Biomedical Ethics

Background: Body touch and close physical proximity are inevitable in some healthcare procedures and can evoke feelings of shame, humiliation, and anger in patients. Given the increasing recognition of human dignity, exploring the occurrence of these negative emotional experiences and identifying mechanisms for their prevention are crucial.Aim: To develop and define the concept of “patient’s sexual dignity discomfort.” Design: A hybrid model of concept development was utilized.Methods: In the theoretical phase, a scoping review was conducted to establish a working definition (...) of patient’s sexual dignity discomfort. This definition was refined and validated using qualitative data collected during the fieldwork phase. In the analytical phase, a final conceptual model of patient’s sexual dignity discomfort was proposed by integrating findings from both the theoretical and fieldwork phases.Ethical considerations: All participants completed an informed consent process, and interviews were conducted via Zoom or phone by a certified psychiatric nurse to ensure confidentiality, anonymity, and comfort.Results: Four themes describing attributes of patient’s sexual dignity discomfort were explored: experiencing shame and embarrassment, vulnerability-induced loss of control, dehumanization and objectification, and uncertain sexual autonomy. Patient’s sexual dignity discomfort occurs when patients perceive care procedures as sexually inappropriate or as involving unnecessary sexual activity, particularly when healthcare providers display unprofessional attitudes or when patients lack consent or are not mentally prepared for the procedure because of insufficient information. This discomfort leads patients to refuse or avoid healthcare treatments and prioritize finding better healthcare services over their health. It can also prompt providers to avoid patients, resulting in a compromised quality of care and poor health outcomes.Conclusions: Patient’s sexual dignity discomfort poses a significant threat to the quality of patient care and preservation of dignity. Nurses can trigger this intentionally or unintentionally, highlighting the need for comprehensive education and training to prevent it. (shrink)

Background Nursing professional values form the basis of nursing interventions and serve as a guide for professional practice, reflecting in all interactions with patients and other healthcare professionals. As nursing professional values constitute powerful influencers in nursing practice, a strong commitment to these values is essential for nursing students to provide high-quality care. Aim To evaluate the impact of high-fidelity simulation training on first-year nursing students’ nursing professional values acquisition. Research design Quasi-experimental study using a longitudinal design with a single (...) group pre- and post-intervention evaluation. Participants and research context 202 first-year nursing students at the Complutense University of Madrid (Spain) participated in the study between September 2023 and May 2024. Their nursing professional values were compared at baseline and after the simulation experience using the “Nurses Professional Values Scale-Revised” (NVPS-R). The acquisition of these values was also evaluated using a verification list during simulation sessions. Five simulated scenarios recreated ethics dilemmas, where students should manage conflictive situations with a standardized patient. Ethical considerations The study was approved by the Research Ethics Committee from the Complutense University of Madrid (reference code: CE_20231116_18_SAL). Results Most of the students (84.87%) acquired the nursing professional values needed to manage adequately simulated ethical dilemmas. Nursing students significantly improved their nursing professional values after the simulation sessions. The effect size was medium for the “professional expertise” and “professional mastery” dimensions, and the total score of NVPS-R, whereas the obtained effect size was small for the “ethics” dimension. Conclusion High-fidelity simulation training using standardized patients allows first-year nursing students to acquire and improve nursing professional values. The inclusion of simulation training programs in nursing study plans to foster nursing professional values is needed to train undergraduate nursing students, providing them with the necessary ethical concepts and principles for their future clinical practice and ensuring high-quality care. (shrink)

The snub-nosed, reclining, and serene image of the fetus is commonplace in cultural representations and analyses of obstetric ultrasound. Yet following the provocation of various feminist scholars, taking the fetal sonogram as the automatic object of concern vis-à-vis ultrasound cedes ground to anti-abortionists, who deploy fetal images to argue that life begins at conception and that the unborn are rights bearing subjects who must be protected. How might feminists escape this analytical trap, where discussions of ultrasonics must always be engaged (...) in the act of debunking? This article orients away from the problem of fetal representation by employing a method which may appear to be wildly unsuitable: media archaeology. Media archaeologists typically reject the body and the human sensory apparatus as the default subject of media and argue that the interpretive methods of the humanities are incapable of accounting for the ontology of machines. I propose, however, that media archaeological methods provide a necessary vocabulary to attend to obstetric ultrasound outside of iconography. I develop and deploy a media archaeological method that integrates feminist concerns—including advocation of subjugated persons and the making visible of maligned subjects—to examine the ultrasonic experiments performed by gynecologist Ian Donald on working-class Glaswegian women during the 1950s and 1960s, ultimately arguing that, in the case of ultrasound, there can be no separation between technical process and the historically situated body. (shrink)

In this paper, we take a data-driven approach to analyse intellectual trends over the first five decades of theJournal of Medical Ethics(JME). Our data set, comprising all texts published in theJMEsince 1975, reveals not only the most distinctive topics of theJMEin comparison to other key journals with similar profiles but also diachronic fluctuations in the prominence of certain topics. Overall, the distribution of topics shifted gradually, with each editorial period at theJMEshowing continuity with its immediate predecessor. However, a significant drift (...) in topic distribution is evident over the 50 years, with some editorial periods being more ‘disruptive’ than others. These disruptions were influenced by external events (eg,Public health emergencies), broader trends in bioethics (eg, the recent growth of topics such asRace,PrivacyandVaccination) or editors’ preferences (eg,Ethics education). Additionally, our data provides insights into editorials where editors outlined their visions for the journal or reflected retrospectively on their past editorship. (shrink)

The ‘tobacco-free generation’ policy, which bans cigarette sales based on birth year, presents a bold public health initiative but raises significant ethical and practical concerns. As behaviours like drug use become legal and criminal penalties are reduced, singling out smoking for generational restriction appears inconsistent within an increasingly permissive society. Kniess1 critiques this approach for creating inequities by selectively limiting freedoms, conflicting with principles of fairness and adult autonomy. A more balanced public health strategy could involve uniform restrictions on harmful (...) substances or prioritising informed personal choice, supported by harm reduction and education to encourage healthier alternatives. The generational smoking ban targets specific birth cohorts, prohibiting tobacco sales to those born after a certain year. Unlike universal bans, it creates two distinct adult classes—those permitted to smoke and those who are not—resulting in an apparently arbitrary division. Critics, including Schmidt,2 point to the ethical inconsistency of restricting liberties for some while leaving others untouched. This policy design has been defended as a pragmatic compromise, aiming to protect future generations without infringing on the established habits of current smokers (Grill and Voigt).3 Kniess1 evaluates this selective restriction through relational egalitarianism which emphasises the importance of equal social relationships. The cut-off, …. (shrink)

Cohen and Marks (2025) discuss medical exceptionalism within the context of psychedelic access pathways, noting that the medical model is just one of many possible approaches to using, understandin...

In their target article, Cohen and Marks (2025) argue that recognizing something as exceptional is a contextual matter. The authors consider the question of whether psychedelics are exceptional by...

In their article “Psychedelic Medicine Exceptionalism,” Cohen and Marks (2025) aim to chart a middle course between two extreme positions—the Scylla and Charybdis of psychedelic “exceptionalism” an...

In their contribution to the rapidly developing field of research on psychedelic medicine, Glenn Cohen and Mason Marks shed light on a frequently overlooked but critical aspect of ethical considera...

The role of touch in psychotherapy has been a topic of debate for several decades, now gaining renewed salience with the (re-)emergence of psychedelic-assisted therapy (P-AT), where altered states...

On August 9, 2024, the U.S. Food and Drug Administration (FDA) declined to approve Lykos Therapeutics’ application for MDMA-assisted therapy (MDMA-AT), in alignment with the recommendation of its i...

This Special Issue on Psychedelic Ethics highlights that while psychedelic medicine may not be “exceptional” in its therapeutic value and risk (Cohen and Marks 2025), it is “distinctive” in that it...

The presence of unusual features in psychedelic treatments has led to the argument that these treatments are exceptional within medicine and should therefore also be treated as exceptional when ana...

Current research on psychedelic-assisted therapy (PAT) focuses on their potential to treat clinical psychiatric conditions such as treatment-resistant depression, anxiety, and PTSD. Presumably, if...

The recent surge in psychedelic-assisted therapy (PAT) research and anticipated Food and Drug Administration (FDA) approval of MDMA (methylenedioxymethamphetamine) and psilocybin treatments has bro...

Research on psychedelic medicines is experiencing a revival. Some clinicians, scientists, and ethicists believe that psychedelics are so different from other treatments that they warrant special consideration in how they are researched, regulated, commercialized, and administered. Others argue that psychedelic medicines show clinical potential, but they should be treated like other medical interventions. In other words, identical standards should apply. This article analyzes whether psychedelic medicines warrant special consideration from a regulatory and ethical perspective.

Cheung et al. (2025) rightly argue that psychedelics should be subject to ethical and evidentiary standards consistent with clinical medicine at large, rather than exceptionalism based on their uni...

In “Distinctive but not Exceptional: The Risks of Psychedelic Ethical Exceptionalism,” Cheung et al. (2025) elaborate the ways that psychedelics share individual ethical considerations with those o...

The resurgence of psychedelic research has brought with it unique ethical considerations, including the role of personal psychedelic experience among facilitators. Some have argued that personal ps...

Neitzke-Spruill et al. (2025) offer an important overview of the ethical considerations around the use of touch within psychedelic assisted therapies (PAT) and MDMA-assisted therapy (MDMA-AT). Thei...

Pain, as Emily Dickinson aptly described, “has an element of blank.” It is perhaps the most universal human experience, yet even in its most visceral and all-consuming forms, pain defies descriptio...

Drawing on comparisons to genetic exceptionalism, Cheung et al. (2025) reject psychedelic exceptionalism—that psychedelics raise unique concerns regarding increased vulnerability and diminished aut...

Increased interest in psychedelic treatments has raised concern regarding consent and whether it can be sufficiently informed. One source of concern is that psychedelic substances are prone to elic...

The US Food and Drug Administration (2023) recently stated, “Psychedelic drugs have shown initial promise as potential treatments… However, these are still investigational products.” Indeed, there...

“Nobody owns healing, you don’t own our culture. You can’t take it from us. We deserve respect.”-Angela Beers, a person of Indigenous Mexican (Zacatecas and Coahuila) heritage, speaking in protest...

When used clinically, psychedelics may appear unusual or even unique when compared to more familiar or long-standing medical interventions, prompting some to suggest that the ethical issues raised may likewise be exceptional. If that is correct, then perhaps psychedelics should be treated differently from other medical substances: for example, by being subjected to different ethical or evidentiary standards. Alternatively, it may be that psychedelics have more in common with various existing medical interventions than first meets the eye. We argue in (...) favor of the latter position, drawing on parallels from earlier debates around genetic exceptionalism in bioethics. We suggest there are risks to adopting a stance of “psychedelic ethical exceptionalism,” and propose that consistent ethical rules and evidentiary standards should be applied across all relevant areas of clinical medicine. Importantly, this does not preclude the possibility that changes to existing standards should be made; but if so, this should not be justified by appealing to the alleged uniqueness of psychedelics. (shrink)

Psychedelic ethics is at a crossroads. Confronted with the undeniable harm wrought by a widespread embrace of exceptionalism, many are approaching psychedelics not only in the context of urgent men...

Exceptionalism in bioethics generally refers to the idea that a particular medical development or intervention warrants special consideration, either ethically or legally, given its unique features...

The integration of psychedelic substances into modern Western therapeutic practice has sparked a critical examination of many topics including: efficacy of psychedelics to treat mental health diagnoses without psychotherapeutic intervention, what models of therapy to use, and ethical implications related to altered states of consciousness. Of utmost concern are issues of power dynamics leading to incidents of sexual abuse. These issues underscore the importance of understanding therapeutic dynamics within the context of psychedelic-assisted therapy. This paper aims to explore these intersections, (...) addressing sexual abuse issues in Western psychedelic-assisted therapy while elucidating pathways towards ethical practice and regulatory frameworks. (shrink)

As research therapists with hundreds of hours of clinical experience supporting adults with PTSD in Phase 3 trials of MDMA assisted-therapy (MAT), we appreciate the opportunity to respond to this s...

Psychedelics are having a moment. This moment is a good time to assess the story of psychedelics. Psychedelic substances like psilocybin, LSD, and others are at the center of FDA regulation, spirit...

Psychedelic researchers and therapists must contend with the fact that psychedelics are highly scrutinized to a degree that does appear to be problematically exceptional. That said, we believe ther...

In August 2024, The U.S. Food and Drug Administration rejected Lykos Therapeutics, Inc.'s new drug application for midomafetamine with psychological intervention (MDMA-AT) to treat post-traumatic stress disorder (PTSD). Among the many issues raised during review was concern about a highly publicized case of alleged sexual misconduct by an unlicensed therapist during a Phase 2 study of MDMA and the potential risk of future abuse. This incident of misconduct, along with several other publicized cases of misconduct by guides, facilitators, and shaman (...) offering psychedelic retreats, has raised the question of whether physical contact is ever appropriate during psychedelic-assisted therapy (PAT). Drawing on research about supportive touch in other clinical contexts and taking into consideration features of psychedelics that exacerbate the potential for harm associated with supportive touch, we advocate for a precautionary approach to harm-reduction while arguing that supportive touch ought not be thrown out whole-cloth. (shrink)

“Ethical exceptionalism” is often used as a pejorative shrouded in a superlative. The charge of wrongly treating similar things differently—for varying motives—has been leveled against exceptional...

Mind Lumen (a non-profit) is an ethics-focused education, research, and policy advocacy organization. We also create tools to make ethics observable, measurable, and auditable.As a neurodivergent I...

As Cohen and Marks (2025) focus their discussion of psychedelic exceptionalism and ethics in the regulatory arena, they rightfully explain that psychedelic exceptionalism also appears in other cont...

We thank the authors of the OPCs for taking the time to respond to our article and for the thoughtful contributions which have re-energized our considerations of this important topic. This dialogue...

This correspondence piece responds to commentaries on the authors' survey of U.S. bioethicists. The authors address two key questions: the definition of a bioethicist and how bioethics should evolve. They identify four distinct roles bioethicists occupy: researchers, pedagogues, consultants, and advocates/activists. The article examines various aspects of inclusiveness in bioethics - demographic, viewpoint, methodological, and topical - while acknowledging inherent tensions and trade-offs between them. For example, including religiously or geographically diverse voices may conflict with other inclusivity goals. The authors (...) argue that while demographic inclusiveness is crucial, other forms of inclusiveness require careful consideration of trade-offs and empirical research to assess their impacts. They emphasize the need for systematic research on bioethicists' beliefs and reasoning, particularly regarding complex issues like disability and racial health disparities. The piece concludes by calling for continued dialogue and better funding for empirical research on ethical perspectives across different groups. (shrink)

Several disturbing trends in recent years seem to be endangering the future of bioethics book publishing. One striking feature of the last two meetings of the American Society for Bioethics and the...

The paper offers a critical response to the proposed “dis/analogy” between the restriction of Jehovah's Witness parental right to refuse life‐saving blood transfusions for their minor children and a “general” and “permanent” ban on “unnecessary” pediatric intersex surgery. The main argument of the analogy is “securing the patient's future autonomy.” Feinberg's theory of rights is used to demonstrate that the proposed analogy is untenable. A new category of developmental rights‐in‐trust is introduced to address specific needs of gender development in DSD (...) situations. Both premises are disputed. First, it is shown that the case of overriding Jehovah's Witness parental rights is not based on securing the patient's future autonomy, but a simple dependency right in Feinberg's theory. Second, it is demonstrated that pediatric intersex surgery is not in the same situation in all morally relevant respects as the Jehovah's Witness case because it represents a special type of developmental right‐in‐trust. In conclusion, the arguments based on the proposed analogy do not justify a “general and permanent” on pediatric intersex surgery. (shrink)

The continental tradition in ethics and philosophy of technology provides a useful differentiation between “system” and “lifeworld” imperatives (Ihde 1990). Behaviors toward system components admit...

Julia Knopes’s study (2025) provides a constructive contribution to neuroethics, demonstrating that individuals in peer support networks understand their mental health conditions in terms that draw...

In their article, Ineichen and Glannon (2025) explore the therapeutic benefits of Deep Brain Stimulation (DBS), addressing the complexities of targeting certain psychiatric conditions and the limit...

Julia Knopes (2025) claims that peer providers are drawing from two models of disability, the medical and neurodiversity models, to understand their experiences. I take no issue with Knopes’s claim...

In a recent article, Knopes (2025) examines how mental health peer support providers make use of the medical model and neurodiversity frameworks to better understand and express their mental health...

Julia Knopes’s (2025) article aims to explain how models of disability apply in the lives and experiences of people with lived mental health conditions who serve as peer support providers. However,...

While the term and concept of neurodiversity emerged within autistic communities, it has never been limited to autism. As Knopes reviews, neurodiversity scholars have identified meaningful overlaps...

At the beginning of the century, there was still debate as to whether neuroethics should be a separate discipline or part of bioethics or medical ethics. One argument in favor of the independence o...