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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
Victoria Vorholt, Neal W Dickert
Clinical trials in emergency situations present unique challenges, because they involve enrolling individuals who lack capacity to consent in the context of acute illness or injury. The US Department of Health and Human Services and Food and Drug Administration regulations allowing an Exception from Informed Consent (EFIC) in these circumstances contain requirements for community consultation, public disclosure and restrictions on study risks and benefits. In this paper, we analyse an issue raised in the regulations that has received little attention or analysis but is ethically complex...
September 15, 2018: Journal of Medical Ethics
Samantha Trace, Simon Kolstoe
No abstract text is available yet for this article.
September 14, 2018: Journal of Medical Ethics
Ash Samanta, Jo Samanta
Dr Bawa-Garba, a senior paediatric trainee who had been involved in the care of a child who died shortly after admission to hospital, was convicted of gross negligence manslaughter and subsequently erased from the medical register. We argue that criminalisation of doctors in this way is fraught with ethical tensions at levels of individual blameworthiness, systemic failures, professionalism, patient safety and at the interface of the regulator and doctor. The current response to alleged manslaughter during clinical care is not fit for purpose because of its narrow focus on criminalisation and punishment of individual doctors...
September 5, 2018: Journal of Medical Ethics
Hafez Ismaili M'hamdi, Inez de Beaufort
Is it morally justifiable to force non-consenting pregnant women to submit to caesarean surgery to save their fetus in distress? Even though proponents and opponents largely agree on the interests at stake, such as the health and life of the fetus and the respect for bodily integrity and autonomy of pregnant women, they disagree on which moral weight to attach to these interests. This is why disagreements about the justifiability of forced caesareans tend to be pervasive and intractable. To sidestep this deadlock, we will focus on conditions that give rise to the 'caesarean dilemma' in the first place, namely the conflict between inherent norms and values medical professionals are committed to by virtue of being a medical professional...
September 4, 2018: Journal of Medical Ethics
Dagmar Schmitz, Dominik GroƟ, Charlotte Frierson, Gerrit A Schubert, Henna Schulze-Steinen, Alexander Kersten
Clinical ethics support (CES) services are experiencing a phase of flourishing and of growing recognition. At the same time, however, the expectations regarding the acceptance and the integration of traditional CES services into clinical processes are not met. Ethics rounds as an additional instrument or as an alternative to traditional clinical ethics support strategies might have the potential to address both deficits. By implementing ethics rounds, we were able to better address the needs of the clinical sections and to develop a more comprehensive account of ethics quality in our hospital, which covers the level of decisions and actions, and also the level of systems and processes and aspects of ethical leadership...
August 28, 2018: Journal of Medical Ethics
Eline M Bunnik, Edo Richard, Richard Milne, Maartje H N Schermer
Many healthy volunteers choose to take part in Alzheimer's disease (AD) prevention studies because they want to know whether they will develop dementia-and what they can do to reduce their risk-and are therefore interested in learning the results of AD biomarker tests. Proponents of AD biomarker disclosure often refer to the personal utility of AD biomarkers, claiming that research participants will be able to use AD biomarker information for personal purposes, such as planning ahead or making important life decisions...
August 28, 2018: Journal of Medical Ethics
William R Smith
Gabriele Badano offers three criticisms of my challenge to the orthodox family of theories of legitimacy in bioethics. First, I assumed an 'oversimplified version of the orthodoxy'. Second, I failed to appreciate its domain of application. Third, I only addressed the ways in which orthodox theorists incorporate substance as an 'afterthought'-and, even then, only by rehashing Gopal Sreenivasan's argument. Here, I respond to each, taking up the first and third before ending with reflections on the second. The first underestimates the insight that criticism of the simplified version provides to that of the more complex relatives...
August 22, 2018: Journal of Medical Ethics
Fiona Woollard
Breastfeeding advocates have criticised the phrase 'breast is best' as mistakenly representing breastfeeding as a departure from the norm rather than the default for infant feeding. Breastfeeding mothers have an interest in representing breastfeeding as the default, for example, to counteract criticism of breastfeeding outside the home. This connects to an increasing trend to frame feeding babies formula as harmful, which can be seen in research papers, public policy and information presented to parents and prospective parents...
August 22, 2018: Journal of Medical Ethics
Melanie Jansen, Peter Ellerton
In recent decades, evidence-based medicine has become one of the foundations of clinical practice, making it necessary that healthcare practitioners develop keen critical appraisal skills for scientific papers. Worksheets to guide clinicians through this critical appraisal are often used in journal clubs, a key part of continuing medical education. A similar need is arising for health professionals to develop skills in the critical appraisal of medical ethics papers. Medicine is increasingly ethically complex, and there is a growing medical ethics literature that modern practitioners need to be able to use in their practice...
August 22, 2018: Journal of Medical Ethics
Samuel Reis-Dennis
Recent years have seen the rise of 'Just Culture' as an ideal in the patient safety movement, with numerous hospitals and professional organisations adopting a Just Culture response to incidents ranging from non-culpable human error to intentional misconduct. This paper argues that there is a deep problem with the Just Culture model, resulting from its impoverished understanding of the value of punitive, fundamentally backward-looking, practices of holding people accountable. I show that the kind of 'accountability' and 'punishment' contemporary Just Culture advocates endorse disrespects both patients and providers...
August 18, 2018: Journal of Medical Ethics
Michael Nair-Collins
No abstract text is available yet for this article.
August 13, 2018: Journal of Medical Ethics
Elizabeth Chloe Romanis
In 2017, a Philadelphia research team revealed the closest thing to an artificial womb (AW) the world had ever seen. The 'biobag', if as successful as early animal testing suggests, will change the face of neonatal intensive care. At present, premature neonates born earlier than 22 weeks have no hope of survival. For some time, there have been no significant improvements in mortality rates or incidences of long-term complications for preterms at the viability threshold. Artificial womb technology (AWT), that might change these odds, is eagerly anticipated for clinical application...
August 10, 2018: Journal of Medical Ethics
Charlie T Blunden
In his paper 'A libertarian case for mandatory vaccination', Jason Brennan argues that even libertarians, who are very averse to coercive measures, should support mandatory vaccination to combat the harmful disease outbreaks that can be caused by non-vaccination. He argues that libertarians should accept the clean hands principle, which would justify mandatory vaccination. The principle states that there is a (sometimes enforceable) moral obligation not to participate in collectively harmful activities. Once libertarians accept the principle, they will be compelled to support mandatory vaccination...
August 7, 2018: Journal of Medical Ethics
Akira Akabayashi, Eisuke Nakazawa, Nancy S Jecker
We examined the ethical justification for a national policy governing public funding for the induced pluripotent stem cell (iPSC) stock project in Japan and argue that the initiation of the iPSC stock project in 2012, when no clinical trial using iPSC-derived products had yet succeeded, was premature and unethical. Our analysis considers a generally accepted justice criterion and shows it fails to justify public funding of the iPSC stock project. We also raise concerns related to the massive amounts of public funding at stake and the absence of evidence supporting claimed success rates...
August 7, 2018: Journal of Medical Ethics
Scott Y H Kim, David Gibbes Miller, Rebecca Dresser
No abstract text is available yet for this article.
August 6, 2018: Journal of Medical Ethics
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