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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]
  • Knowing who to trust: women and public health

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      Authors: Auckland; C.
      Pages: 501 - 503
      Abstract: In this issue of the JME, age-old questions around how to balance the interests of mother and fetus are revisited in two separate contexts: alcohol consumption during pregnancy, and maternal request caesarean sections. Both have been the subject of recent controversy in the UK, with March 2022 seeing the introduction of (contentious) new National Institute for Clinical Excellence (NICE) Quality Standards on combatting foetal alcohol spectrum disorder (FASD)1; and the publication of the long-awaited Ockenden Review into a series of failures in NHS maternity care.2 Both raise important questions about the role of healthcare professionals in policing women’s choices during pregnancy and childbirth, and of the importance of deference to and trust in those choices. In this issue’s Feature Article, Rebecca Bennett and Catherine Bowden explore recent proposals to enhance the screening of pregnant women in order to prevent instances of fetal alcohol spectrum disorder...
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/jme-2022-108490
      Issue No: Vol. 48, No. 8 (2022)
       
  • Ethical decision making during a healthcare crisis: a resource allocation
           framework and tool

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      Authors: Guidolin, K; Catton, J, Rubin, B, Bell, J, Marangos, J, Munro-Heesters, A, Stuart-McEwan, T, Quereshy, F.
      Pages: 504 - 509
      Abstract: The COVID-19 pandemic has strained healthcare resources the world over, requiring healthcare providers to make resource allocation decisions under extraordinary pressures. A year later, our understanding of COVID-19 has advanced, but our process for making ethical decisions surrounding resource allocation has not. During the first wave of the pandemic, our institution uniformly ramped-down clinical activity to accommodate the anticipated demands of COVID-19, resulting in resource waste and inefficiency. In preparation for the second wave, we sought to make such ramp down decisions more prudently and ethically. We report the development of a tool that can be used to make fair and ethical decisions in times of resource scarcity. We formed an interprofessional team to develop and use this tool to ensure that a diverse range of stakeholder perspectives were represented in this development process. This team, called the clinical activity recovery team, established institutional objectives that were combined with well-established procedural values, substantive ethical principles and decision-making criteria by using a variation on the well-known accountability for reasonableness ethical framework. The result of this is a stepwise, semiquantitative, ethical decision tool that can be applied to resource allocation challenges in order to reach fair and ethically defensible decisions. This ethical decision tool can be applied in various contexts and may prove useful at both the institutional and the departmental level; indeed this is how it is applied at our centre. As the second wave of COVID-19 strains healthcare resources, this tool can help clinical leaders to make fair decisions.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107255
      Issue No: Vol. 48, No. 8 (2022)
       
  • Priority vaccination for mental illness, developmental or intellectual
           disability

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      Authors: Shevzov-Zebrun, N; Caplan, A. L.
      Pages: 510 - 511
      Abstract: Coronavirus vaccines have made their debut. Now, allocation practices have stepped into the spotlight. Following Centers for Disease Control and Prevention guidelines, states and healthcare institutions initially prioritised healthcare personnel and elderly residents of congregant facilities; other groups at elevated risk for severe complications are now becoming eligible through locally administered programmes. The question remains, however: who else should be prioritised for immunisation' Here, we call attention to individuals institutionalised with severe mental illnesses and/or developmental or intellectual disabilities—a group highly susceptible to the damages of COVID-19, recent research shows, and critical to consider for priority vaccination. The language describing both federal-level and state-level intentions for this population remains largely vague, despite the population’s diversity across age, diagnosis, functional status and living arrangement. Such absence of specificity, in turn, leaves room for confusion and even neglect of various subgroups. We review data stressing this group’s vulnerability, as well as select state plans for priority vaccination, highlighting the importance of clarity when describing intentions to vaccinate, or even generally care for, diverse populations composed of distinct subgroups in need.
      Keywords: COVID-19
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107247
      Issue No: Vol. 48, No. 8 (2022)
       
  • Can routine screening for alcohol consumption in pregnancy be ethically
           and legally justified'

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      Authors: Bennett, R; Bowden, C.
      Pages: 512 - 516
      Abstract: In the UK, it has been proposed that alongside the current advice to abstain from alcohol completely in pregnancy, there should be increased screening of pregnant women for alcohol consumption in order to prevent instances of fetal alcohol spectrum disorder. The Scottish Intercollegiate Guidelines Network published guidelines in 2019 recommending that standardised screening questionnaires and associated use of biomarkers should be considered to identify alcohol exposure in pregnancy. This was followed in 2020 by the National Institute for Health and Care Excellence Draft Quality Standard, which recommended that pregnant women should have information on their alcohol consumption recorded throughout their pregnancy and this information transferred to the child’s health records. Most recently, Public Health England has stated that the alcohol intake of all women should be recorded throughout pregnancy, not just at the initial booking appointment and that tools such as blood biomarkers and meconium testing should be researched in order to determine true prevalence rates of alcohol in pregnancy. We argue that this proposed enhanced screening undermines women’s autonomy and their legal right to be sufficiently informed to consent to screening. We argue that there is no evidence that this kind of screening will result in a reduction of fetal harm and there is a danger that undermining the autonomy of women and the trust relationship between women and healthcare professionals may even increase harm to future children.
      Keywords: Editor's choice
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107996
      Issue No: Vol. 48, No. 8 (2022)
       
  • Junior doctors and conscientious objection to voluntary assisted dying:
           ethical complexity in practice

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      Authors: McDougall, R. J; White, B. P, Ko, D, Keogh, L, Willmott, L.
      Pages: 517 - 521
      Abstract: In jurisdictions where voluntary assisted dying (VAD) is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture.
      Keywords: Open access
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2020-107125
      Issue No: Vol. 48, No. 8 (2022)
       
  • Healthcare students support opt-out organ donation for practical and moral
           reasons

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      Authors: Qian, L; Li, M. T, King, K. L, Husain, S. A, Cohen, D. J, Mohan, S.
      Pages: 522 - 529
      Abstract: Background and purposeChanges to deceased organ donation policy in the USA, including opt-out and priority systems, have been proposed to increase registration and donation rates. To study attitudes towards such policies, we surveyed healthcare students to assess support for opt-out and priority systems and reasons for support or opposition.MethodsWe investigated associations with supporting opt-out, including organ donation knowledge, altruism, trust in the healthcare system, prioritising autonomy and participants’ evaluation of the moral severity of incorrectly assuming consent in opt-in systems (‘opt-in error’) or opt-out systems (‘opt-out error’), by conducting an online survey among healthcare students at a large academic institution.ResultsOf 523 respondents, 86% supported opt-out, including 53% who strongly supported the policy. The most popular reason for supporting opt-out was the potential for increased donation rates, followed by convenience for those not registered but willing to donate. The most popular reason for opposing opt-out was the belief that presuming consent is morally wrong. Those strongly supporting opt-out viewed the opt-in error as more morally unacceptable, and had higher knowledge and altruism scores. Those opposing opt-out viewed the opt-out error as more unacceptable, and had higher autonomy scores. 48% of respondents supported priority within opt-in systems; 31% supported priority in opt-out.ConclusionsThere is strong support for opt-out organ donation among healthcare students, influenced by both practical and moral considerations.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2020-107053
      Issue No: Vol. 48, No. 8 (2022)
       
  • COVID-19 conscience tracing: mapping the moral distances of coronavirus

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      Authors: Shaw; D.
      Pages: 530 - 533
      Abstract: One of the many problems posed by the collective effort to tackle COVID-19 is non-compliance with restrictions. Some people would like to obey restrictions but cannot due to their job or other life circumstances; others are not good at following rules that restrict their liberty, even if the potential consequences of doing so are repeatedly made very clear to them. Among this group are a minority who simply do not care about the consequences of their actions. But many others fail to accurately perceive the harms that they might be causing. One of the main reasons for this is that the harms done by transmitting COVID-19 to someone else are morally distant from the agent, particularly in cases where infection is asymptomatic. In this paper, I describe seven different aspects of moral distance in the context of COVID-19, explore how they affect (lack of) motivation to obey restrictions, and suggest several ways in which such moral distance can be reduced — primarily through enhanced-contact tracing that makes it clear to individuals and the public precisely who they could be harming and how.
      Keywords: COVID-19
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107326
      Issue No: Vol. 48, No. 8 (2022)
       
  • COVID-19 vaccination and the right to take risks

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      Authors: Huang; P.-h.
      Pages: 534 - 537
      Abstract: The rare but severe cerebral venous thrombosis occurring in some AstraZeneca vaccine recipients has prompted some governments to suspend part of their COVID-19 vaccination programmes. Such suspensions have faced various challenges from both scientific and ethical angles. Most of the criticisms against such suspensions follow a consequentialist approach, arguing that the suspension will lead to more harm than benefits. In this paper, I propose a rights-based argument against the suspension of the vaccine rollouts amid this highly time-sensitive combat of COVID-19. I argue that by suspending a vaccine rollout, a government infringes people’s right to take the risks they deem worth taking for their health. I also consider four potential objections to my argument and explain why none of them undermines my argument.
      Keywords: Open access, COVID-19
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107545
      Issue No: Vol. 48, No. 8 (2022)
       
  • Why we should not 'just use age for COVID-19 vaccine prioritisation

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      Authors: Smith; M. J.
      Pages: 538 - 541
      Abstract: Older age is one of the greatest risk factors for severe outcomes from COVID-19. If we believe it is important to use limited supplies of COVID-19 vaccines to protect the most vulnerable and prevent deaths, then available doses should be allocated with significant priority to older adults. Yet, we should resist the conclusion that age should be the sole criterion for COVID-19 vaccine prioritisation or that no younger populations (eg, those under the age of 60) should be prioritised until all older adults have been vaccinated. This article examines arguments that are commonly presented to abandon ‘complex’ vaccine prioritisation schemes in favour of ‘just using age’ (eg, prioritising those 80 years of age and older and then decreasing in a 5-year age bands until the entire population has had the opportunity to be vaccinated), and articulates the ethical reasons why these arguments are not persuasive.
      Keywords: Open access, COVID-19
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107443
      Issue No: Vol. 48, No. 8 (2022)
       
  • The Judgment of the German Federal Constitutional Court regarding assisted
           suicide: a template for pluralistic states'

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      Authors: Wiesing; U.
      Pages: 542 - 546
      Abstract: The article presents the judgment of the German Federal Constitutional Court from 26 February 2020 on assisted suicide. The statements regarding human dignity, human rights and the relationship between citizens and the state are examined. Furthermore, the consequences resulting from this interpretation of human dignity for states that are pluralistic and based on human rights will be laid out. The court’s judgment limits the power of parliaments and poses a challenge to many laws in states that see themselves as pluralistic, human rights-based states.
      Keywords: Open access
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107233
      Issue No: Vol. 48, No. 8 (2022)
       
  • Are conscientious objectors morally obligated to refer'

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      Authors: Reis-Dennis, S; Brummett, A. L.
      Pages: 547 - 550
      Abstract: In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of female genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2020-107025
      Issue No: Vol. 48, No. 8 (2022)
       
  • In defence of newborns: a response to Kingma

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      Authors: Colgrove; N.
      Pages: 551 - 553
      Abstract: Recently, I argued that subjects inside of artificial wombs—termed ‘gestatelings’ by Romanis—share the same legal and moral status as newborns (neonates). Gestatelings, on my view, are persons in both a legal and moral sense. Kingma challenges these claims. Specifically, Kingma argues that my previous argument is invalid, as it equivocates on the term ‘newborn’. Kingma concludes that questions about the legal and moral status of gestatelings remain ‘unanswered’. I am grateful to Kingma for raising potential concerns with the view I have presented. In this essay, however, I argue that (most) of Kingma’s objections are unpersuasive. First, my original argument does not equivocate on terms like ‘newborn’ or ‘neonate’. The terms denote human beings that have been born recently; that is what matters to the argument. Charges of equivocation, I suspect, rest on a confusion between the denotation and connotations of ‘newborn’ (or ‘neonate’). Next, I show that, contra Kingma, it is clear that—under current law in the USA and UK—gestatelings would count as legal persons. Moral personhood is more difficult. On that subject, Kingma’s criticisms have merit. In response, however, I show that my original claim—that gestatelings should count as moral persons—remains true on several (common) philosophical accounts of personhood. Regarding those accounts that imply gestatelings are not moral persons, I argue that advocates face a troubling dilemma. I conclude that regardless of which view of moral personhood one adopts, questions about the moral status of gestatelings are not ‘unanswered’.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107318
      Issue No: Vol. 48, No. 8 (2022)
       
  • Appropriately framing maternal request caesarean section

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      Authors: Romanis; E. C.
      Pages: 554 - 556
      Abstract: In their paper, ‘How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power’, Eide and Bærøe present maternal request caesarean sections (MRCS) as a site of conflict in obstetrics because birthing people are seeking access to a treatment ‘without any anticipated medical benefit’. While I agree with the conclusions of their paper -that there is a need to reform the approach to MRCS counselling to ensure that the structural vulnerability of pregnant people making birth decisions is addressed—I disagree with the framing of MRCS as having ‘no anticipated medical benefit’. I argue that MRCS is often inappropriately presented as unduly risky,without supporting empirical evidence,and that MRCS is most often sought by birthing people on the basis of a clinical need. I argue that there needs to be open conversation and frank willingness to acknowledge the values that are currently underpinning the presentation of MRCS as ‘clinically unnecessary’; specifically there needs to be more discussion of where and why the benefits of MRCS that are recognised by individual birthing people are not recognised by clinicians. This is important to ensure access to MRCS for birthing people that need it.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107806
      Issue No: Vol. 48, No. 8 (2022)
       
  • A world away and here at home: a prioritisation framework for US
           international patient programmes

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      Authors: Berkman, E; Clark, J, Diekema, D, Jecker, N. S.
      Pages: 557 - 565
      Abstract: Programmes serving international patients are increasingly common throughout the USA. These programmes aim to expand access to resources and clinical expertise not readily available in the requesting patients’ home country. However, they exist within the US healthcare system where domestic healthcare needs are unmet for many children. Focusing our analysis on US children’s hospitals that have a societal mandate to provide medical care to a defined geographic population while simultaneously offering highly specialised healthcare services for the general population, we assume that, given their mandate, priority will be given to patients within their catchment area over other patients. We argue that beyond prioritising patients within their region and addressing inequities within US healthcare, US institutions should also provide care to children from countries where access to vital medical services is unavailable or deficient. In the paper, we raise and attempt to answer the following: (1) Do paediatric healthcare institutions have a duty to care for all children in need irrespective of their place of residence, including international patients' (2) If there is such a duty, how should this general duty be balanced against the special duty to serve children within a defined geographical area to which an institution is committed, when resources are strained' (3) Finally, how are institutional obligations manifest in paradigm cases involving international patients' We start with cases, evaluating clinical and contextual features as they inform the strength of ethical claim and priority for access. We then proceed to develop a general prioritisation framework based on them.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2020-106772
      Issue No: Vol. 48, No. 8 (2022)
       
  • #warriors: sick children, social media and the right to an open future

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      Authors: Burn; E.
      Pages: 566 - 571
      Abstract: The phenomenon of ‘sharenting’, whereby a parent shares news and images of their child on social media, is of growing popularity in contemporary society. There is emerging research into children’s attitudes regarding sharenting and their associated concerns regarding privacy; however, this research most often involves young people who are approaching adulthood and are competent to participate. As a result, children who experience illness or disability are largely absent from current research, and as such, the moral permissibility of a parent sharing their child’s illness journey on a public social media platform is largely unexplored. In this essay, I explore this issue by using the United Nations Convention on the Rights of the Child and Joel Feinberg’s principle of the child’s right to an open future as the basis of my argument: that children with illness and disability have the same rights as healthy children to privacy, identity and an open future and that publication of their illness on a social media platform violates these rights. I conclude that parents, as surrogate decision makers for their children, have the same responsibilities in protecting their child’s privacy as they do in making medical decisions on behalf of their children. As children of the social media generation approach adulthood, it is important to consider the rights of those who cannot speak for themselves and the ethical consequences of sharenting for children with illness and disability.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2020-107042
      Issue No: Vol. 48, No. 8 (2022)
       
  • Open notes in patient care: confining deceptive placebos to the past'

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      Authors: Blease, C; DesRoches, C. M.
      Pages: 572 - 574
      Abstract: Increasing numbers of health organisations are offering some or all of their patients access to the visit notes housed in their electronic health records (so-called ‘open notes’). In some countries, including Sweden and the USA, this innovation is advanced with patients using online portals to access their clinical records including the visit summaries written by clinicians. In many countries, patients can legally request copies of their records; however, open notes are different because this innovation offers patients rapid, real-time access via electronic devices. In this brief report, we explore what open notes might mean for placebo use in clinical care. Survey research into patient access to their clinical notes shows that increased transparency enhances patients’ understanding about their medications and augments engagement with their care. We reflect on the consequences of access for placebo prescribing, particularly for the common practice of deceptive placebo use, in which patients are not aware they are being offered a placebo. In addition, we explore how open notes might facilitate placebo and nocebo effects among patients. Bridging placebo studies with medical ethics, we identify a range of empirical research gaps that now warrant further study.
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/medethics-2021-107746
      Issue No: Vol. 48, No. 8 (2022)
       
  • Ethics briefing

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      Authors: Mussell, R; Brannan, S, Harrison, C. A, English, V, Sheather, J. C.
      Pages: 575 - 576
      Abstract: UK proposals for ‘offshoring’ asylum seekers to Rwanda Legal battles continue in the UK over the Government’s plans to transport asylum seekers arriving on British shores to Rwanda in East Africa. Originally announced as a system for ‘processing’ asylum seekers, the Government has subsequently made it clear that there would not be an option for asylum seekers to return to the UK. The arrangement forms part of a deal between the UK and Rwanda, with the UK promising to invest £120 m in economic growth and development in Rwanda, along with financing the cost of the ‘offshored’ asylum operation.1 The Government states that the policy is designed to break the business model of people traffickers involved in facilitating hazardous trips across the Channel in small, overcrowded and unseaworthy craft, leading to multiple drownings. Critics argue that the policy will do nothing to stop desperate people from seeking...
      PubDate: 2022-07-22T06:57:49-07:00
      DOI: 10.1136/jme-2022-108507
      Issue No: Vol. 48, No. 8 (2022)
       
 
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