Patient portal access for caregivers of adult and geriatric patients: reframing the ethics of digital patient communication
We present an ethical framework that guides policy and clinical workflow development for healthcare institutions to support the best use of patient portals. Caregivers are vital members of the care team and should be supported through novel forms of health information technology (IT). Patients, however, may not want all information to be shared with their proxies so healthcare institutions must support the development and use of separate proxy accounts as opposed to using the patient’s own account as well provide controls for limiting the scope of information displayed in the proxy accounts. Lastly, as socioeconomic ...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Ganta, T., Appel, J. M., Genes, N. Tags: Clinical ethics Source Type: research
Broadening the debate: the future of JME feature articles
The JME editorial team selects its feature articles from the best papers accepted for publication based on their quality, novelty and capacity to move debate forward on a specific issue. Feature articles are made freely available and are published alongside reviewed and submitted commentaries. We do this partly to promote and acknowledge excellent work in medical ethics, but also to encourage authors to submit their best papers to the JME. JME feature articles have deepened the analysis of some central issues for medical ethics. ‘Common morality’ is one way of underpinning general ethical principles and it is a...
Source: Journal of Medical Ethics - February 21, 2023 Category: Medical Ethics Authors: Frith, L., McMillan, J. Tags: Editorial Source Type: research
Ethics briefing
Health, ethics and COP27 On the 20 November 2022, the United Nations Climate Change COP27 announced a breakthrough agreement to provide ‘loss and damage’ funding for resource-poor countries seriously affected by climate change.1 The establishment of the funding stream acknowledges, and attempts to address, one of many thorny ethical issues driven by climate change – to what extent countries that have benefited economically from past emissions of greenhouse gases owe reparative obligations to countries who have contributed minimally to climate change but are most at risk of its harms? One of the many reaso...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Mussell, R., Brannan, S., English, V., Harrison, C. A., Sheather, J. C. Tags: Ethics briefing Source Type: research
Critical role of pathology and laboratory medicine in the conversation surrounding access to healthcare
Pathology and laboratory medicine are a key component of a patient’s healthcare. From academic care centres, community hospitals, to clinics across the country, pathology data are a crucial component of patient care. But for much of the modern era, pathology and laboratory medicine have been absent from health policy conversations. Though select members in the field have advocated for an enhanced presence of these specialists in policy conversations, little work has been done to thoroughly evaluate the moral and ethical obligations of the pathologist and the role they play in healthcare justice and access to care. In...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Lilley, C. M., Mirza, K. M. Tags: Student essay Source Type: research
Why the wrongness of intentionally impairing children in utero does not imply the wrongness of abortion
Perry Hendricks’ ‘impairment argument’, which he has defended in this journal, is intended to demonstrate that the generally conceded wrongness of giving a fetus fetal alcohol syndrome (FAS) shows that abortion must also be immoral, even if we allow that the fetus is not a rights-bearing moral person. The argument fails because the harm of causing FAS is extrinsic but Hendricks needs it to be intrinsic for it to show anything about abortion. Either the subject of the wrong of causing FAS is a person who does not exist in the case of abortion or the wrong is negligible. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Cushing, S. Tags: Response Source Type: research
My body, still my choice: an objection to Hendricks on abortion
In ‘My body, not my choice: against legalised abortion’, Hendricks offers an intriguing argument that suggests the state can coerce pregnant women into continuing to sustain their fetuses. His argument consists partly in countering Boonin’s defence of legalised abortion, followed by an argument from analogy. I argue in this response article that his argument from analogy fails and, correspondingly, it should still be a woman’s legal choice to have an abortion. My key point concerns the burdensomeness of pregnancy which is morally relevant to the question of whether the state can coerce people to use...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: van Oosterum, K. Tags: Response Source Type: research
Orphans cannot be after-birth aborted: a response to Bobier
I offer a response to an objection to my account of the moral difference between fetuses and newborns, an account that seeks to address an analogy between abortion and infanticide, which is based on the apparent equality of moral value of fetuses and newborns. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Singh, P. Tags: Response Source Type: research
Evaluating interventions to improve ethical decision making in clinical practice: a review of the literature and reflections on the challenges posed
We describe the results of our review and reflect on the challenges of assessing ethical decision making in clinical practice that face both developers of educational and support interventions and the regulatory organisations that set and assess competency standards. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Ignatowicz, A., Slowther, A. M., Bassford, C., Griffiths, F., Johnson, S., Rees, K. Tags: Original research Source Type: research
Do doctors have a responsibility to help patients import medicines from abroad?
Almost any medicine can be purchased online from abroad. Many high-income countries permit individuals to import medicines for their personal use. However, those who import medicines face the risk of purchasing poor-quality products that may not work, or that may even harm them. Many people are willing to accept this risk for the opportunity to purchase more affordable medicines. This is especially true of individuals from low socioeconomic backgrounds who already struggle to afford the medicines they need if they are not subsidised by insurers or if copayments are high. As medicine prices and out-of-pocket healthcare spen...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Ghinea, N. Tags: Original research Source Type: research
Commitment devices: beyond the medical ethics of nudges
Commitment devices (CDs) can help people overcome self-control problems to act on their plans and preferences. In these arrangements, people willingly make one of their options worse in order to change their own future behaviour, often by setting aside a sum of money that they will forfeit it if they fail to complete the planned action. Such applications of behavioural science have been used to help people stick to healthier lifestyle choices, overcome addictions and adhere to medication; they are acceptable to many patients and even relatively small sums can be effective. Some authors have objected to the use of nudges in...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Hodson, N. Tags: Original research Source Type: research
Navigating our way through a hospital ransomware attack: ethical considerations in delivering acute orthopaedic care
Ransomware attacks on healthcare systems are becoming more prevalent globally. In May 2021, Waikato District Health Board in New Zealand was devastated by a major attack that crippled its information technology system. The Department of Orthopaedic Surgery faced a number of challenges to the way they delivered care including, patient assessment and investigations, the deferral of elective surgery, and communication and patient confidentiality. These issues are explored through the lens of the four key principles of medical ethics in the hope that they will provide some guidance to future departments who may experience such...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Hoffman, T. W., Baker, J. F. Tags: Original research Source Type: research
Clinical challenges to the concept of ectogestation
Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine support for extremely premature neonates, numerous ethicists have debated the potential implications of such a device. Some have argued that the Biobag represents a natural evolution of traditional newborn intensive care, while others believe that the Biobag would create a new class of being for the patients housed within. Kingma and Finn argued in Bioethics for making a categorical distinction between fetuses, newborns and ‘gestatelings’ in a Biobag on the basis of a conceptual distinction between ectogenesis versu...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Wozniak, P. S. Tags: Original research Source Type: research
Youth should decide: the principle of subsidiarity in paediatric transgender healthcare
Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients’ capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient’s identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, such as parents or judges, if lower level decision-make...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Ashley, F. Tags: Original research Source Type: research
Reconsenting paediatric research participants for use of identifying data
When a minor research participant reaches the age of majority or the level of maturity necessary to be granted legal decision-making capacity, reconsent can be required for ongoing participation in research or use of health information and banked biological materials. Despite potential logistical concerns with implementation and ethical questions about the trade-offs between maximising respect for participant agency and facilitating research that may generate benefits, reconsent is the approach most consistent with both law and research ethics.
Canadian common law consent requirements are expansive and likely compel recons...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Murdoch, B., Jandura, A., Caulfield, T. Tags: Open access Original research Source Type: research
Green prescribing is good, but patients do not have a duty to accept it
Joshua Parker’s article on green inhaler prescribing is important and timely. I agree with much of it, specifically regarding the institutional duty to make climate-friendly changes (from environmentally expensive prescriptions to ‘greener,’ similarly effective ones). The challenge, however, comes in determining how that institutional obligation impacts the rights and duties of patients. In this commentary, I want to offer a friendly alternative to Parker’s view of individual patient obligation, which I suggest is important for reasons that go beyond this one case. Getting causal impotence right Par...
Source: Journal of Medical Ethics - January 24, 2023 Category: Medical Ethics Authors: Rieder, T. N. Tags: Commentary Source Type: research
