4,869 results match your criteria Journal of Medical Ethics [Journal]


What are considered 'good facts'?

J Med Ethics 2019 Feb 18. Epub 2019 Feb 18.

Department of Bioethics & Humanities, University of Washington, Seattle, Washington, USA.

In the January edition of the , Fujita and Tabuchi (hereafter, Authors) responded that we misunderstood the 'facts' in our previous article. Our article's method was twofold. First, it appealed to normative analysis and publicly accessible materials, and second, it targeted a policy-making approach to public funding. Read More

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http://dx.doi.org/10.1136/medethics-2018-105333DOI Listing
February 2019

Ethics of Incongruity: moral tension generators in clinical medicine.

Authors:
Nicholas Kontos

J Med Ethics 2019 Feb 18. Epub 2019 Feb 18.

Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.

Affectively uncomfortable concern, anxiety, indecisionand disputation over 'right' action are among the expressions of moral tension associated with ethical dilemmas. Moral tension is generated and experienced by people. While ethical principles, rules and situations must be worked through in any dilemma, each occurs against a backdrop of people who enact them and stand much to gain or lose depending on how they are applied and resolved. Read More

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http://dx.doi.org/10.1136/medethics-2018-105161DOI Listing
February 2019

Does One Health require a novel ethical framework?

J Med Ethics 2019 Feb 16. Epub 2019 Feb 16.

Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, Wollongong, New South Wales, Australia.

Emerging infectious diseases (EIDs) remain a significant and dynamic threat to the health of individuals and the well-being of communities across the globe. Over the last decade, in response to these threats, increasing scientific consensus has mobilised in support of a One Health (OH) approach so that OH is now widely regarded as the most effective way of addressing EID outbreaks and risks. Given the scientific focus on OH, there is growing interest in the philosophical and ethical dimensions of this approach, and a nascent OH literature is developing in the humanities. Read More

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http://dx.doi.org/10.1136/medethics-2018-105043DOI Listing
February 2019

Meeting the Epicurean challenge: a reply to Christensen.

J Med Ethics 2019 Feb 16. Epub 2019 Feb 16.

Allied Health Sciences, London South Bank University School of Health and Social Care, London, UK.

In 'Abortion and deprivation: a reply to Marquis', Anna Christensen contends that Don Marquis' influential 'future like ours' argument for the immorality of abortion faces a significant challenge from the Epicurean claim that human beings cannot be harmed by their death. If deprivation requires a subject, then abortion cannot deprive a fetus of a future of value, as no individual exists to be deprived once death has occurred. However, the Epicurean account also implies that the wrongness of murder is also not grounded in the badness of death, which is strongly counterintuitive. Read More

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http://dx.doi.org/10.1136/medethics-2018-105267DOI Listing
February 2019

It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness.

Authors:
Charles Foster

J Med Ethics 2019 Feb 14. Epub 2019 Feb 14.

Faculty of Law, University of Oxford, Oxford, UK.

In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. Read More

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http://dx.doi.org/10.1136/medethics-2018-105250DOI Listing
February 2019
1 Read

Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it?

J Med Ethics 2019 Feb 11. Epub 2019 Feb 11.

Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.

In vitro fertilisation (IVF) 'add-ons' are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Read More

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http://dx.doi.org/10.1136/medethics-2018-104983DOI Listing
February 2019

In response to an argument against penile transplantation.

J Med Ethics 2019 Feb 8. Epub 2019 Feb 8.

Division of Urology, Faculty of Medicine and Healthcare Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.

Moodley and Rennie's paper arguing against penile transplantation stated out of context arguments and wrongly quoted statements. The cost of penile transplantation is much less than portrayed. The burden of cases is much less than is communicated. Read More

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http://dx.doi.org/10.1136/medethics-2018-104795DOI Listing
February 2019

Ethics briefing.

J Med Ethics 2019 Feb;45(2):147-148

Medical Ethics, British Medical Association, London, UK.

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http://dx.doi.org/10.1136/medethics-2019-105350DOI Listing
February 2019

'Mrs A': a controversial or extreme case?

Authors:
Jesse Wall

J Med Ethics 2019 Feb;45(2):77-78

Faculty of Law, University of Otago, Dunedin, New Zealand.

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http://dx.doi.org/10.1136/medethics-2019-105351DOI Listing
February 2019

'Is it better not to know certain things?': views of women who have undergone non-invasive prenatal testing on its possible future applications.

J Med Ethics 2019 Jan 24. Epub 2019 Jan 24.

Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Non-invasive prenatal testing (NIPT) is at the forefront of prenatal screening. Current uses for NIPT include fetal sex determination and screening for chromosomal disorders such as trisomy 21 (Down syndrome). However, NIPT may be expanded to many different future applications. Read More

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http://dx.doi.org/10.1136/medethics-2018-105167DOI Listing
January 2019

Moral reasons to edit the human genome: picking up from the Nuffield report.

J Med Ethics 2019 Jan 24. Epub 2019 Jan 24.

Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

In July 2018, the Nuffield Council of Bioethics released its long-awaited report on heritable genome editing (HGE). The Nuffield report was notable for finding that HGE could be morally permissible, even in cases of human enhancement. In this paper, we summarise the findings of the Nuffield Council report, critically examine the guiding principles they endorse and suggest ways in which the guiding principles could be strengthened. Read More

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http://dx.doi.org/10.1136/medethics-2018-105084DOI Listing
January 2019

Internal morality of medicine and physician autonomy.

Authors:
Stephen McAndrew

J Med Ethics 2019 Jan 21. Epub 2019 Jan 21.

Department of Philosophy, University at Buffalo, The State University of New York, Buffalo, New York, USA.

Robert Veatch and others have questioned whether there are internal moral rules of medicine. This paper examines the legal regulatory model for governing professions as the autonomous exercise of professional skills and asks whether there is a theoretical basis for this model. Taking John Rawls's distinction between the justification of a practice and justification of the rules internal to the practice, this paper argues that the autonomous exercise of professional skills is justified so long as it benefits society. Read More

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http://dx.doi.org/10.1136/medethics-2018-105069DOI Listing
January 2019
1 Read

A rebuttal to Akabayashi and colleagues' criticisms of the iPSC stock project.

J Med Ethics 2019 Jan 11. Epub 2019 Jan 11.

Medical Applications Promoting Office, Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan.

In the October edition of the , 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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105248DOI Listing
January 2019

No going back? Reversibility and why it matters for deep brain stimulation.

Authors:
Jonathan Pugh

J Med Ethics 2019 Jan 10. Epub 2019 Jan 10.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105139DOI Listing
January 2019

Blameworthy bumping? Investigating nudge's neglected cousin.

J Med Ethics 2019 Jan 10. Epub 2019 Jan 10.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105179DOI Listing
January 2019

Ethical complexities in assessing patients' insight.

J Med Ethics 2019 Jan 10. Epub 2019 Jan 10.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105109DOI Listing
January 2019
7 Reads

In response to Ballantyne and Schaefer's 'Consent and the ethical duty to participate in health data research'.

J Med Ethics 2019 Jan 7. Epub 2019 Jan 7.

Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105271DOI Listing
January 2019

The Market View on conscientious objection: overvalued.

Authors:
Robert F Card

J Med Ethics 2019 Jan 7. Epub 2019 Jan 7.

Department of Philosophy, State University of New York, Oswego, New York, USA.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105173DOI Listing
January 2019

Authority without identity: defending advance directives via posthumous rights over one's body.

Authors:
Govind Persad

J Med Ethics 2018 Dec 22. Epub 2018 Dec 22.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-104971DOI Listing
December 2018

What (or sometimes who) are organoids? And whose are they?

Authors:
Andrea Lavazza

J Med Ethics 2019 Feb 22;45(2):144-145. Epub 2018 Dec 22.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105268DOI Listing
February 2019

Drs Bramhall and Bawa-Garba and the rightful domain of the criminal law.

Authors:
Suzanne Ost

J Med Ethics 2018 Dec 22. Epub 2018 Dec 22.

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. Dr Bawa-Garba misdiagnosed and failed to properly assess a 6-year-old boy with pneumonia and sepsis under her care, who subsequently died. Read More

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http://dx.doi.org/10.1136/medethics-2018-105135DOI Listing
December 2018

Grounded ethical analysis.

Authors:
John McMillan

J Med Ethics 2019 Jan;45(1):1-2

Bioethics centre, University of Otago, Dunedin, New Zealand.

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http://dx.doi.org/10.1136/medethics-2018-105272DOI Listing
January 2019

Temporising and respect for patient self-determination.

J Med Ethics 2018 Dec 10. Epub 2018 Dec 10.

Departement of Clinical Sciences, Lund, Medical Ethics, Lunds Universitet, Lund, Sweden.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-104851DOI Listing
December 2018

Ethical problems with ethnic matching in gamete donation.

Authors:
Hane Htut Maung

J Med Ethics 2019 Feb 8;45(2):112-116. Epub 2018 Dec 8.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-104894DOI Listing
February 2019
10 Reads

Current appeal system for those detained in England and Wales under the Mental Health Act needs reform.

J Med Ethics 2018 Dec 4. Epub 2018 Dec 4.

Institute of Medical and Biomedical Education, St George's University of London, London, UK.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-104947
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http://dx.doi.org/10.1136/medethics-2018-104947DOI Listing
December 2018
2 Reads

Computer knows best? The need for value-flexibility in medical AI.

J Med Ethics 2018 Nov 22. Epub 2018 Nov 22.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105118DOI Listing
November 2018
22 Reads

Bawa-Garba ruling is not good news for doctors.

Authors:
Nathan Hodson

J Med Ethics 2019 Jan 22;45(1):15-16. Epub 2018 Nov 22.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-105247
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http://dx.doi.org/10.1136/medethics-2018-105247DOI Listing
January 2019
1 Read

Situating requests for medical aid in dying within the broader context of end-of-life care: ethical considerations.

J Med Ethics 2019 Feb 22;45(2):106-111. Epub 2018 Nov 22.

Centre for Applied Ethics, McGill University Health Centre, Montreal, Quebec, Canada.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-104982DOI Listing
February 2019

The importance of ethical expertise.

Authors:
John R McMillan

J Med Ethics 2018 Dec;44(12):799-800

Bioethics centre, University of Otago, Dunedin 9054, New Zealand.

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http://dx.doi.org/10.1136/medethics-2018-105237DOI Listing
December 2018

Should clinicians boycott Australian immigration detention?

Authors:
Ryan Essex

J Med Ethics 2019 Feb 21;45(2):79-83. Epub 2018 Nov 21.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105153DOI Listing
February 2019
8 Reads

Drawing the line on physician-assisted death.

J Med Ethics 2018 Nov 21. Epub 2018 Nov 21.

Weill Cornell Medical College, New York City, New York, USA.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105003DOI Listing
November 2018
5 Reads

'Yes' to mitochondrial replacement techniques and lesbian motherhood: a reply to Françoise Baylis.

J Med Ethics 2018 Nov 21. Epub 2018 Nov 21.

Department of Global Health and Social Medicine, King's College London, London, UK.

In a recent paper - - 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 -- 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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105060DOI Listing
November 2018
7 Reads

Pink and blue: the role of gender in psychiatric diagnosis.

Authors:
George Gillett

J Med Ethics 2018 Nov 14. Epub 2018 Nov 14.

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. The paper assesses the relative merits and significance of each, before turning its attention to the nature of gender and its relevance to psychiatry. The paper introduces a framework to approach gender-based diagnostic bias and concludes by drawing a distinction between qualitative and quantitative standardisation, arguing that gender standardisation of psychiatric diagnoses is ethically justified in the former but not the latter. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-105042
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http://dx.doi.org/10.1136/medethics-2018-105042DOI Listing
November 2018
7 Reads

Abortion and deprivation: a reply to Marquis.

Authors:
Anna Christensen

J Med Ethics 2019 Jan 14;45(1):22-25. Epub 2018 Nov 14.

In '', Don Marquis argues that abortion is wrong for the same reason that murder is wrong, namely, that it deprives a human being of an FLO, a 'future like ours,' which is a future full of value and the experience of life. Marquis' argument rests on the assumption that the human being is somehow deprived by suffering an early death. I argue that Marquis' argument faces the 'Epicurean Challenge'. Read More

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http://dx.doi.org/10.1136/medethics-2018-105045DOI Listing
January 2019

Taking the blame: appropriate responses to medical error.

Authors:
Daniel W Tigard

J Med Ethics 2019 Feb 9;45(2):101-105. Epub 2018 Nov 9.

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. Read More

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http://dx.doi.org/10.1136/medethics-2017-104687DOI Listing
February 2019

Commentary on Charles Foster's 'The rebirth of medical paternalism: an NHS Trust v Y'.

Authors:
Derick T Wade

J Med Ethics 2019 Jan 31;45(1):8-9. Epub 2018 Oct 31.

OxINMAHR, Oxford Brookes University Faculty of Health and Life Sciences, Oxford, UK.

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http://dx.doi.org/10.1136/medethics-2018-105200DOI Listing
January 2019
1 Read

Of dilemmas and tensions: a qualitative study of palliative care physicians' positions regarding voluntary active euthanasia in Quebec, Canada.

J Med Ethics 2019 Jan 30;45(1):48-53. Epub 2018 Oct 30.

Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.

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. Read More

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http://dx.doi.org/10.1136/medethics-2017-104339DOI Listing
January 2019
1 Read

Obesity, equity and choice.

J Med Ethics 2018 Oct 30. Epub 2018 Oct 30.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-104848DOI Listing
October 2018
5 Reads

Organoids as hybrids: ethical implications for the exchange of human tissues.

J Med Ethics 2019 Feb 26;45(2):131-139. Epub 2018 Oct 26.

Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-104846
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http://dx.doi.org/10.1136/medethics-2018-104846DOI Listing
February 2019
19 Reads

Too much medicine: not enough trust?

J Med Ethics 2019 Jan 26;45(1):31-35. Epub 2018 Oct 26.

Faculty of Philosophy, University of Cambridge, Cambridge, UK.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-104866
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http://dx.doi.org/10.1136/medethics-2018-104866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327867PMC
January 2019
10 Reads

Different ways to argue about medical ethics.

Authors:
John R McMillan

J Med Ethics 2018 Nov;44(11):727-728

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http://dx.doi.org/10.1136/medethics-2018-105180DOI Listing
November 2018

Nudging in the clinic: the ethical implications of differences in doctors' and patients' point of view.

J Med Ethics 2018 Oct 25. Epub 2018 Oct 25.

Department of Philosophy and the PEP Program, The Hebrew University of Jerusalem, Jerusalem, Israel.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-104978DOI Listing
October 2018

Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation.

J Med Ethics 2019 Feb 23;45(2):125-130. Epub 2018 Oct 23.

Department of Philosophy, University of New South Wales, Sydney, New South Wales, Australia.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105074DOI Listing
February 2019

Who are 'we' to speak of benefits and harms? And to whom do we speak? A (sympathetic) response to Woollard on breast feeding and language.

Authors:
Ben Saunders

J Med Ethics 2018 Oct 20. Epub 2018 Oct 20.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105122DOI Listing
October 2018

National Standards for Public Involvement in Research: missing the forest for the trees.

J Med Ethics 2018 Dec 18;44(12):801-804. Epub 2018 Oct 18.

Nuffield Department of Population Health, The Ethox Centre, University of Oxford, Oxford, UK.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-105088
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http://dx.doi.org/10.1136/medethics-2018-105088DOI Listing
December 2018
12 Reads

Contributory injustice in psychiatry.

J Med Ethics 2019 Feb 18;45(2):97-100. Epub 2018 Oct 18.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-104761
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http://dx.doi.org/10.1136/medethics-2018-104761DOI Listing
February 2019
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The rebirth of medical paternalism: An NHS Trust v Y.

Authors:
Charles Foster

J Med Ethics 2019 Jan 9;45(1):3-7. Epub 2018 Oct 9.

Faculty of Law, University of Oxford, Oxford OX1 3UL, UK.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105098DOI Listing
January 2019

Reproductive outsourcing: an empirical ethics account of cross-border reproductive care in Canada.

J Med Ethics 2019 Jan 9;45(1):41-47. Epub 2018 Oct 9.

Laboratory of Transdisciplinary Research in Genetics, Systems of Medicine and Social Sciences, Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2017-104515
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http://dx.doi.org/10.1136/medethics-2017-104515DOI Listing
January 2019
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The biobank consent debate: Why 'meta-consent' is not the solution?

Authors:
Neil C Manson

J Med Ethics 2018 Oct 1. Epub 2018 Oct 1.

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. Read More

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http://dx.doi.org/10.1136/medethics-2018-105007DOI Listing
October 2018
8 Reads

Towards a palliative care approach in psychiatry: do we need a new definition?

J Med Ethics 2019 Jan 28;45(1):26-30. Epub 2018 Sep 28.

Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.

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. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-104944
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http://dx.doi.org/10.1136/medethics-2018-104944DOI Listing
January 2019
13 Reads