Is medical aid in dying discriminatory?
In Discrimination Against the Dying, Philip Reed argues, among other things, that ‘right to die laws (euthanasia and assisted suicide) also exhibit terminalism when they restrict eligibility to the terminally ill’.1 Additionally, he suggests ‘the availability of the option of assisted death only for the terminally ill negatively influences the terminally ill who wish to live by causing them to doubt their choice’.1 I argue that on scrutiny, neither of these two points hold. First, we routinely limit a course of treatment to only those for whom we believe the treatment might provide a benefit. Typica...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Riddle, C. A. Tags: Commentary Source Type: research
But I accepted these disadvantages! Can you be discriminated against by holding a right?
To show that discrimination against the terminally ill is a real and worrisome phenomenon Reed presents four examples1 . Here, I focus on the final two: right-to-try and right-to-die laws. I argue that they are not instances of discrimination, because they grant rights. Reed appears to have overlooked that rights differ from obligations in ways that leave his argumentation unsuccessful. According to the most prominent theory of rights, rights function to protect the personal interests of their holders.2 For that reason, strengthening rights implies weakening discrimination. Granting women the right to vote by itself meant ...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Barner, A. K. Tags: Open access Commentary Source Type: research
Examining right to try practices
In ‘Discrimination Against the Dying’, Phillip Reed argues that terminally ill patients are subjected to a distinct form of discrimination called ‘terminalism’. One of Reed’s primary examples of terminalism is right to try laws, which offer terminally ill patients the option to request medications that are not FDA-approved and without IRB involvement. In this analysis, we consider additional contextual factors about right to try, suggesting that it may not neatly count as an exemplar of terminalism. When pursued with appropriate protocols and oversight, right to try has the potential to broade...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Morgan, L. J., Pham, M. T. Tags: Commentary Source Type: research
Terminalism and how dying patients are conditioned as docile bodies
Philip Reed (2023) argues that discrimination against (non-acutely) dying patients constitutes a unique kind—which he calls terminalism—because their status as persons with terminal illness marks them with a socially salient identity which, by means of direct and indirect discrimination, limits their sets of choices and resources, such as in hospice care or organ transplant policies.1 Importantly, Reed also argues that while terminalism is an increasingly prevalent normative phenomenon, it has been overlooked in the literature, ‘hiding in plain sight’ as even though we are ‘aware of it at some...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Han, J. Tags: Commentary Source Type: research
Assisted dying programmes are not discriminatory against the dying
Some jurisdictions that allow assisted dying require participating patients to have a terminal illness. This includes all Australian and US states where assisted dying is allowed.1 Philip Reed2 argues that this requirement constitutes discrimination against the dying. As Reed2 argues: ‘assisted death laws that limit their services to the dying discriminate against them because death is offered to them to solve their problems’. This discrimination could take two forms: (1) via harm to dying patients as a group as a result of the existence of assisted dying programmes; (2) via a negative message that such program...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Sarbey, B. Tags: Commentary Source Type: research
Discrimination against the dying
The purpose of this paper is to identify a kind of discrimination that has hitherto gone unrecognised. ‘Terminalism’ is discrimination against the dying, or treating the terminally ill worse than they would expect to be treated if they were not dying. I provide four examples from healthcare settings of this kind of discrimination: hospice eligibility requirements, allocation protocols for scarce medical resources, right to try laws and right to die laws. I conclude by offering some reflections on why discrimination against the dying has been hard to identify, how it differs from ageism and ableism, and its sign...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Reed, P. Tags: Feature article Source Type: research
Unconditional access to non-invasive prenatal testing (NIPT) for adult-onset conditions: a defence
Over the past decade, non-invasive prenatal testing (NIPT) has been adopted into routine obstetric care to screen for fetal sex, trisomies 21, 18 and 13, sex chromosome aneuploidies and fetal sex determination. It is predicted that the scope of NIPT will be expanded in the future, including screening for adult-onset conditions (AOCs). Some ethicists have proposed that using NIPT to detect severe autosomal AOCs that cannot be prevented or treated, such as Huntington’s disease, should only be offered to prospective parents who intend to terminate a pregnancy in the case of a positive result. We refer to this as the &ls...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Marks, I. R., Mills, C., Devolder, K. Tags: Editor's choice Clinical ethics Source Type: research
Assessing the performance of ChatGPT in bioethics: a large language models moral compass in medicine
This study evaluated the accuracy of ChatGPT-3.5 (April 2023 version) in answering text-based, multiple choice bioethics questions at the level of US third-year and fourth-year medical students. A total of 114 bioethical questions were identified from the widely utilised question banks UWorld and AMBOSS. Accuracy, bioethical categories, difficulty levels, specialty data, error analysis and character count were analysed. We found that ChatGPT had an accuracy of 59.6%, with greater accuracy in topics surrounding death and patient–physician relationships and performed poorly on questions pertaining to informed consent. ...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Chen, J., Cadiente, A., Kasselman, L. J., Pilkington, B. Tags: Original research Source Type: research
Exploring the potential utility of AI large language models for medical ethics: an expert panel evaluation of GPT-4
This study reveals limitations in the ability of GPT-4 to appreciate the depth and nuanced acceptability of real-world ethical dilemmas, particularly those that require a thorough understanding of relational complexities and context-specific values. Ongoing evaluation of LLM capabilities within medical ethics remains paramount, and further refinement is needed before it can be used effectively in clinical settings. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Balas, M., Wadden, J. J., Hebert, P. C., Mathison, E., Warren, M. D., Seavilleklein, V., Wyzynski, D., Callahan, A., Crawford, S. A., Arjmand, P., Ing, E. B. Tags: Original research Source Type: research
Open AI meets open notes: surveillance capitalism, patient privacy and online record access
Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding and remembering their treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of in...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Blease, C. Tags: Open access Original research Source Type: research
Consent-GPT: is it ethical to delegate procedural consent to conversational AI?
Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of ways. One possible solution to this clinical dilemma is through the use of conversational artificial i...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Allen, J. W., Earp, B. D., Koplin, J., Wilkinson, D. Tags: Open access Current controversy Source Type: research
Generative AI and medical ethics: the state of play
Since their public launch, a little over a year ago, large language models (LLMs) have inspired a flurry of analysis about what their implications might be for medical ethics, and for society more broadly.1 Much of the recent debate has moved beyond categorical evaluations of the permissibility or impermissibility of LLM use in different general contexts (eg, at work or school), to more fine-grained discussions of the criteria that should govern their appropriate use in specific domains or towards certain ends.2 With each passing week, it seems more and more inevitable that LLMs will be a pervasive feature of many, if not ...
Source: Journal of Medical Ethics - January 23, 2024 Category: Medical Ethics Authors: Zohny, H., Porsdam Mann, S., Earp, B. D., McMillan, J. Tags: Editorial Source Type: research
Constructing a South Asian cardiovascular disease: a qualitative analysis on how researchers study cardiovascular disease in South Asians
Conclusions
These findings reflect a broader trend in biomedical research in which race and racial health disparities are poorly defined and studied, limiting scientists’ understanding of the relationship between race and health. I propose methodologies to help researchers define populations and design studies without relying on biologically reductive assumptions. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - December 14, 2023 Category: Medical Ethics Authors: Kawano, B. Tags: Editor's choice Student essay Source Type: research
A Nietzschean critique of liberal eugenics
Ethical debates about liberal eugenics frequently focus on the supposed unnaturalness of its means and possible harm to autonomy. I present a Nietzsche-inspired critique focusing on intention rather than means and harm to abilities rather than to autonomy. I first critique subjective eugenics, the selection of extrinsically valuable traits, drawing on Nietzsche’s notion of ‘slavish’ values reducible to the negation of another’s good. Subjective eugenics slavishly evaluates traits relative to a negatively evaluated norm (eg, above-average intelligence), disguising a harmful intention to diminish the ...
Source: Journal of Medical Ethics - December 14, 2023 Category: Medical Ethics Authors: Miyasaki, D. T. Tags: Extended essay Source Type: research
Webinar report: stakeholder perspectives on informed consent for the use of genomic data by commercial entities
This report describes the consensus concerns and recommendations raised during the meeting and will be informative for future research on ethical considerations for genomic research in the African research context. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - December 14, 2023 Category: Medical Ethics Authors: Schultz, B., Agamah, F. E., Ewuoso, C., Madden, E. B., Troyer, J., Skelton, M., Mwaka, E., On behalf of H3Africa Ethics and Community Engagement Working Group Tags: Open access Short report Source Type: research
