Understanding genetic justice in the post-enhanced world: a reply to Sinead Prince
In her recent article, Prince has identified a critical challenge for those who advocate genetic enhancement to reduce social injustices. The gene–environment interaction prevents genetic enhancement from having equitable effects at the phenotypic level, even if enhancement were available to the entire population. The poor would benefit less than the rich from their improved genes because their genotypes would interact with more unfavourable socioeconomic environments. Therefore, Prince believes that genetic enhancement should not be used to combat social inequalities, since it can likely aggravate them. In this arti...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Rueda, J. Tags: Response Source Type: research

Vaccine mandates for prospective versus existing employees: reply to Smith
Employment-based vaccine mandates have worse consequences for existing than prospective employees. Prospective employees are not yet dependent on a particular employment arrangement, so they are better positioned to respond to such mandates. Yet despite this asymmetry in consequences, Smith argues that if vaccine mandates are justified for prospective employees, they are similarly justified for existing employees. This paper responds to Smith’s argument. First, Smith holds that bona fide occupational requirements are actions that are necessary for the safe and effective completion of one’s job. As such, they ap...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Paetkau, T. Tags: Response Source Type: research

Research ethics and public trust in vaccines: the case of COVID-19 challenge trials
Despite their clearly demonstrated safety and effectiveness, approved vaccines against COVID-19 are commonly mistrusted. Nations should find and implement effective ways to boost vaccine confidence. But the implications for ethical vaccine development are less straightforward than some have assumed. Opponents of COVID-19 vaccine challenge trials, in particular, made speculative or empirically implausible warnings on this matter, some of which, if applied consistently, would have ruled out most COVID-19 vaccine trials and many non-pharmaceutical responses. (Source: Journal of Medical Ethics)
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Eyal, N. Tags: Editor's choice, COVID-19 Extended essay Source Type: research

Gene-environment interaction: why genetic enhancement might never be distributed fairly
Ethical debates around genetic enhancement tend to include an argument that the technology will eventually be fairly accessible once available. That we can fairly distribute genetic enhancement has become a moral defence of genetic enhancement. Two distribution solutions are argued for, the first being equal distribution. Equality of access is generally believed to be the fairest and most just method of distribution. Second, equitable distribution: providing genetic enhancements to reduce social inequalities. In this paper, I make two claims. I first argue that the very assumption that genetic enhancements can be distribut...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Prince, S. Tags: Original research Source Type: research

The ethics of firing unvaccinated employees
Some organisations make vaccination a condition of employment. This means prospective employees must demonstrate they have been vaccinated (eg, against measles) to be hired. But it also means organisations must decide whether existing employees should be expected to meet newly introduced vaccination conditions (eg, against COVID-19). Unlike prospective employees who will not be hired if they do not meet vaccination conditions, existing employees who fail to meet new vaccination conditions risk being fired. The latter seems worse than the former. Hence, objections to vaccination mandates commonly centre on the harms that wi...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Smith, M. J. Tags: Open access, COVID-19 Original research Source Type: research

A human right to pleasure? Sexuality, autonomy and egalitarian strategies
This article builds on previous research and offers a conceptual framework for addressing sexual pleasure and exclusion in terms of human rights. It argues that human rights aim to safeguard autonomy, which is interpreted as multidimensional. It, thus, divides autonomy into the four dimensions of liberty (freedom from threat and coercion), opportunity (options to choose between), capacity (what an agent is capable of doing) and authenticity (the extent to which choices are genuine). Furthermore, it distinguishes between distinct egalitarian strategies, which offer different problems and possibilities, and may be combined. ...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Wittrock, J. Tags: Open access Original research Source Type: research

Ethical considerations for psychedelic-assisted therapy in military clinical settings
Psychedelic treatments, particularly 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapies, have recently seen renewed interest in their clinical potential to treat various mental health conditions. Clinical trials for both MDMA-assisted and psilocybin-assisted therapies have shown to be highly efficacious for post-traumatic stress disorder and major depression. Recent research trials for psychedelic-assisted therapies (PAT) have demonstrated that although they are resource-intensive, their effects are rapid-acting, durable and cost-effective. These results have generated enthusiasm among rese...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Hoener, S., Wolfgang, A., Nissan, D., Howe, E. Tags: Original research Source Type: research

Enhancing social value considerations in prioritising publicly funded biomedical research: the vital role of peer review
The main goal of publicly funded biomedical research is to generate social value through the creation and application of knowledge that can improve the well-being of current and future people. Prioritising research with the greatest potential social value is crucial for good stewardship of limited public resources and ensuring ethical involvement of research participants. At the National Institutes of Health (NIH), peer reviewers hold the expertise and responsibility for social value assessment and resulting prioritisation at the project level. However, previous research has shown that peer reviewers place more emphasis on...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Saylor, K. W., Joffe, S. Tags: Original research Source Type: research

Blaming the unvaccinated during the COVID-19 pandemic: the roles of political ideology and risk perceptions in the USA
Individuals unvaccinated against COVID-19 (C19) experienced prejudice and blame for the pandemic. Because people vastly overestimate C19 risks, we examined whether these negative judgements could be partially understood as a form of scapegoating (ie, blaming a group unfairly for an undesirable outcome) and whether political ideology (previously shown to shape risk perceptions in the USA) moderates scapegoating of the unvaccinated. We grounded our analyses in scapegoating literature and risk perception during C19. We obtained support for our speculations through two vignette-based studies conducted in the USA in early 2022....
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Graso, M., Aquino, K., Chen, F. X., Bardosh, K. Tags: COVID-19 Original research Source Type: research

What makes a medical intervention invasive? A reply to commentaries
We are grateful to the commentators for their close reading of our article1 and for their challenging and interesting responses to it. We do not have space to respond to all of the objections that they raise, so in this reply, we address only a selection of them. Some commentaries question the usefulness of developing an account of the sort we provide,2 or of revising the Standard Account (SA) in doing so.3–5 Our schema is intended to provide a framework for developing a full account of invasiveness that captures existing uses of the term. On the assumption that the term is used somewhat reliably and consistently&nda...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: De Marco, G., Simons, J., Forsberg, L., Douglas, T. Tags: Commentary Source Type: research

Incision or insertion makes a medical intervention invasive. Commentary on 'What makes a medical intervention invasive?
De Marco and colleagues claim that the standard account of invasiveness as commonly encountered ‘...does not capture all uses of the term in relation to medical interventions1 ’. This is open to challenge. Their first example is ‘non-invasive prenatal testing’. Because it involves puncturing the skin to obtain blood, De Marco et al take this as an example of how an incision or insertion is not sufficient to make an intervention invasive; here is a procedure that involves an incision, but it is regarded as non-invasive. However, this ignores the context, and the term should really be understood in re...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Affleck, P., Cons, J., Kolstoe, S. E. Tags: Commentary Source Type: research

The name of the game: a Wittgensteinian view of 'invasiveness
In their forthcoming article, ‘What makes a medical intervention invasive?’ De Marco, Simons, and colleagues explore the meaning and usage of the term ‘invasive’ in medical contexts. They describe a ‘Standard Account’, drawn from dictionary definitions, which defines invasiveness as ‘incision of the skin or insertion of an object into the body’. They then highlight cases wherein invasiveness is employed in a manner that is inconsistent with this account (eg, in describing psychotherapy) to argue that the term invasiveness is often used to explicitly or implicitly reference in...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Chen, S. S., Brenna, C. T. A., Cho, M., McCoy, L. G., Das, S. Tags: Commentary Source Type: research

Redefining mental invasiveness in psychiatric treatments: insights from schizophrenia and depression therapies
Over 50% of the world population will develop a psychiatric disorder in their lifetime.1 In the realm of psychiatric treatment, two primary modalities have been established: pharmacotherapy and psychotherapy. Yet, pharmacological interventions often take precedence as the initial treatment choice despite their comparable outcomes, severe side effects and disputed evidence of their efficacy. This preference for medication foregrounds a vital re-examination of what it means to be invasive in medical treatments, namely in psychiatric care. De Marco et al challenge the standard account of invasiveness, presenting consideration...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: McFarland, C. W., Gordon, J. V. Tags: Commentary Source Type: research

Navigating the ambiguity of invasiveness: is it warranted? A response to De Marco et al
Navigating the ambiguity of invasiveness: is it warranted? Authors De Marco and colleagues have presented a new model on the concept of invasiveness, redefining both its technical definition and practical implementation.1 While the authors raise valid critiques regarding the discrepancy in definitions, I cannot help but wonder about the purpose of redefining terms for which little confusion, if any, exists? This commentary seeks to scrutinise the rationale supporting the new model in the absence of significant clinical confusion and to explore the implications for clinical practice. What are we trying to solve? Initially, ...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Tito, N. S. Tags: Commentary Source Type: research

Rethinking medical invasiveness in the clinical encounter
De Marco et al1 argue that the standard account of medical ‘invasiveness’ (as ‘incision’ or ‘insertion’) fails to capture three aspects of its existing use, namely that invasiveness can come in degrees, often depends on features of alternative medical interventions and can be non-physical. They propose a new schematic account that suggests that medical interventions can possess ‘basic invasiveness’ (which can come in degrees and of which they suggest at least two types: physical and mental), and ‘threshold invasiveness’ which can depend on the alternatives a speci...
Source: Journal of Medical Ethics - March 20, 2024 Category: Medical Ethics Authors: Slack, S. K., Higgins, N. Tags: Commentary Source Type: research