4,891 results match your criteria Journal of Medical Ethics [Journal]


Ethics of crisis sedation: questions of performance and consent.

J Med Ethics 2019 Apr 20. Epub 2019 Apr 20.

Institute of Ethics, Dublin City University, Dublin, Ireland.

This paper focuses on the practice of injecting patients who are dying with a relatively high dose of sedatives in response to a catastrophic event that will shortly precipitate death, something that we term 'crisis sedation.' We first present a confabulated case that illustrates the kind of events we have in mind, before offering a more detailed account of the practice. We then comment on some of the ethical issues that crisis sedation might raise. Read More

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http://dx.doi.org/10.1136/medethics-2018-105285DOI Listing

Gatekeeping hormone replacement therapy for transgender patients is dehumanising.

Authors:
Florence Ashley

J Med Ethics 2019 Apr 15. Epub 2019 Apr 15.

Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical care. Physicians should abandon this unethical requirement in favour of an informed consent approach to transgender care. Read More

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http://dx.doi.org/10.1136/medethics-2018-105293DOI Listing
April 2019
1 Read

Correction: .

Authors:

J Med Ethics 2019 04;45(4):284

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http://dx.doi.org/10.1136/medethics-2018-105135corr1DOI Listing

Ethics briefing.

J Med Ethics 2019 Apr;45(4):282-283

Department of Medical Ethics, British Medical Association, London, UK.

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http://dx.doi.org/10.1136/medethics-2019-105438DOI Listing

The Concise Argument.

Authors:
Lucy Frith

J Med Ethics 2019 Apr;45(4):217-218

Health Services Research, University of Liverpool, Liverpool, UK.

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http://dx.doi.org/10.1136/medethics-2019-105439DOI Listing

The need for feasible compromises on conscientious objection: response to Card.

J Med Ethics 2019 Mar 14. Epub 2019 Mar 14.

Department of Philosophy, Duke University, Durham, North Carolina, USA.

Robert Card criticises our proposal for managing some conscientious objections in medicine. Unfortunately, he severely mischaracterises the nature of our proposal, its scope and its implications. He also overlooks the fact that our proposal is a compromise designed for a particular political context. Read More

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http://dx.doi.org/10.1136/medethics-2019-105425DOI Listing

The biobank consent debate: why 'meta-consent' is still the solution!

J Med Ethics 2019 Mar 14. Epub 2019 Mar 14.

Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK.

In a recent article in the Neil Manson sets out to show that the meta-consent model of informed consent is not the solution to perennial debate on the ethics of biobank participation. In this response, we shall argue that (i) Manson's considerations on the costs of a meta-consent model are incomplete and therefore misleading; (ii) his view that a model of broad consent passes a threshold of moral acceptability rests on an analogy that misconstrues how biobank research is actually conducted and (iii) a model of meta-consent is more in tune with the nature of biobank research and enables autonomous choice. Read More

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http://dx.doi.org/10.1136/medethics-2018-105258DOI Listing

Moral case for legal age change.

Authors:
Joona Räsänen

J Med Ethics 2019 Mar 14. Epub 2019 Mar 14.

Department of Philosophy, Classics, History of Art and Ideas, University of Oslo, Oslo, Norway.

Should a person who feels his legal age does not correspond with his experienced age be allowed to change his legal age? In this paper, I argue that in some cases people should be allowed to change their legal age. Such cases would be when: (1) the person genuinely feels his age differs significantly from his chronological age and (2) the person's biological age is recognised to be significantly different from his chronological age and (3) age change would likely prevent, stop or reduce ageism, discrimination due to age, he would otherwise face. I also consider some objections against the view that people should be allowed to change their legal age and find them lacking. Read More

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http://dx.doi.org/10.1136/medethics-2018-105294DOI Listing

Canadian neurosurgeons' views on medical assistance in dying (MAID): a cross-sectional survey of Canadian Neurosurgical Society (CNSS) members.

J Med Ethics 2019 Mar 12. Epub 2019 Mar 12.

Division of Neurosurgery, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada.

Background: The Supreme Court of Canada removed the prohibition on physicians assisting in patients dying on 6 February 2015. Bill C-14, legalising medical assistance in dying (MAID) in Canada, was subsequently passed by the House of Commons and the Senate on 17 June 2016. As this remains a divisive issue for physicians, the Canadian Neurosurgical Society (CNSS) has recently published a position statement on MAID. Read More

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http://dx.doi.org/10.1136/medethics-2018-105160DOI Listing
March 2019
4 Reads

Taxonomy of justifications for consent waivers: When and why are public views relevant?

J Med Ethics 2019 Mar 12. Epub 2019 Mar 12.

Centre For Biomedical Ethics, National University of Singapore, Singapore, Singapore.

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2018-105318
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http://dx.doi.org/10.1136/medethics-2018-105318DOI Listing
March 2019
4 Reads

The moral argument for heritable genome editing requires an inappropriately deterministic view of genetics.

J Med Ethics 2019 Mar 12. Epub 2019 Mar 12.

Department of Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK.

Gyngell and colleagues consider that the recent Nuffield Council report does not go far enough: heritable genome editing (HGE) is not just justifiable in a few rare cases; instead, there is a moral imperative to undertake it. We agree that there is a moral argument for this, but in the real world it is mitigated by the fact that it is not usually possible to ensure a better life. We suggest that a moral imperative for HGE can currently only be concluded if one first buys into an overly deterministic view of a genome sequence, and the role of variation within in it, in the aetiology of the disease: most diseases cannot simply be attributed to specific genetic variants that we could edit away. Read More

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http://jme.bmj.com/lookup/doi/10.1136/medethics-2019-105390
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http://dx.doi.org/10.1136/medethics-2019-105390DOI Listing
March 2019
6 Reads

Smoking and hospitalisation: harnessing medical ethics and harm reduction.

J Med Ethics 2019 Mar 7. Epub 2019 Mar 7.

Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.

As resident physicians practicing Internal Medicine in hospitals within the USA, we are confronted on a daily basis with patients who wish to leave the hospital floor to smoke a cigarette. While many physicians argue that hospitals should do everything in their power to prevent patients from smoking, we argue that a more comprehensive and nuanced approach is needed. In part 1 of this perspective piece, we outline the various forms of smoking bans in hospital settings, applauding the development of indoor smoking bans while questioning the move towards stricter, campus-wide smoking bans. Read More

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http://dx.doi.org/10.1136/medethics-2018-105065DOI Listing

Differential payment to research participants in the same study: an ethical analysis.

J Med Ethics 2019 Mar 7. Epub 2019 Mar 7.

Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.

Recognising that offers of payment to research participants can serve various purposes-reimbursement, compensation and incentive-helps uncover differences between participants, which can justify differential payment of participants within the same study. Participants with different study-related expenses will need different amounts of reimbursement to be restored to their preparticipation financial baseline. Differential compensation can be acceptable when some research participants commit more time or assume greater burdens than others, or if inter-site differences affect the value of compensation. Read More

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http://dx.doi.org/10.1136/medethics-2018-105140DOI Listing

We don't need unilateral DNRs: taking informed non-dissent one step further.

J Med Ethics 2019 Mar 6. Epub 2019 Mar 6.

Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA.

Although shared decision-making is a standard in medical care, unilateral decisions through process-based conflict resolution policies have been defended in certain cases. In patients who do not stand to receive proportional clinical benefits, the harms involved in interventions such as cardiopulmonary resuscitation seem to run contrary to the principle of non-maleficence, and provision of such interventions may cause clinicians significant moral distress. However, because the application of these policies involves taking choices out of the domain of shared decision-making, they face important ethical and legal problems, including a recent challenge to their constitutionality. Read More

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http://dx.doi.org/10.1136/medethics-2018-105305DOI Listing
March 2019
1 Read

Is it just semantics? Medical students and their 'first patients'.

Authors:
Natalie Cohen

J Med Ethics 2019 Mar 2. Epub 2019 Mar 2.

Medical School, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.

There have been multiple factors involved in the decline of the anatomy course's central role in medical education over the last century. The course has undergone a multitude of changes, in large part due to the rise in technology and cultural shifts away from physical dissection. This paper argues that, as the desire of medical schools to introduce clinical experiences earlier in the curriculum increased, anatomy courses began implementing changes that would align themselves with the shifting culture towards incorporating humanistic values early on in the medical curriculum. Read More

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http://dx.doi.org/10.1136/medethics-2017-104306DOI Listing

Should the deceased be listed as authors?

J Med Ethics 2019 Mar 1. Epub 2019 Mar 1.

Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden.

Sometimes participants in research collaboration die before the paper is accepted for publication. The question we raise in this paper is how authorship should be handled in such situations. First, the outcome of a literature survey is presented. Read More

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http://dx.doi.org/10.1136/medethics-2018-105304DOI Listing
March 2019
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Goldilocks and the two principles. A response to Gyngell .

Authors:
Peter Mills

J Med Ethics 2019 Feb 28. Epub 2019 Feb 28.

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http://dx.doi.org/10.1136/medethics-2019-105395DOI Listing
February 2019

Informed consent for functional MRI research on comatose patients following severe brain injury: balancing the social benefits of research against patient autonomy.

J Med Ethics 2019 Feb 25. Epub 2019 Feb 25.

Brain and Mind Institute, Western University, London, Ontario, Canada.

Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. Read More

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http://dx.doi.org/10.1136/medethics-2018-104867DOI Listing
February 2019

Uterus transplantation in women who are genetically XY.

J Med Ethics 2019 Feb 25. Epub 2019 Feb 25.

Department of Obstetrics and Gynecology, New York University School of Medicine, New York City, New York, USA.

Uterus transplantation is an emerging technology adding to the arsenal of treatments for infertility; specifically the only available treatment for uterine factor infertility. Ethical investigations concerning risks to uteri donors and transplant recipients have been discussed in the literature. However, missing from the discourse is the potential of uterus transplantation in other groups of genetically XY women who experience uterine factor infertility. Read More

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http://dx.doi.org/10.1136/medethics-2018-105222DOI Listing
February 2019
1 Read

At the moral margins of the doctor-patient relationship.

Authors:
Michael Dunn

J Med Ethics 2019 Mar;45(3):149-150

The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

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http://dx.doi.org/10.1136/medethics-2019-105407DOI Listing

The Two tragedies argument.

Authors:
William Simkulet

J Med Ethics 2019 Feb 22. Epub 2019 Feb 22.

Department of Philosophy and Religion, Central Michigan University, Mt. Pleasant, MI, USA.

Opposition to induced abortion rests on the belief that fetuses have a moral status comparable to beings like us, and that the loss of such a life is tragic. Antiabortion, or pro-life, theorists argue that (1) it is wrong to induce abortion and (2) it is wrong to allow others to perform induced abortion. However, evidence suggests that spontaneous abortion kills far more fetuses than induced abortion, and critics argue that most pro-life theorists neglect the threat of spontaneous abortion and ought to do more to prevent it. Read More

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http://dx.doi.org/10.1136/medethics-2018-105145DOI Listing
February 2019
1 Read

'I just need an opiate refill to get me through the weekend'.

J Med Ethics 2019 Apr 22;45(4):219-224. Epub 2019 Feb 22.

Pediatric Hematology-Oncology, University of California, San Diego, California, USA.

In this article, we discuss the ethical dimensions for the prescribing behaviours of opioids for a chronic pain patient, a scenario commonly witnessed by many physicians. The opioid epidemic in the USA and Canada is well known, existing since the late 1990s, and individuals are suffering and dying as a result of the easy availability of prescription opioids. More recently, this problem has been seen outside of North America affecting individuals at similar rates in Australia and Europe. Read More

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http://dx.doi.org/10.1136/medethics-2018-105099DOI Listing
April 2019
4 Reads

Equity and preventive regulations.

Authors:
Elizabeth Fenton

J Med Ethics 2019 Feb 22. Epub 2019 Feb 22.

In 'Obesity, equity and choice' ( 2018;0:1-7. doi:10.1136/medethics-2018-104848), Timothy Wilkinson argues that preventive regulations to address obesity, such as taxes on sugary drinks, are at worst inequitable and at best fail to increase or improve equity. Read More

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http://dx.doi.org/10.1136/medethics-2019-105352DOI Listing
February 2019
1 Read

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 Apr 18;45(4):244-248. 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

Does One Health require a novel ethical framework?

J Med Ethics 2019 Apr 16;45(4):239-243. 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

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 Apr 14;45(4):265-270. 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
April 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 Apr 24;45(4):231-238. 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

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 Mar 21;45(3):198-203. 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
March 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
1 Read

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

Authors:
Jonathan Pugh

J Med Ethics 2019 Apr 10;45(4):225-230. 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
April 2019
1 Read

Blameworthy bumping? Investigating nudge's neglected cousin.

J Med Ethics 2019 Apr 10;45(4):257-264. 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
April 2019
1 Read

Ethical complexities in assessing patients' insight.

J Med Ethics 2019 Mar 10;45(3):178-182. 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
March 2019
14 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
1 Read

The Market View on conscientious objection: overvalued.

Authors:
Robert F Card

J Med Ethics 2019 Mar 7;45(3):168-172. 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
March 2019
1 Read

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

Authors:
Govind Persad

J Med Ethics 2019 Apr 22;45(4):249-256. 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
April 2019
1 Read

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
1 Read

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

Authors:
Suzanne Ost

J Med Ethics 2019 Mar 22;45(3):151-155. 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
March 2019
1 Read

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
1 Read

Temporising and respect for patient self-determination.

J Med Ethics 2019 Mar 10;45(3):161-167. 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
March 2019
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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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388904PMC
February 2019
16 Reads

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

J Med Ethics 2019 Mar 4;45(3):173-177. 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
March 2019
3 Reads

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

J Med Ethics 2019 Mar 22;45(3):156-160. 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
March 2019
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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
2 Reads