of people suffering from psychiatric conditions can be divided into those with clinicians at the forefront of decision-making and those who rely heavily on the judiciary. The system in England and Wales takes a clinical approach where doctors have widespread powers to detain and treat patients involuntarily. A protection in this system is the right of the individual to challenge a decision to deprive them of their liberty or treat them against their will. This protection is provided by the First-tier Tribunal; however, the number of successful appeals is low...
December 4, 2018: Journal of Medical Ethics
Rosalind J McDougall
Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM's Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making...
November 22, 2018: Journal of Medical Ethics
Nathan Hodson
Although some doctors celebrated when the Court of Appeal overturned Hadiza Bawa-Garba's erasure from the medical register, it is argued here that in many ways the ruling is by no means good news for the medical profession. Doctors' interests are served by transparent professional tribunals but the Court of Appeal's approach to the GMC Sanctions Guidance risks increasing opacity in decision-making. Close attention to systemic factors in the criminal trial protects doctors yet the Court of Appeal states that the structural circumstances surrounding Bawa-Garba's failings were only of peripheral relevance to her conviction...
November 22, 2018: Journal of Medical Ethics
Lori Seller, Marie-Ève Bouthillier, Veronique Fraser
BACKGROUND: Medical aid in dying (MAiD) was introduced in Quebec in 2015. Quebec clinical guidelines recommend that MAiD be approached as a last resort when other care options are insufficient; however, the law sets no such requirement. To date, little is known about when and how requests for MAiD are situated in the broader context of decision-making in end-of-life care; the timing of MAiD raises potential ethical issues. METHODS: A retrospective chart review of all MAiD requests between December 2015 and June 2017 at two Quebec hospitals and one long-term care centre was conducted to explore the relationship between routine end-of-life care practices and the timing of MAiD requests...
November 22, 2018: Journal of Medical Ethics
Ryan Essex
Australian immigration detention has been called state sanctioned abuse, cruel and degrading and likened to torture. Clinicians have long worked both within the system providing healthcare and outside of it advocating for broader social and political change. It has now been over 25 years and little, if anything, has changed. The government has continued to consolidate power to enforce these policies and has continued to attempt to silence dissent. It was in this context that a boycott was raised as a possible course of action...
November 21, 2018: Journal of Medical Ethics
Lynn A Jansen, Steven Wall, Franklin G Miller
Drawing the line on physician assistance in physician-assisted death (PAD) continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that can be accepted by defenders as well as critics of PAD for the terminally ill...
November 21, 2018: Journal of Medical Ethics
César Palacios-González, Giulia Cavaliere
In a recent paper - Lesbian motherhood and mitochondrial replacement techniques: reproductive freedom and genetic kinship - we argued that lesbian couples who wish to have children who are genetically related to both of them should be allowed access to mitochondrial replacement techniques (MRTs). Françoise Baylis wrote a reply to our paper - 'No' to lesbian motherhood using human nuclear genome transfer - where she challenges our arguments on the use of MRTs by lesbian couples, and on MRTs more generally. In this reply we respond to her claims and further clarify our position...
November 21, 2018: Journal of Medical Ethics
George Gillett
Why are the diagnostic criteria of some psychiatric disorders standardised by gender while others are not? Why standardise symptom questionnaires by gender but not other personal characteristics such as ethnicity, socioeconomic class or sexual orientation? And how might our changing attitudes towards gender, born from scientific research and changing societal narratives, alter our opinion of these questions? This paper approaches these dilemmas by assessing the concept of diagnosis in psychiatry itself, before analysing two common approaches to the study of psychiatric diagnosis; the naturalist and constructivist views...
November 14, 2018: 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
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