Capacity assessment during labour and the role of opt-out consent
The authors of the feature article argue against implied consent in all episiotomy cases, but allow that opt-out consent might be appropriate in limited circumstances.1 However, they do not indicate how clinicians should assess whether the pregnant person is capable of consenting in this way during an obstetric emergency. This commentary will focus on how capacity should be determined during these circumstances, suggest next steps for clinicians if capacity is deemed uncertain or absent, and discuss the appropriate role for opt-out consent in labour. Previous studies investigating the extent to which pregnant persons retai...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Mumford, K. Tags: Commentary Source Type: research
Consent and the problem of epistemic injustice in obstetric care
An episiotomy is ‘an intrapartum procedure that involves an incision to enlarge the vaginal orifice,’1 and is primarily justified as a way to prevent higher degrees of perineal trauma or to facilitate a faster birth in cases of suspected fetal distress. Yet the effectiveness of episiotomies is controversial, and many professional bodies recommend against the routine use of episiotomies. In any case, unconsented episiotomies are alarmingly common, and some care providers in obstetric settings often fail to see consent as necessary in context. In their article, ‘The ethics of consent during labour and birth...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Lee, J. Y. Tags: Commentary Source Type: research
The ethics of consent during labour and birth: episiotomies
Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. We then discuss challenges and opportunities fo...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: van der Pijl, M., Verhoeven, C., Hollander, M., de Jonge, A., Kingma, E. Tags: Open access Feature article Source Type: research
We want to help: ethical challenges of medical migration and brain waste during a pandemic
Health worker shortages in many countries are reaching crisis levels, exacerbated by factors associated with the COVID-19 pandemic. In New Zealand, the medical specialists union has called for a health workforce emergency to be declared, yet at the same time, many foreign-trained healthcare workers are unable to stay in the country or unable to work. While their health systems differ, countries such as New Zealand, the USA and the UK at least partially rely on international medical graduates (IMGs) to ensure access to health services, particularly in underserved communities. This paper focuses on the challenges faced by ma...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Fenton, E., Chillag, K. Tags: Editor's choice Current controversy Source Type: research
Paediatric surgeons current knowledge and practices of obtaining assent from adolescents for elective reconstructive procedures
Conclusion
Paediatric surgeons largely acknowledge the importance of assent, but variably practice the principles of obtaining assent from adolescent patients undergoing elective reconstructive procedures. Fewer surgeons are explicitly aware of formal policy statements or received formal training. Additional surgeon education and institutional policies are warranted to maximise inclusion of adolescents in their medical care. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Lai, K., Rubalcava, N. S., Weidler, E. M., van Leeuwen, K. Tags: Clinical ethics Source Type: research
'How is it possible that at times we can be physicians and at times assistants in suicide? Attitudes and experiences of palliative care physicians in respect of the current legal situation of suicide assistance in Switzerland
Discussion and conclusion
These results could enrich national and international reflection on suicide assistance in the context of palliative care by reducing confusion between the two practices and strengthening the confidence of patients and their relatives. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Tomczyk, M., Andorno, R., Jox, R. J. Tags: Clinical ethics Source Type: research
Medical necessity and consent for intimate procedures
This issue considers the ethics of a healthcare provider intervening into a patient’s genitalia, whether by means of cutting or surgery or by ‘mere’ touching/examination. Authors argue that the permissibility of such actions in the absence of a relevant medical emergency does not primarily turn on third-party judgments of expected levels of physical harm versus benefit, or on related notions such as extensiveness or invasiveness; rather, it turns on the patient’s own consent. To bolster this argument, attention is drawn to the status of the genitals as ‘intimate’ anatomy—a status t...
Source: Journal of Medical Ethics - August 30, 2023 Category: Medical Ethics Authors: Earp, B. D., Bruce, L. Tags: Editorial Source Type: research
Analysis of the institutional landscape and proliferation of proposals for global vaccine equity for COVID-19: too many cooks or too many recipes?
This article outlines and compares current and proposed global institutional mechanisms to increase equitable access to COVID-19 vaccines, focusing on their institutional and operational complementarities and overlaps. It specifically considers the World Health Organization's (WHO’s) COVAX (COVID-19 Vaccines Global Access) model as part of the Access to COVID-19 Tools Accelerator (ACT-A) initiative, the WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS (Trade-Related Aspects of Intellectual Property Agreement) intellectual property waiver and other proposed WHO and World Trade Organiz...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Geiger, S., McMahon, A. Tags: COVID-19 Extended essay Source Type: research
Response to commentaries: 'autonomy-based criticisms of the patient preference predictor
The authors respond to four JME commentaries on their Feature Article, ‘Autonomy-based criticisms of the patient preference predictor’. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Wasserman, D., Wendler, D. Tags: Response Source Type: research
Evidence, ethics and the promise of artificial intelligence in psychiatry
Researchers are studying how artificial intelligence (AI) can be used to better detect, prognosticate and subgroup diseases. The idea that AI might advance medicine’s understanding of biological categories of psychiatric disorders, as well as provide better treatments, is appealing given the historical challenges with prediction, diagnosis and treatment in psychiatry. Given the power of AI to analyse vast amounts of information, some clinicians may feel obligated to align their clinical judgements with the outputs of the AI system. However, a potential epistemic privileging of AI in clinical judgements may lead to un...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: McCradden, M., Hui, K., Buchman, D. Z. Tags: Open access Original research Source Type: research
Human equality arguments against abortion
In this paper, I argue that a commitment to a very modest form of egalitarianism—equality between non-disabled human adults—implies fetal personhood. Since the most plausible bases for human value are in being human, or in a gradated property, and since the latter of which implies an inequality between non-disabled adult humans, I conclude that the most plausible basis for human equality is in being human—an attribute which fetuses have. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Miller, C. Tags: Original research Source Type: research
Dirty work: well-intentioned mental health workers cannot ameliorate harms in offshore detention
Professional providers of mental health services are motivated to help people, including, or especially, vulnerable people. We analyse the ethical implications of mental health providers accepting employment at detention centres that operate out of the normal regulatory structure of the modern state. Specifically, we examine tensions and moral harms experienced by providers at the Australian immigration detention centre on the island of Nauru. Australia has adopted indefinite offshore detention for asylum-seekers arriving by boat as part of a deterrence strategy that relies on making detainment conditions harsh. This has k...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Winters, J. P., Owens, F., Winters, E. Tags: Original research Source Type: research
Ethical problems with kindness in healthcare
Kindness and its kindred concepts, compassion and empathy, are strongly valued in healthcare. But at the same time, health systems all too often treat people unfairly and cause harm. Is it possible that kindness actually contributes to these unkind outcomes? Here, I argue that, despite its attractive qualities, kindness can pose and perpetuate systemic problems in healthcare. By being discretionary, it can interfere with justice and non-maleficence. It can be problematic for autonomy too. Using the principalist lens allows us to visualise kindness more clearly and to dissect out its key qualities. Ideally, kindness should ...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Jesudason, E. Tags: Editor's choice Original research Source Type: research
Externalist argument against medical assistance in dying for psychiatric illness
Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between the person and the external environment in the constitution ...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Maung, H. H. Tags: Open access Original research Source Type: research
Further remarks on testimonial injustice in medical machine learning: a response to commentaries
Introduction In my paper entitled ‘Testimonial injustice in medical machine learning’,1 I argued that machine learning (ML)-based Prediction Drug Monitoring Programmes (PDMPs) could infringe on patients’ epistemic and moral standing inflicting a testimonial injustice.2 I am very grateful for all the comments the paper received, some of which expand on it while others take a more critical view. This response addresses two objections raised to my consideration of ML-induced testimonial injustice in order to clarify the position taken in the paper. The first maintains that my critical stance toward ML-based ...
Source: Journal of Medical Ethics - July 24, 2023 Category: Medical Ethics Authors: Pozzi, G. Tags: Commentary Source Type: research
