Being ethical in difficult times
Many countries are looking back at the pandemic and reflecting on what could have been done better. The UK COVID-19 Inquiry rumbles on1 and other influential groups such as the British Medical Association have already reviewed the British response to the pandemic and made recommendations about what should happen in the future.2 The UK is not alone in looking for lessons from the pandemic with a view to preparing for the next one. Countries with a very different COVID-19 experience, such as Australia and New Zealand, have also commenced national inquiries with a view to becoming better prepared for the next pandemic.3 4 Whi...
Source: Journal of Medical Ethics - December 14, 2023 Category: Medical Ethics Authors: McMillan, J. Tags: Editorial Source Type: research
Ethics briefings
United nations climate change conference Health will feature more prominently at this year’s United Nations Conference of the Parties (COP) to the Framework Convention on Climate Change. COP281 will include a ‘Health/Relief/Recovery and Peace’ day on the 3 December. The health day inevitably engages issues of equity and justice. It includes perspectives on identifying and scaling up adaption measures to address health impacts of climate change, acknowledging ‘findings that climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Mussell, R., Hamm, D. Tags: Ethics briefing Source Type: research
Opt-out paradigms for deceased organ donation are ethically incoherent
The Organ Donation Act 2019 has introduced an opt-out organ donor register in England, meaning that consent to the donation of organs upon death is presumed unless an objection during life was actively expressed. By assessing the rights of the dead over their organs, the sick to those same organs, and the role of consent in their requisition, this paper interrogates whether such paradigms for deceased organ donation are ethically justifiable. Where legal considerations are applicable, I focus on the recent changes in England as a case in point; however, this paper ultimately challenges the justifiability of opt-out systems...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Qurashi, G. M. Tags: Extended essay Source Type: research
Abortion policies at the bedside: a response
Hersey et al have outlined a proposed ethical framework for assessing abortion policies that locates the effect of government legislation between the provider and the patient, emphasising its influence on interactions between them. They claim that their framework offers an alternative to the personal moral claims that lie behind legislation restricting abortion access. However, they fail to observe that their own understanding of reproductive justice and the principles of medical ethics are similarly predicated on their individual moral beliefs. Consequently, the conclusions obtained from their framework are also derived f...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Blackshaw, B. P. Tags: Response Source Type: research
Whose models? Which representations? A response to Wagner
In Where the Ethical Action Is, we argued that medical and ethical modes of thought are not different in kind but different aspects of a situation. One of the consequences of this argument is that the requirement for or benefits of normative moral theorising in bioethics is undercut. In response, Wagner has argued that normative moral theories should be reconceived as models. Wagner’s argument seems to be that once reconceived as models, the rationale for moral theorising, undercut by our arguments in Where the Ethical Action Is, will be re-established because we will see those moral-theories-now-rebranded-as-models ...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Hardman, D., Hutchinson, P. Tags: Open access Response Source Type: research
Mapping out the arguments for and against patient non-attendance fees in healthcare: an analysis of public consultation documents
Conclusion
A narrow economic understanding of incentives cannot capture the breadth of arguments for and against patient non-attendance fees. Policy makers may draw on this insight when implementing similar incentive schemes. The study may also contribute to the general debate on ethics and incentives. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Fystro, J. R., Feiring, E. Tags: Open access Original research Source Type: research
Machine learning models, trusted research environments and UK health data: ensuring a safe and beneficial future for AI development in healthcare
Digitalisation of health and the use of health data in artificial intelligence, and machine learning (ML), including for applications that will then in turn be used in healthcare are major themes permeating current UK and other countries’ healthcare systems and policies. Obtaining rich and representative data is key for robust ML development, and UK health data sets are particularly attractive sources for this. However, ensuring that such research and development is in the public interest, produces public benefit and preserves privacy are key challenges. Trusted research environments (TREs) are positioned as a way of...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Kerasidou, C., Malone, M., Daly, A., Tava, F. Tags: Open access Original research Source Type: research
Harnessing legal structures of virtue for planetary health
Humans and other species depend on the planet’s well-being to survive and flourish. The health of the planet and its ecosystems is under threat from anthropogenic climate change, pollution and biodiversity loss. The promotion of planetary health against entrenched degradation of nature urgently requires ethical guidance. Using an ecocentric virtue jurisprudence approach, this article argues that the highest end of safeguarding planetary health is to secure the flourishing of the Earth community, of which the flourishing of humanity is but one component. The article demonstrates how law, despite its historic role in f...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Ip, E. C. Tags: Original research Source Type: research
With great power comes great vulnerability: an ethical analysis of psychedelics therapeutic mechanisms proposed by the REBUS hypothesis
Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing the influence of bottom-up i...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Villiger, D., Trachsel, M. Tags: Original research Source Type: research
Reconsidering reinterpretation: response to commentaries
The results of tests carried out using next-generation genomic sequencing (NGS) possess a peculiar and perhaps unique ‘diagnostic durability’. Unlike most other forms of testing, if genomic results or data are stored over time, then it remains possible to interrogate that information indefinitely, without having to retest the patient. Another peculiar property of genomic results is that their interpretations are subject to change within relatively short time frames. For instance, a genomic variant that is of uncertain significance (VUS) at the time of testing may shortly afterwards come to be understood as path...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Watts, G., Newson, A. J. Tags: Commentary Source Type: research
Professionalism or prejudice? Modelling roles, risking microaggressions
We agree with McCullough, Coverdale and Chervenak1 that ‘medical educators and academic leaders are in a pivotal and powerful position to role model’ to counter ‘incivility’ in medicine, which can include ‘dismissing’ or ‘demeaning others’. They note that ‘women may be at greater risk for experiencing incivility compared with men’, as may other individuals who experience ‘patterns of disrespect based on minority status’. The authors promote ‘professionalism’ and ‘etiquette’ to foster civility within medicine. Yet theory and expe...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Miller, E., Tang Girdwood, S., Shah, A., Anyigbo, C., Lanphier, E. Tags: Commentary Source Type: research
Promoting diagnostic equity: specifying genetic similarity rather than race or ethnicity
In their article on the limited duty to reinterpret genetic variants, Watts and Newson argue that clinical labs are not morally obligated to conduct routine reinterpretation despite its potential clinical and personal value.1 We endorse the authors’ argument for a circumscribed duty to reclassify genomic variants in certain cases, including to promote diagnostic equity for racial and ethnic minority populations that have been historically excluded from and exploited by genomic research and medicine. However, given the history and resilience of scientific racism, the use of socially constructed racial and ethnic categ...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Saylor, K. W., Martschenko, D. O. Tags: Commentary Source Type: research
Moral obligation to actively reinterpret VUS and the constraint of NGS technologies
Central to Watts and Newson’s argument in their seminal paper ‘Is there a duty to routinely reinterpret genomic variant classifications?’ is that diagnostic laboratories are not morally obligated to actively reinterpret variants of uncertain significance (VUS) due to the superior outcomes offered by next-generation sequencing (NGS) compared with traditional methods.1 NGS technologies can identify, analyse and interpret millions of genetic variations at once. For example, ‘the use of conventional molecular assays in clinical contexts could require doing a lot of assays for various mutations. Using th...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Wolemonwu, V. C. Tags: Commentary Source Type: research
Primary duty is to communicate moment-in-time nature of genetic variant interpretation
In late 2021, tennis star Chris Evert learned new genetic information about her sister, who died from ovarian cancer in January 2020. As Evert has explained in posts published by ESPN, her sister had a variant in the BRCA1 gene that was reclassified—upgraded—from a variant of uncertain significance (VUS) to pathogenic. Hearing about the variant’s reclassification likely saved Evert’s life. After getting genetic testing that showed she also carried the variant, Evert underwent prophylactic surgery. Clinical testing associated with the procedure revealed she already had stage 1c ovarian cancer. The Wa...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Chapman, C. R. Tags: Commentary Source Type: research
Downgrades: a potential source of moral tension
While Gabriel Watts and Ainsley Newson argue that diagnostic laboratories do not have a general duty to routinely reinterpret genomic variant classifications, they do formulate several restricted duties to actively reinterpret specific types of classifications.1 They place these duties with laboratories, acknowledging that they are setting aside any responsibilities that might arise for clinicians. Here, we will discuss the implications of this obligation for clinicians and the moral tension it may confront them with. We focus in particular on the consequences of the proposed moral obligation to actively reinterpret varian...
Source: Journal of Medical Ethics - November 23, 2023 Category: Medical Ethics Authors: Oerlemans, A. J., Feenstra, I., Yntema, H. G., Boenink, M. Tags: Commentary Source Type: research
