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Kyoko Wada, Louis C Charland, Geoff Bellingham
There are reasons to believe that decision-making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women's decisional capacity. Decision-making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to 'understanding' alone. A systematic literature search identified a total of 20 empirical studies focused on women's decision-making about epidural analgesia for labor pain...
October 25, 2018: Bioethics
Marc Sørensen, Lars Willy Andersen
Limiting intensive care is paid increasing attention. In the echoing call for physicians' ethical self-restriction, it is easily overlooked, however, that ethics needs a critical epistemological analysis before it can suffice as an emergency brake to futile treatment. This analysis is provided by the present essay. The authors suggest that the difficulties of resolving moral dilemmas related to limiting intensive care may just be due to the unclarified epistemological status of moral claims. Even if normative ethics cannot prescribe right decisions, but only draw conclusions from defined premises, the premises may or may not be true...
October 20, 2018: Bioethics
Bryanna Moore
Patients and families are increasingly turning to crowdfunding to help them cover the cost of medical care. The ethics of crowdfunding has garnered some attention in the bioethical literature. In this paper I examine an ethical aspect of medical crowdfunding (MCF) that has received limited attention: the role of donors. I defend a virtue ethical approach to analyzing the role of donors in MCF. Vicious donation, where donors do not exercise the relevant virtues, can compound some of the ethical risks associated with MCF, as seen in the several recent, high-profile cases...
October 20, 2018: Bioethics
Bruce P Blackshaw, Daniel Rodger
Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson's violinist analogy, which argues for a woman's right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson's reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive...
October 20, 2018: Bioethics
Jens Greve
This paper considers Habermas' model of a post-secular political order in the light of the debate on male circumcision that arose in Germany after a court ruled that male circumcision was an unjustifiable act of bodily harm. Central to this model is the idea that religious reasons can only become effective in central legal institutions when they are translated into secular reasons. My paper demonstrates that there are two distinguishable readings of this proviso. On the one hand, there is a broad reading according to which it is only necessary to reach a conclusion that is in line with the democratic principle stating that all citizens can be regarded as co-legislators even if non-generalizable value orientations might then shape the interpretation of fundamental rights (in the case of circumcision, the right to bodily integrity)...
October 20, 2018: Bioethics
Rieke van der Graaf, Indira S E van der Zande, Johannes J M van Delden
As early as 2002, CIOMS stated that pregnant women should be presumed eligible for participation in research. Despite this position and calls of other well-recognized organizations, the health needs of pregnant women in research remain grossly under-researched. Although the presumption of eligibility remains unchanged, the revision of the 2002 CIOMS International ethical guidelines for biomedical research involving human subjects involved a substantive rewrite of the guidance on research with pregnant women and related guidelines, such as those on fair inclusion and vulnerability...
October 20, 2018: Bioethics
Jonathan Beever, Nicolae Morar
This paper argues that the practical reach and ethical impact of the One Health paradigm is conditional on satisfactorily distinguishing between interconnected and interdependent factors among human, non-human, and environmental health. Interconnection does not entail interdependence. Offering examples of interconnections and interdependence in the context of existing One Health literature, we demonstrate that the conversations about One Health do not yet sufficiently differentiate between those concepts. They tend to either ignore such distinctions or embrace bioethically untenable positions...
October 20, 2018: Bioethics
Philip Shadd, Joshua Shadd
Whether institutions and not just individual doctors have a right to not participate in medical assistance in dying (MAID) is controversial, but there is a tendency to frame the issue of institutional non-participation in a particular way. Conscience is central to this framing. Non-participating health centres are assumed to be religious and full participation is expected unless a centre objects on conscience grounds. In this paper we seek to reframe the issue. Institutional non-participation is plausibly not primarily, let alone exclusively, about conscience...
October 16, 2018: Bioethics
S Matthew Liao
Advances in genomic technologies such as CRISPR-Cas9, mitochondrial replacement techniques, and in vitro gametogenesis may soon give us more precise and efficient tools to have children with certain traits such as beauty, intelligence, and athleticism. In this paper, I propose a new approach to the ethics of reproductive genetic engineering, a human rights approach. This approach relies on two claims that have certain, independent plausibility: (a) human beings have equal moral status, and (b) human beings have human rights to the fundamental conditions for pursuing a good life...
October 12, 2018: Bioethics
Oliver Hallich
A central question in the ethical debate on the practice of relinquishing in vitro fertilization surplus embryos for family building is whether we ought to think of it more in terms of donating these embryos or in terms of having them adopted. Deciding between these two alternatives is more than a matter of mere terminology. It has an impact on normative questions, e.g., on the question of what criteria for parent selection ought to be applied to the recipients of the embryos, and on the moral evaluation of the act of 'donating' the embryo or 'having it adopted'...
October 10, 2018: Bioethics
Maartje H N Schermer, Edo Richard
In the hope of future treatments to prevent or slow down the disease, there is a strong movement towards an ever-earlier detection of Alzheimer's disease (AD). In conjunction with scientific developments, this has prompted a reconceptualization of AD, as a slowly progressive pathological process with a long asymptomatic phase. New concepts such as 'preclinical' and 'prodromal' AD have been introduced, raising a number of conceptual and ethical questions. We evaluate whether these new concepts are theoretically defensible, in light of theories of health and disease, and whether they should be understood as disease or as an at-risk state...
October 10, 2018: Bioethics
Bruce Jennings
Many working in bioethics today are engaging in forms of normative interpretation concerning the meaningful contexts of relational agency and institutional structures of power. Using the framework of relational bioethics, this article focuses on two significant social practices that are significant for health policy and public health: the practices of solidarity and the practices of care. The main argument is that the affirming recognition of, and caring attention paid to, persons as moral subjects can politically motivate a society in three respects...
September 28, 2018: Bioethics
Benjamin Zolf
Most proponents of conscientious objection accommodation in medicine acknowledge that not all conscientious beliefs can justify refusing service to a patient. Accordingly, they admit that constraints must be placed on the practice of conscientious objection. I argue that one such constraint must be an assessment of the reasonability of the conscientious claim in question, and that this requires normative justification of the claim. Some advocates of conscientious object protest that, since conscientious claims are a manifestation of personal beliefs, they cannot be subject to this kind of public justification...
September 26, 2018: Bioethics
Christopher Kaczor
Both many critics of abortion and many defenders of abortion have suggested that artificial wombs could end the abortion debate. If the fetus is removed from the uterus, women have an end to an unwanted pregnancy. If the living fetus is then put in an artificial uterus for ectogenesis, there is no termination of the life of the fetus. Joona Räsänen challenges this view in his article, Ectogenesis, abortion and a right to the death of the fetus. Räsänen provides three arguments for a right to secure the death of the human being in utero, namely the 'right not to become a biological parent argument', the 'right to genetic privacy argument', and the 'right to property argument'...
September 25, 2018: Bioethics
Johan C Bester
This article presents arguments that reframe the discussion on vaccination ethics. The correct starting point for discussions on vaccination ethics is not what society owes parents, but rather what society owes children. Drawing on the justice theory of Powers and Faden, two conclusions are defended by presenting and defending a set of arguments. First, a just society is obligated to protect its children against serious vaccine-preventable diseases such as measles through adequate levels of vaccination. Second, this obligation of the just society rests on identifiable individuals and institutions: parents, healthcare professionals, government, and vaccine producers have important obligations in this regard...
September 19, 2018: Bioethics
Alison Douglass, Angela Ballantyne
The revision of the Council of International Organizations of Medical Sciences (CIOMS) International ethical guidelines for health-related research (2016) heralds a paradigm shift from the 'protectionist' policies that emerged following historical research atrocities of the 20th century, towards a more nuanced and inclusive approach to research participation. Adopting this modified approach will enable countries to secure the benefits of research for individuals and for society as a whole, while at the same time minimizing the potential for exploitation and research-related harms...
September 18, 2018: Bioethics
Barbara Prainsack, Alena Buyx
Designing the future of work is crucial to the health and well-being of people and societies. Experts predict that developments such as the advancement of digital technologies, automation, and the movement of manufacturing jobs to low-wage countries will lead to major transformations in the labour market, and some foresee significant job losses. Due to the close relationship between employment and health, major job losses would have significant negative impacts on the health and well-being of individuals and societies...
September 18, 2018: Bioethics
Jukka Varelius
In the end-of-life context, alleviation of the suffering of a distressed patient is usually seen as a, if not the, central goal for the medical personnel treating her. Yet it has also been argued that suffering should be seen as a part of good dying. More precisely, it has been maintained that alleviating a dying patient's suffering can make her unable to take care of practical end-of-life matters, deprive her of an opportunity to ask questions about and find meaning in and for her existence, and detach her from reality...
September 18, 2018: Bioethics
Anke Snoek, Dorothee Horstkötter
When doing research among vulnerable populations, researchers are obliged to protect their subjects from harm. We will argue that traditional ethical guidelines are not sufficient to do this, since they mainly focus on direct harms that can occur: for example, issues around informed consent, fair recruitment and risk/harm analysis. However, research also entails indirect harms that remain largely unnoticed by research ethical committees and the research community. Indirect harms do not occur during data collection, but in the analysis of the data, and how the data is presented to the scientific and wider societal community...
September 18, 2018: Bioethics
Kristin Peterson, Morenike O Folayan
In 2004, the first ever multi-sited clinical trials studied the prospect of HIV biomedical prevention (referred to as pre-exposure prophylaxis-'PrEP'). The trials were implemented at several international sites, but many officially closed down before they completed. At most sites, both scientists and community AIDS advocates raised concerns over the ethics and scientific rationales of the trial. Focusing on the Nigerian trial site, we detail the controversy that emerged among mostly Nigerian research scientists who scrutinized the research design and protocol...
September 10, 2018: Bioethics
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