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  Subjects -> PHILOSOPHY (Total: 762 journals)
Showing 1 - 135 of 135 Journals sorted by number of followers
Philosophical Review     Full-text available via subscription   (Followers: 70)
Ethics     Full-text available via subscription   (Followers: 69)
European Journal of Philosophy     Hybrid Journal   (Followers: 66)
Journal of Political Philosophy     Hybrid Journal   (Followers: 65)
Mind     Hybrid Journal   (Followers: 62)
Australasian Journal of Philosophy     Hybrid Journal   (Followers: 57)
Philosophy & Public Affairs     Hybrid Journal   (Followers: 57)
Contemporary Political Theory     Hybrid Journal   (Followers: 52)
Nous     Hybrid Journal   (Followers: 51)
International Journal for Philosophy of Religion     Hybrid Journal   (Followers: 51)
Philosophical Quarterly     Hybrid Journal   (Followers: 46)
Journal of the History of Philosophy     Full-text available via subscription   (Followers: 46)
Journal of Applied Philosophy     Hybrid Journal   (Followers: 43)
American Journal of Theology & Philosophy     Full-text available via subscription   (Followers: 41)
British Journal for the History of Philosophy     Hybrid Journal   (Followers: 41)
British Journal for the Philosophy of Science     Hybrid Journal   (Followers: 40)
Analysis     Hybrid Journal   (Followers: 36)
Journal of Moral Philosophy     Hybrid Journal   (Followers: 36)
Philosophy and Phenomenological Research     Hybrid Journal   (Followers: 35)
Philosophy of Science     Full-text available via subscription   (Followers: 33)
Journal of Medical Ethics     Partially Free   (Followers: 32)
Erkenntnis     Hybrid Journal   (Followers: 30)
Philosophy and Literature     Full-text available via subscription   (Followers: 30)
Journal of Social Philosophy     Hybrid Journal   (Followers: 27)
Inquiry : An Interdisciplinary Journal of Philosophy     Hybrid Journal   (Followers: 27)
Journal of Ethics & Social Philosophy     Open Access   (Followers: 27)
Constellations     Hybrid Journal   (Followers: 26)
Canadian Journal of Philosophy     Full-text available via subscription   (Followers: 25)
Continental Philosophy Review     Partially Free   (Followers: 25)
Social Philosophy and Policy     Full-text available via subscription   (Followers: 25)
Ethical Theory and Moral Practice     Hybrid Journal   (Followers: 24)
Journal of Law, Medicine & Ethics     Hybrid Journal   (Followers: 23)
Philosophy & Social Criticism     Hybrid Journal   (Followers: 22)
Philosophical Studies     Hybrid Journal   (Followers: 22)
Linguistics and Philosophy     Hybrid Journal   (Followers: 22)
British Journal of Aesthetics     Hybrid Journal   (Followers: 22)
The Heythrop Journal     Hybrid Journal   (Followers: 21)
Philosophy and Rhetoric     Full-text available via subscription   (Followers: 20)
Philosophy Compass     Hybrid Journal   (Followers: 19)
BMC Medical Ethics     Open Access   (Followers: 19)
Biology and Philosophy     Hybrid Journal   (Followers: 18)
Journal of Medical Ethics and History of Medicine     Open Access   (Followers: 18)
Philosophers' Imprint     Open Access   (Followers: 17)
Philosophy     Full-text available via subscription   (Followers: 17)
Jurisprudence     Hybrid Journal   (Followers: 17)
Assuming Gender     Open Access   (Followers: 16)
Mouseion: Journal of the Classical Association of Canada     Full-text available via subscription   (Followers: 16)
Pragmatics & Cognition     Hybrid Journal   (Followers: 16)
International Studies in the Philosophy of Science     Hybrid Journal   (Followers: 15)
Journal of the Philosophy of History     Hybrid Journal   (Followers: 15)
Bioethics Research Notes     Full-text available via subscription   (Followers: 15)
Philosophy East and West     Full-text available via subscription   (Followers: 15)
Journal of Media Ethics : Exploring Questions of Media Morality     Hybrid Journal   (Followers: 14)
Episteme     Hybrid Journal   (Followers: 14)
Midwest Studies In Philosophy     Hybrid Journal   (Followers: 14)
Review of Philosophy and Psychology     Hybrid Journal   (Followers: 13)
Social Epistemology: A Journal of Knowledge, Culture and Policy     Hybrid Journal   (Followers: 13)
Phronesis : A journal for Ancient Philosophy     Hybrid Journal   (Followers: 13)
Philosophy & Technology     Hybrid Journal   (Followers: 13)
Ethical Perspectives     Full-text available via subscription   (Followers: 12)
Pragmatics and Society     Hybrid Journal   (Followers: 12)
Reformed Theological Review, The     Full-text available via subscription   (Followers: 12)
Journal of Global Ethics     Hybrid Journal   (Followers: 12)
Utilitas     Hybrid Journal   (Followers: 11)
Philosophy of Photography     Hybrid Journal   (Followers: 11)
Open Journal of Philosophy     Open Access   (Followers: 11)
Philosophy, Psychiatry, & Psychology     Full-text available via subscription   (Followers: 11)
Estudos Bíblicos     Open Access   (Followers: 11)
Journal of Chinese Philosophy     Hybrid Journal   (Followers: 11)
Journal of Indian Philosophy     Hybrid Journal   (Followers: 11)
Kennedy Institute of Ethics Journal     Full-text available via subscription   (Followers: 10)
Metaphor and Symbol     Hybrid Journal   (Followers: 10)
Pacific Philosophical Quarterly     Hybrid Journal   (Followers: 10)
Polis : The Journal of the Society for Greek Political Thought     Hybrid Journal   (Followers: 10)
Dao : A Journal of Comparative Philosophy     Hybrid Journal   (Followers: 10)
Myth & Symbol     Hybrid Journal   (Followers: 9)
Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences     Full-text available via subscription   (Followers: 9)
Journal of Philosophical Logic     Hybrid Journal   (Followers: 9)
Film-Philosophy Journal     Open Access   (Followers: 9)
Journal of the Gilded Age and Progressive Era     Full-text available via subscription   (Followers: 9)
HTS Theological Studies     Open Access   (Followers: 9)
Philosophical Perspectives     Hybrid Journal   (Followers: 8)
Philosophia     Hybrid Journal   (Followers: 8)
Research in Phenomenology     Hybrid Journal   (Followers: 8)
Philosophical Books     Hybrid Journal   (Followers: 8)
Diogenes     Hybrid Journal   (Followers: 8)
Philosophical Issues     Hybrid Journal   (Followers: 7)
African Journal of Business Ethics     Open Access   (Followers: 7)
SubStance     Full-text available via subscription   (Followers: 7)
Metaphilosophy     Hybrid Journal   (Followers: 7)
Medicine, Health Care and Philosophy     Hybrid Journal   (Followers: 7)
Nordic Journal of Aesthetics     Open Access   (Followers: 7)
Contributions to the History of Concepts     Full-text available via subscription   (Followers: 7)
International Journal of Philosophical Studies     Hybrid Journal   (Followers: 7)
Axiomathes     Hybrid Journal   (Followers: 6)
The Southern Journal of Philosophy     Hybrid Journal   (Followers: 6)
Journal of Speculative Philosophy     Full-text available via subscription   (Followers: 6)
Think     Full-text available via subscription   (Followers: 6)
Zeitschrift für philosophische Forschung     Full-text available via subscription   (Followers: 6)
History and Philosophy of Logic     Hybrid Journal   (Followers: 6)
Philosophical Investigations     Hybrid Journal   (Followers: 6)
Contemporary Chinese Thought     Full-text available via subscription   (Followers: 6)
Contagion : Journal of Violence, Mimesis, and Culture     Full-text available via subscription   (Followers: 6)
Philosophical Magazine Letters     Hybrid Journal   (Followers: 6)
Philosophical Explorations: An International Journal for the Philosophy of Mind and Action     Hybrid Journal   (Followers: 6)
Dialogue Canadian Philosophical Review/Revue canadienne de philosophie     Full-text available via subscription   (Followers: 6)
International Journal of the Platonic Tradition     Open Access   (Followers: 5)
Journal of Empirical Research on Human Research Ethics     Full-text available via subscription   (Followers: 5)
Journal of Critical Realism     Hybrid Journal   (Followers: 5)
Australasian Catholic Record, The     Full-text available via subscription   (Followers: 5)
Critical Horizons     Hybrid Journal   (Followers: 5)
Journal of Nietzsche Studies     Full-text available via subscription   (Followers: 5)
Aisthesis     Open Access   (Followers: 5)
Endeavour     Hybrid Journal   (Followers: 5)
Philosophical Papers     Hybrid Journal   (Followers: 5)
Review of Contemporary Philosophy     Full-text available via subscription   (Followers: 5)
Zeitschrift für Religions- und Geistesgeschichte     Hybrid Journal   (Followers: 5)
Church Heritage     Full-text available via subscription   (Followers: 4)
South African Journal of Philosophy = Suid-Afrikaanse Tydskrif vir Wysbegeerte     Hybrid Journal   (Followers: 4)
Bochumer Philosophisches Jahrbuch für Antike und Mittelalter     Hybrid Journal   (Followers: 4)
Franciscan Studies     Full-text available via subscription   (Followers: 4)
Transactions of the Charles S. Peirce Society     Full-text available via subscription   (Followers: 4)
Hume Studies     Full-text available via subscription   (Followers: 4)
Journal of Theoretical & Philosophical Psychology     Full-text available via subscription   (Followers: 4)
The Philosophical Forum     Hybrid Journal   (Followers: 4)
National Catholic Bioethics Quarterly     Hybrid Journal   (Followers: 4)
Royal Institute of Philosophy Supplements     Full-text available via subscription   (Followers: 4)
Philosophy in Review     Open Access   (Followers: 4)
Recherches de Théologie et Philosophie Médiévales     Full-text available via subscription   (Followers: 3)
Topoi     Hybrid Journal   (Followers: 3)
Australian Humanist, The     Full-text available via subscription   (Followers: 3)
Studia Logica     Hybrid Journal   (Followers: 3)
Utopian Studies     Full-text available via subscription   (Followers: 3)
Russell : the Journal of Bertrand Russell Studies     Full-text available via subscription   (Followers: 3)
Journal of Religion and Business Ethics     Open Access   (Followers: 3)
The Pluralist     Full-text available via subscription   (Followers: 3)
Bijdragen     Full-text available via subscription   (Followers: 3)
Studies in Philology     Full-text available via subscription   (Followers: 3)
Bulletin de Philosophie Medievale     Full-text available via subscription   (Followers: 3)
Kantian Review     Full-text available via subscription   (Followers: 3)
CR : The New Centennial Review     Full-text available via subscription   (Followers: 3)
Between the Species     Open Access   (Followers: 2)
International Journal of Žižek Studies     Open Access   (Followers: 2)
Socioaffective Neuroscience and Psychology     Open Access   (Followers: 2)
Horizonte : Revista de Estudos de Teologia e Ciências da Religião     Open Access   (Followers: 2)
International Journal for the Study of Skepticism     Hybrid Journal   (Followers: 2)
Cultura : International Journal of Philosophy of Culture and Axiology     Open Access   (Followers: 2)
Erasmus Studies     Hybrid Journal   (Followers: 2)
Empedocles : European Journal for the Philosophy of Communication     Hybrid Journal   (Followers: 2)
Sartre Studies International     Full-text available via subscription   (Followers: 2)
Journal of Scottish Philosophy     Hybrid Journal   (Followers: 2)
Journal of Friends of Lutheran Archives     Full-text available via subscription   (Followers: 2)
Philosophy & Theory in Biology     Open Access   (Followers: 2)
Kriterion: Revista de Filosofia     Open Access   (Followers: 2)
Poiesis & Praxis : International Journal of Technology Assessment and Ethics of Science     Open Access   (Followers: 2)
Quaestio     Full-text available via subscription   (Followers: 2)
Grazer Philosophische Studien     Full-text available via subscription   (Followers: 2)
Journal of Aesthetic Education     Full-text available via subscription   (Followers: 2)
Australian Journal of Parapsychology     Full-text available via subscription   (Followers: 2)
Noesis     Open Access   (Followers: 1)
Journal of Humanistic Mathematics     Open Access   (Followers: 1)
Éthique publique     Open Access   (Followers: 1)
Philosophia Scientiæ     Open Access   (Followers: 1)
Nóema     Open Access   (Followers: 1)
International Journal of Social Quality     Full-text available via subscription   (Followers: 1)
Revista Latinoamericana de Filosofía     Open Access   (Followers: 1)
PAN: Philosophy Activism Nature     Full-text available via subscription   (Followers: 1)
Revue Philosophique de Louvain     Full-text available via subscription   (Followers: 1)
Le Portique     Open Access   (Followers: 1)
Temporalités     Open Access   (Followers: 1)
Husserl Studies     Hybrid Journal   (Followers: 1)
Revue d’études benthamiennes     Open Access   (Followers: 1)
Ethische Perspectieven     Full-text available via subscription   (Followers: 1)
Laval théologique et philosophique     Full-text available via subscription   (Followers: 1)
Eleutheria     Open Access   (Followers: 1)
Veritas : Revista de Filosofí­a y Teología     Open Access   (Followers: 1)
Hobbes Studies     Hybrid Journal   (Followers: 1)
Collingwood and British Idealism Studies     Full-text available via subscription  
Grotiana     Hybrid Journal  
Signos Filosóficos     Open Access  
Eidos     Open Access  
Cinta de Moebio     Open Access  
Cuyo Anuario de Filosofía Argentina y Americana     Open Access  
Tópicos. Revista de Filosofía de Santa Fe     Open Access  
Rhuthmos     Open Access  
Philosophiques     Open Access  
Ramon Llull Journal of Applied Ethics     Open Access  
Studia Philosophica Estonica     Open Access  
Synthesis (La Plata)     Open Access  
Revista de Filosofia     Open Access  
Alpha (Osorno)     Open Access  
Circe de clásicos y modernos     Open Access  
Estudios de Filosofía Práctica e Historia de las Ideas     Open Access  
Doctor virtualis     Open Access  
Humanidades Médicas     Open Access  
Methodos     Open Access  
Labyrinthe     Open Access  
Astérion     Open Access  
Trans/Form/Ação - Revista de Filosofia     Open Access  
Russian Studies in Philosophy     Full-text available via subscription  

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Similar Journals
Journal Cover
Journal of Medical Ethics
Journal Prestige (SJR): 0.618
Citation Impact (citeScore): 1
Number of Followers: 32  
 
  Partially Free Journal Partially Free Journal
ISSN (Print) 0306-6800 - ISSN (Online) 1473-4257
Published by BMJ Publishing Group Homepage  [62 journals]
  • Dr Daly's principlist defence of multiple heart valve replacements for
           continuing opiate users: the importance of Aristotles formal principle of
           justice

    • Free pre-print version: Loading...

      Authors: Gillon; R.
      Pages: 651 - 652
      Abstract: In this journal, Dr Daniel Daly, an American bioethicist, uses a principlist approach (respect for autonomy, non-maleficence, beneficence and justice) to argue that intravenous opiate users should not be denied repeat heart valve replacements if these are medically indicated, ‘unless the valve replacement significantly violates another’s autonomy or one or more of the three remaining principles’.1 In brief outline, the paper seeks to use a widely accepted ethical theory—‘principlism’ as developed by Beauchamp and Childress over the last 40 plus years and eight editions of their ground-breaking book Principles of Biomedical Ethics2—to resolve clinical disagreement about the ethics of denying medically indicated life-prolonging treatment to patients who continue or resume intravenous opiate use. The argument Dr Daly's argument in very brief summary is that in the context of contemporary American medical practice, such treatment is ethically justified—perhaps even ethically required—if requested or accepted by an...
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/jme-2022-108588
      Issue No: Vol. 48, No. 10 (2022)
       
  • The 'haves and 'have-nots of personal protective equipment during the
           COVID-19 pandemic: the ethics of emerging inequalities amongst healthcare
           workers

    • Free pre-print version: Loading...

      Authors: Shelton, C; El-Boghdadly, K, Appleby, J. B.
      Pages: 653 - 657
      Abstract: The COVID-19 pandemic has exacerbated inequalities, including among the healthcare workforce. Based on recent literature and drawing on our experiences of working in operating theatres and critical care in the UK’s National Health Service during the pandemic, we review the role of personal protective equipment and consider the ethical implications of its design, availability and provision at a time of unprecedented demand. Several important inequalities have emerged, driven by factors such as individuals purchasing their own personal protective equipment (either out of choice or to address a lack of provision), inconsistencies between guidelines issued by different agencies and organisations, and the standardised design and procurement of equipment required to protect a diverse healthcare workforce. These, we suggest, have resulted largely because of a lack of appropriate pandemic planning and coordination, as well as insufficient appreciation of the significance of equipment design for the healthcare setting. As with many aspects of the pandemic, personal protective equipment has created and revealed inequalities driven by economics, gender, ethnicity and professional influence, creating a division between the ‘haves’ and ‘have-nots’ of personal protective equipment. As the healthcare workforce continues to cope with ongoing waves of COVID-19, and with the prospect of more pandemics in the future, it is vital that these inequalities are urgently addressed, both through academic analysis and practical action.
      Keywords: COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107501
      Issue No: Vol. 48, No. 10 (2022)
       
  • A vaccine tax: ensuring a more equitable global vaccine distribution

    • Free pre-print version: Loading...

      Authors: Albertsen; A.
      Pages: 658 - 661
      Abstract: While COVID-19 vaccines provide light at the end of the tunnel in a difficult time, they also bring forth the complex ethical issue of global vaccine distribution. The current unequal global distribution of vaccines is unjust towards the vulnerable living in low-income countries. A vaccine tax should be introduced to remedy this. Under such a scheme, a small fraction of the money spent by a country on vaccines for its own population would go into a fund, such as COVAX, dedicated to buying vaccines and distributing them to the world’s poorest. A vaccine tax would provide a much-needed injection of funds to remedy the unequal distribution of vaccines. The tax allows for a distribution that, to a lesser degree, reflects the ability to pay and is superior to a donation-based model because it minimises the opportunity for free-riding.
      Keywords: Press releases, COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107418
      Issue No: Vol. 48, No. 10 (2022)
       
  • Three for me and none for you' An ethical argument for delaying
           COVID-19 boosters

    • Free pre-print version: Loading...

      Authors: Jecker, N. S; Lederman, Z.
      Pages: 662 - 665
      Abstract: This paper argues in support of the WHO’s proposal to forego COVID-19 booster shots until 10% of people in every country are fully vaccinated. The Ethical Argument section shows that we save the most lives and ensure the least amount of suffering by allocating doses first to unvaccinated people. It also argues that there is a duty to support decent lives and to promote health equity, which establish that refraining from boosters is a requirement of justice, not charity. The Replies to Objections section answers objections that appeal to pragmatism, nationalism, ownership, scientific advancement, self-interest, semantics and futility. The Conclusion section emphasizes that for now, wealthy nations should not boost vaccinated people’s immunity and should instead send doses to poorer nations where they are most urgently needed.
      Keywords: COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107824
      Issue No: Vol. 48, No. 10 (2022)
       
  • COVID-19 vaccines: a look at the ethics of the clinical research involving
           children

    • Free pre-print version: Loading...

      Authors: Cabiedes-Miragaya, L; Galende-Dominguez, I.
      Pages: 666 - 671
      Abstract: Currently, millions of minors are being inoculated against SARS-CoV-2 in many countries in the world. Ethical concerns about clinical research involving children have barely been addressed in the literature, despite the fact that the paediatric population is particularly vulnerable within this context. Children should be included in the research plans for COVID-19 vaccines. Nevertheless, it is necessary to critically assess to what extent clinical trials are being conducted according to methodological and ethical criteria that allow us to conclude that the results are valid and, in consequence, how far the vaccination plans for children are scientifically justified.The principal aim of this article is to analyse critically the process of clinical research on COVID-19 vaccines involving children, highlighting the ethical concerns that arise, including the need to stratify the results from older adolescents separately for analysis before proceeding, if further research is warranted, in descending age order. The development of COVID-19 vaccines is examined, with a special look at the participation of children throughout their clinical development, including a review of the clinical trials registered in three international databases. We also offer some additional considerations about the inclusion of minors in vaccination plans. Finally, we conclude with some recommendations, with particular emphasis on the following ethical duties: research in children should be carried out only once the relevant research in adults has previously been conducted; issues that concern children’s needs and rights should be specifically addressed; and, therefore, the highest standards of ethical and scientific quality should be met.
      Keywords: COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107941
      Issue No: Vol. 48, No. 10 (2022)
       
  • Organisational failure: rethinking whistleblowing for tomorrows doctors

    • Free pre-print version: Loading...

      Authors: Taylor, D. J; Goodwin, D.
      Pages: 672 - 677
      Abstract: The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan’s ‘Normalisation of Deviance’ (NoD) provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five ‘serious untoward incidents’ occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/jme-2022-108328
      Issue No: Vol. 48, No. 10 (2022)
       
  • Root causes of organisational failure: look up, not down

    • Free pre-print version: Loading...

      Authors: Newdick; C.
      Pages: 678 - 679
      Abstract: ‘Organisational failure’ is central to medical ethics. In the National Health Service (NHS), we usually examine failures at hospital level. We have had around 100 hospital inquiries since the first in 1969, into Ely Hospital, Cardiff. This year, we had the Ockenden Report into Shrewsbury and Telford Hospital. Last year, we had the Outram Inquiry into West Suffolk Hospital. In 2020, the James Inquiry into Ian Paterson. And, before that, Morecombe Bay, Gosport War Memorial, Mid Staffordshire, Liverpool Community Health, Winterbourne View, Anthony Ledward, Stoke Mandeville, Bristol Royal Infirmary and so on. As Taylor says, these reports teach us clinical failure usually has an institutional setting and that blaming individuals overlooks working ‘culture’. They have also led to: (a) new regulatory bodies to manage, investigate and improve NHS standards, (b) new codes of conduct to mandate reporting of serious accidents—backed up by the Whistle-blower’s Act and explicit statutory duties...
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/jme-2022-108579
      Issue No: Vol. 48, No. 10 (2022)
       
  • Manufacturing safer medics

    • Free pre-print version: Loading...

      Authors: Jesudason; E.
      Pages: 680 - 681
      Abstract: How do we teach medical students to protect patients' My initial reaction to the question posed by Taylor and Goodwin was like first glimpsing ‘Jaws’: we’re going to need a bigger boat. The authors’ answer makes two important claims: first, that safety should be ethically sourced by better integration between teaching of safety and ethics; second, that teaching should encourage students to think about organisational failure rather than focusing on individual blame and personal responsibility to whistleblow.1 On the first, they highlight how ethics teaching often sits apart from that on safety. For the second, they use the concept normalisation of deviance, with its contained idea of structural secrecy, to depict organisational failure that is argued as largely immune to whistleblowing. Why wouldn’t these challenges warrant a bigger boat' On their first claim: it is not just for safety, but throughout the curriculum that ethics teaching needs...
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/jme-2022-108581
      Issue No: Vol. 48, No. 10 (2022)
       
  • To what extent can tomorrows doctors prevent organisational failure by
           speaking up'

    • Free pre-print version: Loading...

      Authors: Powell; M.
      Pages: 682 - 683
      Abstract: Daniel Taylor and Dawn Goodwin present a case study of the Morecambe Bay Inquiry (MBI), which examined the high rate of maternal and neonatal deaths over a period of 9 years (2004–2013), within the small maternity unit of Furness General Hospital (FGH), one of the three hospitals comprising Morecambe Bay Hospitals Trust.1 They examine this through a conceptual lens, and provide a solution involving changes in medical education. This commentary explores both these elements. First, they use the lens of ‘Normalisation of Deviance’ (NoD) to explain organisational failure. However, other available lenses such as ‘Sociology of Disasters’, ‘Organisational Silence’ and ‘Comfort-seeking Behaviour’ may point to different problems and solutions. More justification for their choice of the lens of NoD would have been useful. Similarly, more justification for their focus on a cluster of five ‘serious untoward incidents’ (SUIs) occurring in 2008 would also have been useful. They...
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/jme-2022-108580
      Issue No: Vol. 48, No. 10 (2022)
       
  • Whistleblowing in the NHS: the need for a new generation to learn the
           lessons

    • Free pre-print version: Loading...

      Authors: McHale; J. V.
      Pages: 684 - 684
      Abstract: Whistleblowing in the NHS engages the fundamental right to free speech and as the paper makes clear is a means of ensuring individual patient safety. The discourse around the whistleblower is not simply about individuals being safeguarded if they blow the whistle on poor standards of patient care but that they may indeed be obliged as healthcare professionals to positively make the decision to blow the whistle to raise concerns. As noted in the paper, the NHS is an organisation in which many—though not all—individuals who work there are bound by their own professional codes of practice in addition to broader employment requirements in relation to ethical and safety issues. But having an obligation to raise concerns and actually doing so are very different things. Individuals who blow the whistle have often found that following their conscience comes with consequences. They may ultimately be vindicated, as, for example in...
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/jme-2022-108627
      Issue No: Vol. 48, No. 10 (2022)
       
  • Principlist approach to multiple heart valve replacements for patients
           with intravenous drug use-induced endocarditis

    • Free pre-print version: Loading...

      Authors: Daly; D.
      Pages: 685 - 688
      Abstract: Medical professionals often deny patients who inject opioids a second or third heart valve replacement, even if such a surgery is medically indicated. However, such a position is not well defended. As this paper demonstrates, the ethical literature on the topic too often fails to develop and apply an ethical lens to analyse the issue of multiple valve replacements. This paper addresses this lacuna by analysing the case of Mr Walsh, a composite case which protects the identity of any one patient, through the principlist approach of Beauchamp and Childress. It argues that the hospital should offer Mr Walsh, a second valve replacement because the procedure is: medically indicated, autonomously requested, non-maleficent, beneficent and does not violate a formal account of justice. The paper concludes with clinical ethical guidelines for valve surgery for patients with opioid use disorder.
      Keywords: Editor's choice
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107685
      Issue No: Vol. 48, No. 10 (2022)
       
  • Ethics of genomic passports: should the genetically resistant be exempted
           from lockdowns and quarantines'

    • Free pre-print version: Loading...

      Authors: Gyngell, C; Savulescu, J.
      Pages: 689 - 694
      Abstract: Lockdowns and quarantines have been implemented widely in response to the COVID-19 pandemic. This has been accompanied by a rise in interest in the ethics of ‘passport’ systems that allow low-risk individuals greater freedoms during lockdowns and exemptions to quarantines. Immunity and vaccination passports have been suggested to facilitate the greater movement of those with acquired immunity and who have been vaccinated. Another group of individuals who pose a low risk to others during pandemics are those with genetically mediated resistances to pathogens. In this paper, we introduce the concept of genomic passports, which so far have not been explored in the bioethics literature. Using COVID-19 as an illustrative example, we explore the ethical issues raised by genomic passports and highlight differences and similarities to immunity passports. We conclude that, although there remain significant practical and ethical challenges to the implementation of genomic passports, there will be ways to ethically use them in the future.
      Keywords: Open access, COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107297
      Issue No: Vol. 48, No. 10 (2022)
       
  • Clinical ethics support services during the COVID-19 pandemic in the UK: a
           cross-sectional survey

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      Authors: Dittborn, M; Cave, E, Archard, D.
      Pages: 695 - 701
      Abstract: BackgroundThe COVID-19 pandemic highlighted the need for clinical ethics support provision to ensure as far as possible fair decision making and to address healthcare workers’ moral distress.PurposeTo describe the availability, characteristics and role of clinical ethics support services (CESSs) in the UK during the COVID-19 pandemic.MethodA descriptive cross-sectional online survey was developed by the research team. The survey included questions on CESSs characteristics (model, types of support, guidance development, membership, parent and patient involvement) and changes in response to the pandemic. Invitations to participate were widely circulated via National Health Service institutional emails and relevant clinical ethics groups known to the research team.ResultsBetween October 2020 and June 2021, a total of 53 responses were received. In response to the pandemic, new CESSs were established, and existing provision changed. Most took the form of clinical ethics committees, groups and advisory boards, which varied in size and membership and the body of clinicians and patient populations they served. Some services provided moral distress support and educational provision for clinical staff. During the pandemic, services became more responsive to clinicians’ requests for ethics support and advice. More than half of respondents developed local guidance and around three quarters formed links with regional or other local services. Patient and/or family members’ involvement in ethics discussions is infrequent.ConclusionsThe pandemic has resulted in an expansion in the number of CESSs. Though some may disband as the pandemic eases, the reliance on CESSs during the pandemic demonstrates the need for additional research to better understand the effectiveness of their various forms, connections, guidance, services and modes of working and for better support to enhance consistency, transparency, communication with patients and availability to clinical staff.
      Keywords: COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107818
      Issue No: Vol. 48, No. 10 (2022)
       
  • Why we should stop using animal-derived products on patients without their
           consent

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      Authors: Rodger; D.
      Pages: 702 - 706
      Abstract: Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to respect patients’ dietary preferences and then use animal-derived medicines or medical devices on them without their informed consent. I then address several anticipated objections and conclude that the continued failure to address this issue is an ethical blind spot that warrants applying the principles of respect for autonomy and informed consent consistently.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107371
      Issue No: Vol. 48, No. 10 (2022)
       
  • Doctors have an ethical obligation to ask patients about food insecurity:
           what is stopping us'

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      Authors: Knight, J. K; Fritz, Z.
      Pages: 707 - 711
      Abstract: Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions (on both individual and public health policy levels) frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours (eg, smoking and alcohol use), as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities.
      Keywords: Open access
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107409
      Issue No: Vol. 48, No. 10 (2022)
       
  • Investigation of post-trial access views among study participants and
           stakeholders using photovoice and semistructured interviews

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      Authors: Ngwenya, N; Iwuji, C, Petersen, N, Myeni, N, Nxumalo, S, Ngema, U, Seeley, J.
      Pages: 712 - 717
      Abstract: PurposeWe examine the levels of post-trial responsibility ascribed to different stakeholders, following a community-based clinical trial and how the ‘responsibility’ is understood.MethodsWe employed photovoice, unstructured observations and key informant interviews to gain insights into contexts of access to care following transition to the public health system post trial. We used an inductive narrative analysis to explore experiences and understandings of post-trial access (PTA).ResultsIn their photovoice stories, many participants expressed a sense of abandonment after the trial. This was viewed as a contributing factor to failing to re-engage with care available in the public health system. This led to the experiences of loss as some trial participants defaulted and died. Research investigators, department of health participants and sponsor agreed that PTA was especially important for communities in resource-limited settings. The government has an obligation towards its citizens while researchers have a responsibility to ensure a smooth transition of patients to public clinics. Sponsors have a responsibility to ensure that the trial is conducted in accordance with the protocol and post-trial agreements are in place and adhered to. Research partnerships among stakeholders were affected by power imbalances making it difficult to negotiate and plan for post-trial care responsibilities.ConclusionsThe research community still struggles with understanding the scope of PTA responsibilities. Power dynamics between public health actors and research sponsors need to be managed to ensure that government involvement is not tokenistic. The responsibility of trial participants and ethics committees needs to be investigated further.
      Keywords: Open access
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2020-107011
      Issue No: Vol. 48, No. 10 (2022)
       
  • Voluntarily chosen roles and conscientious objection in health care

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      Authors: Robinson; M.
      Pages: 718 - 722
      Abstract: The longstanding dominant view is that health care practitioners should be permitted to refrain from participating in medical interventions when they have a conscientious objection to doing so in a broad range of cases. In recent years, a growing minority have been fervently advocating a sea change. In their view, medical professionals should not be permitted to refuse to participate in medical interventions merely because doing so conflicts with their own moral or religious views. One of the most commonly offered arguments in support of this position focuses on the fact that health care practitioners knew what they were getting into when they voluntarily chose to take on their professional roles; nobody forced them to do this. I will argue that, despite its popularity among opponents of conscientious refusal, this argument from voluntariness fails to provide us with a good reason to reject broad accommodationism in favour of non-accommodationism.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107581
      Issue No: Vol. 48, No. 10 (2022)
       
  • Intimacy for older adults in long-term care: a need, a right, a
           privilege--or a kind of care'

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      Authors: Schouten, V; Henrickson, M, Cook, C. M, McDonald, S, Atefi, N.
      Pages: 723 - 727
      Abstract: BackgroundTo investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being.MethodsThe present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were conducted with 75 staff, residents and family members.ResultsIt was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular (a staff member) described receiving intimate touch as a ‘kind of care’—a particularly useful way of framing the conversation.ConclusionWhile staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach—one that focuses on caring for the whole person in order to improve overall well-being and quality of life.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2020-107171
      Issue No: Vol. 48, No. 10 (2022)
       
  • Research abuses against people of colour and other vulnerable groups in
           early psychedelic research

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      Authors: Strauss, D; de la Salle, S, Sloshower, J, Williams, M. T.
      Pages: 728 - 737
      Abstract: There is a growing resurgence in the study of psychedelic medicines for the treatment of mental health and substance use disorders. However, certain early investigations are marred by questionable research methods, abuses against research participants, and covert Central Intelligence Agency financial involvement. The purpose of this study was to understand how and to what extent people of colour and other vulnerable populations, specifically, individuals who were incarcerated or incapacitated due to mental health issues (inpatients with psychotic disorders), were exploited during the first wave of psychedelic research in the USA (1950–1980). To do so, we reviewed available empirical publications according to current ethical standards. Variables of interest included race and ethnicity of participants, population vulnerability, drug administration conditions, informed consent and undue influence. Our findings draw attention to the history of research abuses against people of colour in Western psychedelic research. In light of these findings, we urge a call-to-action to current psychedelic researchers to prioritise culturally inclusive and socially responsible research methods in current and future studies.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107262
      Issue No: Vol. 48, No. 10 (2022)
       
  • Ethics of split liver transplantation: should a large liver always be
           split if medically safe'

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      Authors: Kim, T. W; Roberts, J, Strudler, A, Tayur, S.
      Pages: 738 - 741
      Abstract: Split liver transplantation (SLT) provides an opportunity to divide a donor liver, offering transplants to two small patients (one or both could be a child) rather than keeping it whole and providing a transplant to a single larger adult patient. In this article, we attempt to address the following question that is identified by the Organ Procurement and Transplant Network and United Network for Organ Sharing: ‘Should a large liver always be split if medically safe'’ This article aims to defend an answer—‘not always’—and clarify under what circumstances SLT is ethically desirable. Our answer will show why a more dynamic approach is needed to the ethics of SLT. First, we discuss a case that does not need a dynamic approach. Then, we explain what is meant by a dynamic approach and why it is needed.
      Keywords: Open access
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107400
      Issue No: Vol. 48, No. 10 (2022)
       
  • A note on psychological continuity theories of identity and
           neurointerventions

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      Authors: Holmen; S. J.
      Pages: 742 - 745
      Abstract: An important concern sometimes voiced in the neuroethical literature is that swift and radical changes to the parts of a person’s mental life essential for sustaining his/her numerical identity can result in the person ceasing to exist—in other words, that these changes may disrupt psychological continuity. Taking neurointerventions used for rehabilitative purposes as a point of departure, this short paper argues that the same radical alterations of criminal offenders’ psychological features which under certain conditions would result in a disruption of numerical identity (and, thus, the killing of the offender) can be achieved without these having any effect on numerical identity. Thus, someone interested in making radical alterations to offenders’ psychology can avoid the charge that this would kill the offenders, while still achieving a radical transformation of them. The paper suggests that this possibility makes the question of what kinds of qualitive alterations to offenders’ identity are morally permissible (more') pressing, but then briefly highlights some challenges for arguments against making radical qualitative identity alterations to offenders.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107492
      Issue No: Vol. 48, No. 10 (2022)
       
  • Physician moral injury in the context of moral, ethical and legal codes

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      Authors: Day, P; Lawson, J, Mantri, S, Jain, A, Rabago, D, Lennon, R.
      Pages: 746 - 752
      Abstract: After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to ‘burnout’, there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how—if at all—this changes anything.The current research seeks to develop the construct of moral injury outside military contexts, generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107225
      Issue No: Vol. 48, No. 10 (2022)
       
  • 'First Do No Harm: physician discretion, racial disparities and opioid
           treatment agreements

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      Authors: Beck, A. S; Svirsky, L, Howard, D.
      Pages: 753 - 758
      Abstract: The increasing use of opioid treatment agreements (OTAs) has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the current way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2020-107030
      Issue No: Vol. 48, No. 10 (2022)
       
  • Physician perspectives on placebo ethics

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      Authors: Bliamptis, J; Barnhill, A.
      Pages: 759 - 763
      Abstract: Clinical use of placebos is controversial among bioethicists. While placebos have been shown to provide benefit for patients with some conditions, offering placebos to patients without disclosing that they are placebos raises ethical concerns, including the concern that this lack of transparency about the nature of placebos amounts to deceiving patients. Some have proposed open-label placebos (OLPs) as an ethically preferable alternative: patients are offered placebos and told that the treatment being offered is a placebo. To contribute to the ongoing discussion about the ethics and feasibility of clinical use of placebos, we conducted focus groups to explore physician attitudes about clinical use of placebos, including non-disclosed and OLPs, and physician attitudes about the underlying ethical issues. We found that while the non-transparency and deceptiveness of offering non-disclosed placebos was a concern for some physicians, their primary focus when considering both non-disclosed and OLPs was identifying and weighing potential harms and benefits to patients. Some participants also felt further research and training in prescribing OLPs would be needed before they would be willing to use them in their practice.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107446
      Issue No: Vol. 48, No. 10 (2022)
       
  • Defining the undefinable: the black box problem in healthcare artificial
           intelligence

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      Authors: Wadden; J. J.
      Pages: 764 - 768
      Abstract: The ‘black box problem’ is a long-standing talking point in debates about artificial intelligence (AI). This is a significant point of tension between ethicists, programmers, clinicians and anyone else working on developing AI for healthcare applications. However, the precise definition of these systems are often left undefined, vague, unclear or are assumed to be standardised within AI circles. This leads to situations where individuals working on AI talk over each other and has been invoked in numerous debates between opaque and explainable systems. This paper proposes a coherent and clear definition for the black box problem to assist in future discussions about AI in healthcare. This is accomplished by synthesising various definitions in the literature and examining several criteria that can be extrapolated from these definitions.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107529
      Issue No: Vol. 48, No. 10 (2022)
       
  • Reflections of methodological and ethical challenges in conducting
           research during COVID-19 involving resettled refugee youth in Canada

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      Authors: Salam, Z; Nouvet, E, Schwartz, L.
      Pages: 769 - 773
      Abstract: Research involving migrant youth involves navigating and negotiating complex challenges in order to uphold their rights and dignity, but also all while maintaining scientific rigour. COVID-19 has changed the global landscape within many domains and has increasingly highlighted inequities that exist. With restrictions focusing on maintaining physical distancing set in place to curb the spread of the virus, conducting in-person research becomes complicated. This article reflects on the ethical and methodological challenges encountered when conducting qualitative research during the pandemic with Syrian migrant youth who are resettled in Canada. The three areas discussed from the study are recruitment, informed consent and managing the interviews. Special attention to culture as being part of the study’s methodology as an active reflexive process is also highlighted. The goal of this article is to contribute to the growing understanding of complexities of conducting research during COVID-19 with populations which have layered vulnerabilities, such as migrant youth. This article hopes that the reflections may help future researchers in conducting their research during this pandemic by being cognizant of both the ethical and methodological challenges discussed.
      Keywords: COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107291
      Issue No: Vol. 48, No. 10 (2022)
       
  • Privacy, autonomy and direct-to-consumer genetic testing: a response to
           Vayena

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      Authors: van Oosterum; K.
      Pages: 774 - 775
      Abstract: In Vayena’s article, ‘direct-to-consumer (DTC) genomics on the scales of autonomy’, she claims that there may be a strong autonomy-based argument for permitting DTC genomic services. In this response, I point out how the diminishment of one’s genetic privacy can cause a relevant autonomy-related harm which must be balanced against the autonomy-related gains DTC services provide. By drawing on conceptual connections between privacy and the Razian conception of autonomy, I show that DTC genetic testing may decrease the range of valuable options individuals possess, which impacts the extent to which would-be consumers can exercise their autonomy.
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107999
      Issue No: Vol. 48, No. 10 (2022)
       
  • COVID-19 vaccination status should not be used in triage tie-breaking

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      Authors: Schuman, O; Robertson-Preidler, J, Bibler, T. M.
      Pages: 776 - 778
      Abstract: This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status.
      Keywords: COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107836
      Issue No: Vol. 48, No. 10 (2022)
       
  • Lord Sumption and the values of life, liberty and security: before and
           since the COVID-19 outbreak

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      Authors: Coggon; J.
      Pages: 779 - 784
      Abstract: Lord Sumption, a former Justice of the Supreme Court, has been a prominent critic of coronavirus restrictions regulations in the UK. Since the start of the pandemic, he has consistently questioned both the policy aims and the regulatory methods of the Westminster government. He has also challenged rationales that hold that all lives are of equal value. In this paper, I explore and question Lord Sumption’s views on morality, politics and law, querying the coherence of his broad philosophy and his arguments regarding coronavirus regulations with his judicial decision in the assisted-dying case of R (Nicklinson) v Ministry of Justice. In Nicklinson, Lord Sumption argued for restrictions on liberty given the priority of the sanctity of life principle and the protection of others who may be vulnerable, as well as for deference to policy-making institutions in instances of values-based disagreement. The apparent inconsistencies in his positions, I argue, are not clearly reconcilable, and invite critical analysis of his impacts on health law and policy.
      Keywords: Open access, COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107332
      Issue No: Vol. 48, No. 10 (2022)
       
  • Patients, clinicians and open notes: information blocking as a case of
           epistemic injustice

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      Authors: Blease, C; Salmi, L, Rexhepi, H, Hägglund, M, DesRoches, C. M.
      Pages: 785 - 793
      Abstract: In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (‘open notes’). However, even in countries that have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety.
      Keywords: Open access
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107275
      Issue No: Vol. 48, No. 10 (2022)
       
  • Should coronavirus policies remain in place to prevent future paediatric
           influenza deaths'

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      Authors: Perdomo; D.
      Pages: 794 - 796
      Abstract: The 2019–2020 to 2020–2021 influenza seasons in the USA saw a dramatic 99.5% decrease in paediatric mortality, with only one influenza death recorded during the latter season. This decrease has been attributed to a substantial reduction in transmission, resulting from the various restrictive measures enacted during the COVID-19 pandemic, onset March 2020. The relative disappearance of influenza raises specific policy questions, such as whether these measures should be kept in place after COVID-19 transmission reaches acceptable levels or herd immunity is achieved. Given the nature of these measures as liberty restricting, it is worth discussing their intended outcome and what values they promote. Do these measures in fact promote health, or simply give the comfort of safety while undermining long-term health and individual liberties' I argue that the year-long endurance of the pandemic well into 2021 may have flattened our value landscape into one where health reigns supreme. Discussions are underway regarding whether we should modify previously accepted health risks, such as the risk of contracting influenza. In this paper, I attempt to clarify the values that motivate our policies and discuss how our present historical context has appreciated the value of health. I also provide an analysis of various pandemic policies and their relation to influenza paediatric deaths. Ultimately, the cost of certain measures on values such as education, socialisation and liberty, among others, is too high to justify their use beyond regulating the spread of COVID-19.
      Keywords: COVID-19
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/medethics-2021-107982
      Issue No: Vol. 48, No. 10 (2022)
       
  • Ethics briefing

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      Authors: Mussell, R; Brannan, S, Harrison, C. A, Sheather, J. C, English, V.
      Pages: 797 - 798
      Abstract: The Tavistock and Portman NHS Foundation Trust - Cass Review and potential further legal action In previous Ethics briefings1 we have highlighted the developments in the case of Bell & Another v the Tavistock and Portman NHS Foundation Trust. The case concerned a judicial review of the practice of prescribing puberty blocking treatment to children and young people at the Gender Identity Development Service (GIDS) managed by the Tavistock and Portman NHS Foundation Trust (the Trust). The Court of Appeal in its judgement2 found the Trust’s practices to be lawful, and overturned previous guidance given by the High Court which had contradicted the 'Gillick principle' regarding whether a child or young person could consent to medical treatment, without the consent of its parent. Despite this legal success, concerns over the GIDS continued. In September, NHS England commissioned an independent and wide-ranging review of gender...
      PubDate: 2022-09-28T07:15:13-07:00
      DOI: 10.1136/jme-2022-108608
      Issue No: Vol. 48, No. 10 (2022)
       
 
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