Ethics briefing
UK: Migration, health and human rights At the time of writing, the UK Government’s ‘Illegal Migration Bill’1 had started progressing through the House of Commons. The Bill will enable the removal of people who have come to the UK seeking asylum by ‘illegal’ routes, including via the dangerous Channel crossing in small boats.2 That duty would apply whether a person makes a protection claim, human rights claim or is a victim of modern slavery or human trafficking. Asylum seekers risk crossing the Channel because there are very few, if any, safe and lawful ways to reach the UK. At least 60% of th...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Mussell, R., Brannan, S., English, V., Harrison, C. A., Sheather, J. C. Tags: Ethics briefing Source Type: research
Chronicity: a key concept to deliver ethically driven chronic care
Chronic diseases are the main disease burden worldwide, leading to premature deaths and poor individual and population health outcomes. Although modern medicine has made significant progress in developing effective treatments, only around 50% of people follow long-term treatment recommendations in high-income countries and presumably even less in low-income and middle-income countries.1 Health outcomes for chronic diseases follow a social gradient across socioeconomic groups, suggesting that the 50% adherence rate distributes unequally across social groups, affecting those who live in disadvantage the most despite universa...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Stutzin Donoso, F. Tags: Words Source Type: research
Ethical theories as multiple models
Hardman and Hutchinson claim that ethics is ‘grounded in particular, everyday concerns’. According to them, an implication of this is that ethics courses for (future) clinicians should de-emphasise teaching the theories and principles of philosophical ethics and focus instead on pedagogical activities more closely related to everyday concerns, for example, exposure to real patient accounts. I respond that, even if ethics is an ‘everyday’ phenomenon, learning philosophical ethics may be of significant practical benefit to clinicians. I argue that the theories of philosophical ethics can reasonably be...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Wagner, I. A. Tags: Response Source Type: research
Reasoning and reversibility in capacity law
A key objective of the law in the assessment of decision-making capacity in clinical settings is to allow clinicians and judges to avoid making value judgements about the reasons that patients use to refuse treatment. This paper advances two lines of argument in respect of this objective. The first is that authorities cannot rationally avoid significant evaluative judgements in the assessment of a patient’s own assessment of the facts of their case. Assessing reasoning is unavoidably value-laden. Yet the underlying motivation behind clinicians’ and the law’s value-neutral aims, ie, the avoidance of undue ...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Hass, B. Tags: Original research Source Type: research
Proposal to support making decisions about the organ donation process
In this paper, we propose a novel approach to permit members of the public opportunity to record more nuanced wishes in relation to organ donation. Recent developments in organ donation and procurement have made the associated processes potentially more multistaged and complex than ever. At the same time, opt-out legislation has led to a more simplistic recording of wishes than ever. We argue that in order to be confident that a patient would really wish to go ahead with the various interventions and procedures that now accompany organ donation, more nuanced information than a simple ‘yes’ or ‘no’ m...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Moorlock, G., Draper, H. Tags: Original research Source Type: research
Reimagining research ethics to include environmental sustainability: a principled approach, including a case study of data-driven health research
In this paper we argue the need to reimagine research ethics frameworks to include notions of environmental sustainability. While there have long been calls for healthcare ethics frameworks and decision-making to include aspects of sustainability, less attention has focused on how research ethics frameworks could address this. To do this, we first describe the traditional approach to research ethics, which often relies on individualised notions of risk. We argue that we need to broaden this notion of individual risk to consider issues associated with environmental sustainability. This is because research is associated with...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Samuel, G., Richie, C. Tags: Open access Original research Source Type: research
Making psychiatry moral again: the role of psychiatry in patient moral development
Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should aim to do so. Our goal is to offer a practical and ethical path through th...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: McConnell, D., Broome, M., Savulescu, J. Tags: Open access Original research Source Type: research
Regulating abortion after ectogestation
A few decades from now, it might become possible to gestate fetuses in artificial wombs. Ectogestation as this is called, raises major legal and ethical issues, especially for abortion rights. In countries allowing abortion, regulation often revolves around the viability threshold—the point in fetal development after which the fetus can survive outside the womb. How should viability be understood—and abortion thus regulated—after ectogestation? Should we ban, allow or require the use of artificial wombs as an alternative to standard abortions? Drawing on Cohen, I evaluate three possible positions for the ...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Räsänen, J. Tags: Original research Source Type: research
Implications of identity-relative paternalism
I am grateful to the commentators for their thoughtful engagement with my paper.1 I am unable in this short response to reply to all of the important questions raised. Instead, I will focus on the practical application of identity-relative paternalism. Some commentators felt that this novel concept would yield implausible implications,2 others that it would have no impact because of uncertainty,3 or because existing ethical principles would yield the same conclusion.4 In the paper, I proposed the following principle: Identity-relative paternalistic intervention: Individuals should be prevented from doing to future selves (...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Wilkinson, D. Tags: Commentary Source Type: research
On Wilkinson: unpacking Parfit, paternalism and the primacy of autonomy in contemporary bioethics
In his essay on paternalism and personal identity, Wilkinson draws on Derek Parfit’s Reasons and Persons (1984) to call for a reappraisal of the role of paternalism in healthcare decision-making in situations in which patients with capacity make decisions which are likely to have harmful consequences for themselves.1 The imperative to respect autonomy, coupled with JS Mill’s insistence that the state is justified in interfering with an individual’s liberty only in situations in which she harms or threatens to harm another person, leaves clinicians with little room to constrain decisions in which a patient...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Sheahan, L., Campbell, L. Tags: Commentary Source Type: research
Identity-relative paternalism fails to achieve its apparent goal
In a recent article, Wilkinson puts forward the notion of identity-relative paternalism. According to Wilkinson’s final formulation of this principle, ‘[i]ndividuals should be prevented from doing to future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others’.1 In medical ethics, it is usually assumed that hard paternalism, that is, acting against a competent person’s wishes for their own benefit, is not justified. According to Mill’s harm principle, we may only limit people’s fre...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Braun, E. Tags: Commentary Source Type: research
Identity-relative paternalism and allowing harm to others
Dominic Wilkinson’s defence of identity-relative paternalism raises many important issues that are well worth considering.1 In this short paper, I will argue that there could be two important differences between the first-party and third-party cases that Wilkinson discusses, namely, a difference in associative duties and how the decision relates to the decision maker’s own autonomous life. This could mean that identity-relative paternalism is impermissible in a greater number of cases than he suggests. Let us begin by examining a key part of Wilkinson’s argument. He writes that ‘even if these [third...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Birks, D. Tags: Commentary Source Type: research
Paternalism, with and without identity
Interference is paternalistic when it restricts an individual’s freedom for their own good. Anti-paternalists, such as John Stuart Mill, object to this for various reasons, including that the individual is usually a better judge of her own interests than the would-be paternalist. However, Wilkinson argues that a Parfitian reductivist approach to personal identity opens the door to what he calls ‘identity-relative paternalism’ where someone’s present action is restricted for the sake of a different future self.1 This is an interesting argument, but it is not clear whether it involves permissible pate...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Saunders, B. Tags: Commentary Source Type: research
Does identity-relative paternalism prohibit (future) self-sacrifice? A reply to Wilkinson
Introduction Paternalism has attracted new defenders in recent years. Such defenders typically either downplay the normative significance of autonomy or deny that we are sufficiently rational for paternalistic interventions to be objectionable.1 Both of these argumentative strategies constitute challenges to John Stuart Mill’s influential anti-paternalistic ‘harm principle’, which states that coercive interference with the liberty of competent adults is justifiable only if such interference prevents harm to non-consenting third parties (Mill, p. 23).2 In this journal, Wilkinson has provided a novel, provo...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Garstman, C., de Jong, S., Bernstein, J. Tags: Commentary Source Type: research
Identity-relative paternalism is internally incoherent
Identity-Relative Paternalism, as defended by Wilkinson, holds that paternalistic intervention is justified to prevent an individual from doing to their future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others.1 Wilkinson, drawing on the work of Parfit and others, defends the notion of Identity-Relative Paternalism from a series of objections. I argue here, however, that Wilkinson overlooks a significant problem for Identity-Relative Paternalism—namely, that it yields unactionable and self-contradictory resu...
Source: Journal of Medical Ethics - May 22, 2023 Category: Medical Ethics Authors: Schantz, E. G. Tags: Commentary Source Type: research
