Artificial intelligence (AI) and its introduction into clinical pathways presents an array of ethical issues that are being discussed in the JME. 1–7 The development of AI technologies that can produce text that will pass plagiarism detectors 8 and are capable of appearing to be written by a human author 9 present new issues for medical ethics. One set of worries concerns authorship and whether it will now be possible to know that an author or student in fact produced submitted (...) work. That seems likely to be a general worry for secondary and higher education, as well as for all academic journals. Thus far generative AI chatbots do not seem to be able to produce a fully referenced and well-argued ethics article, but they probably could generate a blog or student essay that would... (shrink)

The first editorial in the Journal of Medical Ethics described an ambition to be a ‘forum for the reasoned discussion of moral issues arising from the provision of medical care’.1 While that statement of intent might seem broad, it is one that has been reaffirmed by successive editors of the journal.2–4 It is an aim that aligns with the mission statement of JME and The Institute of Medical Ethics, to promote ‘ethical reflection and conduct in scientific research and medical conduct.’ (...) It is an end worthy of some reflection because it illuminates how the journal has developed and implies a conception of what good medical ethics is. During his time as editor, Raanan Gillon was a champion for philosophical medical ethics and he wrote an excellent and influential book on that topic.5 In the July issue of JME, Julian Savulescu, Tom Douglas and Dominic Wilkinson affirm the importance of philosophical medical ethics and ably demonstrate why it matters in the Charlie Gard case.6 Does that mean papers published in the JME must be philosophical? In one sense, clearly no and in another yes. Good medical ethics is not philosophy. The degree of scepticism, the narrow focus on a search for truth, the technical nature of some philosophy and it not needing to deliver normative or practical ethical conclusions mean that a narrowly philosophical approach is unlikely to be good medical ethics. JME has never been a narrowly philosophical journal and the perils of this were described well by its first editor: > We therefore intend to put editorial weight behind what we consider to be carefully argued and well informed judgments and not to allow every value …. (shrink)

Psychopathy, as articulated in Hare’s PCL-R, appears to reliably pick out a forensic category of troubled people. This chapter considers the use and utility of PCL-R by focussing upon two interrelated questions. Does philosophical investigation direct attention toward the issues that should interest us about psychopathy? Is being diagnosed as psychopathic or having ASPD clinically useful, as well as for judicial and sentencing purposes? While the research programmes that developed following the attention paid to psychopathy are warranted, more attention could (...) be directed to the varied nature of psychopathy and the presentations of it that Cleckley described in the Mask of Sanity. It is important to understand psychopathy as it affects lives, as well as a forensic problem. (shrink)

The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment have conducted visits and written reports criticising the surgical castration of sex offenders in the Czech Republic and Germany. They claim that surgical castration is degrading treatment and have called for an immediate end to this practice. The Czech and German governments have published rebuttals of these criticisms. The rebuttals cite evidence about clinical effectiveness and point out this is an intervention that must be requested (...) by the sex offender and cannot occur without informed consent. This article considers a number of relevant arguments that are not discussed in these reports but which are central to how we might assess this practice. First, the article discusses the possible ways in which sex offenders could be coerced into castration and whether this is a decisive moral problem. Then, it considers a number of issues relevant to determining whether sex offenders are harmed by physical castration. The article concludes by arguing that sex offenders should not be coerced into castration, be that via threats or offers, but that there is no reason to think that this is occurring in the Czech Republic or Germany. In some cases, castration might be useful for reconfiguring a life that has gone badly awry and where there is no coercion, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment are mistaken about this being degrading treatment. (shrink)

The question of whether any of us can truly be held responsible for what we do is an issue that occupied the ancient Greeks and continues to entertain our leading thinkers. Whether we can be held responsible for our health, or lack thereof, has additional layers of complexity because of the way in which what we do over time impacts our health. Those of us who have ever self-deceptively wondered about the apparent shrinking of our belt or at the fact (...) that the stairs seem to have multiplied are familiar with the idea that our health can change gradually over time as a result of successive choices that we have made. While there are one-off behaviours that can have an impact on health, for example, a single exposure to a very high level of radiation, in general, ill health develops over time, within an environment and complex set of interactions with other people. The implications of that complexity are central to this issue’s Feature Article by Brown and Savulescu.1 They note that there is debate over whether responsibility should play a role in the allocation of healthcare, and, rather than taking a view on that issue, make a number of suggestions about how the concept of responsibility used in healthcare can be enriched by attending to the complex relationship between behaviour and health. …. (shrink)

Many countries are looking back at the pandemic and reflecting on what could have been done better. The UK COVID-19 Inquiry rumbles on 1 and other influential groups such as the British Medical Association have already reviewed the British response to the pandemic and made recommendations about what should happen in the future. 2 The UK is not alone in looking for lessons from the pandemic with a view to preparing for the next one. Countries with a very different COVID-19 (...) experience, such as Australia and New Zealand, have also commenced national inquiries with a view to becoming better prepared for the next pandemic. 3 4 While many of the issues revolve around public health and government responses, there are also profound ethical issues that demand reflection on the conceptual resources we use when responding to new ethical challenges. The _Journal of Medical Ethics_... (shrink)

Policy-makers have attempted to frame the ethical requirements that are relevant to the creation of human beings via reproductive technologies. Various reports and laws enacted in New Zealand, Canada, Australia, and Britain have introduced tests for how we should weigh child welfare when using these technologies. A number of bioethicists have argued that child welfare should be interpreted as a “best interests” test. Others have argued that there are ethical reasons why we should abandon this kind of test. I will (...) argue that at least some of the relevant policy can be interpreted as requiring those wishing to exercise their procreative liberty to have a reasonable plan to care and nurture any resulting child, thereby respecting the internal preconditions of that liberty. This interpretation of child welfare requirements answers some of the ethical worries about a child welfare test. (shrink)

This is the first book that explains how you actually go about doing good bioethics. John McMillan develops an account of the nature of bioethics; he reveals how a number of methodological spectres have obstructed bioethics; and then he shows how moral reason can be brought to bear upon practical issues via an 'empirical, Socratic' approach.

There will always be debates in medical ethics about whether any particular value can be considered foundational, but there are reasons for thinking that ‘trust’ is the ground upon which many other important values is built. Sisela Bok remarks: > If there is no confidence in the truthfulness of others, is there any way to assess their fairness, their intentions to help or to harm? How, then, can they be trusted? Whatever matters to human beings, trust is the atmosphere in (...) which it thrives.1 p31 The idea that trust in what others tell us is the bedrock on which human relationships and other values are built seems plausible, but how trust is created, nurtured and sustained is perhaps the challenge for medical ethics. Annette Baier noted that trust occurs within the context of a relationship of some sort, be that with another person or an institution. > “Trust me!” is for most of us an invitation which we cannot accept at will—either we do already trust the one who says …. (shrink)

John Rawls begins a Theory of Justice with the observation that "Justice is the first virtue of social institutions, as truth is of systems of thought… Each person possesses an inviolability founded on justice that even the welfare of society as a whole cannot override"1 (p.3). The COVID-19 pandemic has resulted in lock-downs, the restriction of liberties, debate about the right to refuse medical treatment and many other changes to the everyday behaviour of persons. The justice issues it raises (...) are diverse, profound and will demand our attention for some time. How we can respect the Rawlsian commitment to the inviolability of each person, when the welfare of societies as a whole is under threat goes to the heart of some of the difficult ethical issues we face and are discussed in this issue of the Journal of Medical Ethics. The debate about ICU triage and COVID-19 is quite well developed and this journal has published several articles that explore aspects of this issue and how different places approach it.2–5 Newdick et al add to the legal analysis of triage decisions and criticise the calls for respecting a narrow conception of a legal right to treatment and more detailed national guidelines for how triage decisions should be made.6 They consider scoring systems for clinical frailty, organ failure assessment, and raise some doubts about the fairness of their application to COVID-19 triage situations. Their argument seems to highlight instances of what is called the McNamara fallacy. US Secretary of Defense Robert McNamara used enemy body counts as a measure …. (shrink)

When Beauchamp and Childress articulated the necessary and sufficient conditions for informed consent, they might have thought that would be the final word on what informed consent is.1 It’s emphasis in the Belmont Report,2 the Nuremberg Code,3 the Helsinki Declaration4 and numerous codes of professional ethics seems more than sufficient for emphasising its importance. Nonetheless, its place as the central issue for medical ethics appears undiminished and Pubmed lists 6192 publications with ‘Informed Consent’ in the title since 1979. One view (...) of this is that medical ethics has channelled too much intellectual effort into consent, perhaps at the expense of other important ethical issues. Papers in this issue of the Journal of Medical Ethics suggest that the discussion of consent continues because of the need to consider what it means in new contexts, how it can be a challenge in some contexts, how it is related to tough theoretical issues about the value of choice and autonomy and how it can blend into other debates. The development of biobanking and the challenges it presents about which variant of consent should apply have been discussed in the JME before. One option is for consent to be ‘broad’, meaning that when consent is given for the collection of tissue the ‘type’ of future secondary uses are specified but not the specific research studies, on the basis that the potential benefits are significant, the risks low and the costs of gaining consent for every use of tissue significant. Hofmann has argued against broad consent on the basis that being ‘informed’ is a crucial aspect of …. (shrink)

Hempeler et al. (2024) provide convincing reasons for why we should view a broad set of treatment pressures as coercive. They’re correct that in order for us to understand the ways in which patient...

While the era following the Bland decision in 19931 might be thought of as the time when concepts such as ‘futility’ were placed under pressure and scrutiny, it’s an idea that has been debated for at least forty years. In a 1983 JME commentary Bryan Jennett distinguishes three kinds of reason why Cardiopulmonary Resuscitation might be withheld: > ‘… that CPR would be futile because it is very unlikely to be successful; that quality of life after CPR is likely to (...) be changed to so poor a level as to be a greater burden than the benefit gained from prolongation of life, and that quality of life is already so poor due to chronic or terminal disease that life should not be prolonged by CPR.’ pp-142-1432 This crisp definition seems as applicable as it did then, but it was not the final word on the concept. Mitchell, Kerridge and Lovat explore, as others did in the post-Bland and Quinlan eras, how ‘futility’ might apply to those in a …. (shrink)

When explaining the inadequacy of the words “Cheer him up” to describe the purpose of offering a drink to a murderer, TS Elliot’s Sweeney remarks, > Well here again that don’t apply > > But I’ve gotta use words when I talk to you.1 The importance of words to medical ethics cannot be denied. While a narrow view of conceptual analysis is not conducive to good medical ethics,2 the adequacy and clarity of the words we use continues to be the (...) foundation for all ethical analysis. While some key ideas such as ‘paternalism’3 or ‘coercion’4 are well theorised and tend to be used in a consistent way that most understand, other words that are important to ethics, often are not. Our ability to notice, perceive and understand ethical issues is the starting point for all ethical inquiry. The ethical words we choose structure and give content to our ethical perception. As Kant observed, ‘Thoughts without content are empty, intuitions without concepts are …. (shrink)

Cohen (2023), Rahimzadeh and colleagues (2023), and Porsdam Mann and colleagues (2023) have written thorough and well-canvassed pieces about the ethical and conceptual challenges of large language...

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 91-92 [Access article in PDF] Jaspers and Defining Phenomenology John McMillan IT IS POSSIBLE TO DISTINGUISH a number of positions that you might take on the importance of phenomenology for the study of the mind. The strongest position is to think that phenomenology is sufficient for understanding the mind. This is a position that would be very hard to defend and (...) it is unlikely that Gupta and Kay want to endorse such a view. It is clear that Jaspers did not believe this; although he thought that first-person experience was undervalued, his project was an attempt to make sense of different kinds of explanation, all of which contribute to our understanding of the mind.A second position is to deny that phenomenology gives us anything that is of use in understanding the mind and psychopathology. Philosophers have developed a number of such positions, from the eliminativism of Churchland (1981) to the heterophenomenology of Daniel Dennett (1989, 1991).A third position is to hold that phenomenology is one of the methods that are useful for understanding the mind and psychopathology. Along with neuroscience and other more behavioral approaches to behavior, phenomenology is an important component of an adequate understanding of the mind. This position appears to be that endorsed by Jaspers, Gupta, Kay, and the authors they discuss. It is also the position that Grant Gillett and I defend in Consciousness and Intentionality (2001). Gupta and Kay's paper presents an argument about where the boundaries between phenomenology and other approaches to the mind and psychopathology ought to be drawn. Gupta and Kay, following Jaspers, think that the boundaries of the phenomenological ought to be drawn around those approaches that employ empathy and the presuppositionless stance and do not include objective phenomena.Given that the paper is primarily about what phenomenology means and that it endorses the way that Jaspers used the term, it is fairly important that we have a definition from Jaspers. Gupta and Kay give a description of some of Jaspers's methods for getting at subjective phenomena, but do not give an account of what Jaspers thinks the aim of phenomenology is. In other words, one way to classify something as phenomenological is its methods and another is by what the point of the exercise is. In General Psychopathology, Jaspers (1997) says that phenomenology is an empirical method for investigating "individual psychic experience" (p. 55). We can think of this as a claim about the objective of phenomenology and then consider the merits of different phenomenological methodologies in terms of their success in achieving this objective. This opens up the possibility that a theory may be genuinely phenomenological because it has a plausible method for getting at psychic lived experience but does not use all of the methods advocated by Jaspers.Gupta and Kay are correct that Jaspers does stress the importance of the presuppositionless [End Page 91] stance, the importance of empathy and the importance of not simply relying on objective phenomena. However, it is not obvious why an approach to understanding the mind or psycho- pathology must satisfy these conditions to be phenomenological. Imagine the following kind of situation: when I am observed to hit my big toe against a brick and give a yelp, it is possible to infer something about my psychic lived experience. There is not much is room for doubt about my first-person experience and, although you might ask me questions about my pain, they are unlikely to add much to what you can simply read from my behavior. This example may appear a little crude because the first-person experience in this case is not especially complex and is not that interesting as a entrance to the inner workings of an individual's mental life. It is not hard to come up with other examples where we can read the first-person experience from behavior in a fairly accurate and informative way. A father gazing at his young child while she is sleeping in his arms may be having a number of thoughts that we would not know about... (shrink)

Owen, Freyenhagen, and Martin should be lauded for bringing the complexities of competence assessment and acquired brain injury to light. This discussion is often a difficult and vexed exercise for an array of conditions including ABI, and is usually a judgment that is critically important for determining whether or not a patient has the right to make their own decisions. There are a number of themes in their article that chime with ideas developed by Fulford about the nature of illness, (...) and I suggest that, in addition to teasing out some subtleties of competence assessment, they have also explained, in a phenomenologically grounded way, why it is that we should consider ABI an illness.Tests of... (shrink)

Clarifying the meaning of ethical concepts is fundamental for medical ethics. Many of the best papers in the Journal of Medical Ethics have advanced our understanding of the limits and implications of ethical concepts. This issue includes a number of papers that give us reason to reflect on the use, implications and grounding of some important ethical concepts. The concepts we use are rarely neutral. For example, those arguing against assisted dying are more likely to use terms such as ‘euthanasia’ (...) or perhaps even ‘killing’, while those arguing in favour of it might opt for ‘aid in dying’ or ‘facilitated aid in dying’. Of course, these are different concepts and do not mean the same thing, but the different associations and implications of concepts can weaken or strengthen a position. Woollard analyses the way in which the terms used in public information and discussions about breastfeeding can be morally loaded and thereby cause guilt or detract from the effectiveness of public information.1 She argues that normative concepts such as ‘harm’ or ‘dangerous’ and slogans such as ‘breast is best’ can imply moral duties or criticism when it is unhelpful and inappropriate to do so. She does this by showing how concepts such as ‘harm’ and ‘risk’, …. (shrink)

:This article describes the well-developed and long-standing medical ethics teaching programs in both of New Zealand’s medical schools at the University of Otago and the University of Auckland. The programs reflect the awareness that has been increasing as to the important role that ethics education plays in contributing to the “professionalism” and “professional development” in medical curricula.

While apparently helpful concepts such as ”best interests“ appear to have the virtue of simplicity, they are really place holders for the communication, time and listening that’s required to understand what truly matters to patients and others involved in healthcare. When we know what matters to a patient, we can have confidence that we have a “legitimate” view of what’s important to them. Two papers in this issue of the Journal of Medical Ethics explore different ways in which values can (...) be legitimised and applied consistently in healthcare. When a patient can no longer say what it is that matters to them and a significant decision needs to be made, the values that will inform what should happen next need to be legitimised in some way. Common ways of doing that include proxy decision makers or advanced directives. In this issue Jacob Appel calls for the ways in which “substituted judgments” are used for patients who have previously expressed a wish to die, to …. (shrink)

Scholarly inquiry into medical ethics should inform and guide those involved in making challenging ethical decisions.1 It should strive to be integral to the work of health care professionals and health care institutions2 and clinical relevance seems essential for this to happen. To acknowledge the importance of clinical relevance for medical ethics, the Journal of Medical Ethics has introduced a regular Clinical Ethics section at the beginning of each issue. Papers that we think are likely to be of particular interest (...) and relevance to clinicians will be placed in this section of the journal. One way in which a paper can be framed for a more clinical audience is by organising it around a scenario that healthcare professions might face. The paper published in this issue’s Clinical Ethics section considers a dilemma about whether an egg donor should be contacted to help diagnose a condition that the resulting child might have.3 While egg donation has become more common, the complexities presented by this scenario might appear removed from those which most health professionals face. However, the way in which genomics is becoming incorporated into healthcare means that the issues this scenario raises are relevant to all healthcare professionals. The spread of genomics into practice means that the …. (shrink)

The British have taken a comprehensive approach to regulating reproductive medicine. A loophole in the current law leaves some cases of sex selection uncovered; if that loophole were closed, however, the law is robust enough to address the concerns about sex selection while permitting it in many cases.

Socially responsible publishers, such as the BMJ Publishing Group, have demonstrated a commitment to health equity and working towards rectifying the structural racism that exists both in healthcare and in medical publishing.1 The commitment of academic publishers to collecting information relevant to promoting equity and diversity is important and commendable where it leads to that result.2 However, collecting sensitive demographic data is not a morally neutral activity. Rather, it carries with it both known and potential risks. Among these are issues (...) around privacy or data misuse, as well as more basic concerns about how, when or why people should be categorised in certain ways and/or prompted to conceive of themselves or their identities in certain terms.3 If such data are to be collected, therefore, their effectiveness in achieving the stated ends must have a sufficiently compelling evidence base so as to justify the various risks involved. And where possible, these risks must also be identified and minimised. As Varcoe et al 4 argue, > While most leaders and healthcare workers and some patients [in their study] envisioned potential benefits associated with having ethnicity data, these benefits were seen as largely contingent upon action being taken to [actually] ameliorate inequities. Overwhelmingly, however, leaders from ethno-cultural communities and patients of diverse identities anticipated potential harm arising both from having ethnicity data and the process of collection. The analysis illustrates that in today’s sociopolitical context, collecting ethnicity data in clinical contexts may engender considerable harm, particularly for racialized, vulnerable patients. (p1569) Varcoe et al refer to ‘ethnicity’ data, which as they note is an ambiguous concept, potentially encompassing such diverse notions as ancestry, language, religion or culture. It is also a term that is in some contexts—for example, the USA—often used interchangeably with a different, more highly charged term: ‘race’. Data …. (shrink)

The JME editorial team selects its feature articles from the best papers accepted for publication based on their quality, novelty and capacity to move debate forward on a specific issue. Feature articles are made freely available and are published alongside reviewed and submitted commentaries. We do this partly to promote and acknowledge excellent work in medical ethics, but also to encourage authors to submit their best papers to the JME. JME feature articles have deepened the analysis of some central issues (...) for medical ethics. ‘Common morality’ is one way of underpinning general ethical principles and it is a concept that is central to the justification that Beauchamp and Childress give in their classic articulation of the four principles. 1 Rhodes’ critical discussion of common morality in her feature article 2 has been well cited since then, which is a good thing from the perspective of the author... (shrink)

Hume criticised ‘humility’ as a ‘monkish virtue’ and objected to it on the basis that such virtues ‘stupefy the understanding and harden the heart, obscure the fancy and sour the temper.’1 Despite the appeal of Hume’s plea for less restraint and self-denial, other thinkers such as Kant consider epistemic humility to be fundamental, given the limits of our rationality and our struggle to know and do the right thing.2 By epistemic humility, he did not mean weakness or being self-effacing, instead (...) he was referring to an appropriate degree of self-respect that’s tempered by an awareness of the ways in which we can go wrong. ‘Epistemic’ comes from the ancient Greek episteme, which is often translated as knowledge, understanding or acquaintance. So epistemic humility can be understood as an appropriate awareness of the limits of what we know, understand or have experienced. There are a number of reasons why epistemic humility and being mindful of the ways we can go wrong is important for medical ethics. They include that ethics is interdisciplinary and often focuses on the new, it discusses ethical questions that require detailed and accurate information and that it analyses issues …. (shrink)

Bentham’s famous remark was a response to the assertation of natural rights that did not depend on law or some other foundation for their normative force.1 Whatever we make of that claim, it flags a problem for making and evaluating rights-based arguments in medical ethics. He wasn’t trying to say that rights are all meaningless, nor that we can readily do without them. Rather, it’s an objection to a particular way of asserting rights where they are taken to express free (...) standing claims that don’t require further defence or justification. Whether or not the rise of human rights in medical law has enriched the ability of the courts to deal with complex issues in a nuanced way is debatable, but there’s no doubting their prominence and unavoidability.2 For medical ethics, rights analysis requires paying heed to the kind of rights in play when arguing about ethics, as well as what’s distinctive about rights analysis. For many, rights operate as strong moral assertions intended to override other, less weighty, considerations and Ronald Dworkin claimed that we should view rights as a way of expressing particularly important claims that should constrain the state in its actions.3 Rights imply duties and focussing on a right's correlative duty can …. (shrink)

The kind of expertise someone who specialises in ethics has, or indeed whether it makes sense to talk of moral expertise, is keenly debated and is a far from settled issue. It has been of interest to moral philosophers, partly because of the light it might shine on the nature of morality.1 2 It has also been debated within medical ethics, with some arguing against the idea that expertise in moral philosophy translates into ethical expertise and others arguing that skills (...) in ethical justification can be viewed as ethical expertise.3 4 This issue of the Journal of Medical Ethics includes a number of papers that demonstrate the importance of ethical expertise and some of the distinctive elements of it. Public involvement in research is seen in a number of countries as something valuable and in some, such as Australia, it can be a criterion for research grants. The UK National Standards for Public Involvement in Research are discussed in this issue of JME and McCoy et al provide a good illustration of why ethical expertise is important for framing public policy.5 The appeal of stakeholders having some say into research projects, particularly when they are funded via taxation is easy to understand, so who would not see public involvement as a good thing? However, McCoy et al claim that while there is a substantial and growing literature on public involvement in research that tends to emphasise the importance of public involvement, it doesn’t explain how or what this looks like when …. (shrink)

There’s no doubt that medical ethics should be ‘grounded’, in the sense that it aims to make a practical, normative contribution to significant ethical issues in medicine. There are a number of ways in which ethics can do that, two of which feature in this issue of the Journal of Medical Ethics. One way is by responding to significant new policy or legal developments that will have an impact on clinical practice. This issue discusses two legal developments that matter to (...) patients and healthcare professionals: the sanctions applied to Dr Bawa-Garba and the Supreme Court’s ruling on the withdrawal of artificial nutrition and hydration. A second way of grounding ethical analysis in the reality and complexity of ethical issues is by using empirical methods. There are two papers in this issue from Canada that illustrate how the subtleties of complex ethical issues can be teased out via qualitative methods. Medical tourism is an important and rapidly developing phenomenon that raises a set of interesting and tricky ethical issues.1 It has been discussed in the Journal of Medical Ethics before and its implications for end of life, dentistry and other health interventions have been explored.2 3 Reproductive tourism occurs in many countries and the complications it can create for issues such as the citizenship of resulting children have been discussed at some length in the JME.4 5 Reproductive tourism is a good example of an area where it is particularly important for ethical analysis to be grounded in the facts and reality of a situation and an empirical approach to ethics is therefore a good option for this topic. In this issue, Couture et …. (shrink)

Lord Scarman’s judgment about when someone under the age of 16 years should have the right to make their own medical decisions emphasised the decision-making abilities of the particular child. He said: > …the parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.1 That created a duty on (...) healthcare practitioners to assess whether a particular minor has decision-making abilities at a degree that would enable them to understand the decision to a high extent, sufficient hopefully that they would ‘own’ the decision. In December of 2020, the High Court considered whether young people with gender dysphoria and seeking access to puberty blocking therapy, were likely to pass Scarman’s mature minor test and cast doubt on their ability to fully understand that decision, thereby making it less likely that a healthcare practitioner would decide they are a mature minor for that therapy. The High Court said: > It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child …. (shrink)

This article argues that hope is of value in clinical ethics and that it can be important for clinicians to be sensitive to both the risks of false hope and the importance of retaining hope. However, this sensitivity requires an understanding of the complexity of hope and how it bears on different aspects of a well-functioning doctor-patient relationship. We discuss hopefulness and distinguish it from three different kinds of hope, or ‘hopes for’, and then relate these distinctions back to differing (...) accounts of autonomy. This analysis matters because it shows how an overly narrow view of the ethical obligations of a clinician to their patient, and autonomy, might lead to scenarios where patients regret the choices they make. (shrink)

This article considers two related and fundamental issues about morality in a virtual world. The first is whether the anonymity that is a feature of virtual worlds can shed light upon whether people are moral when they can act with impunity. The second issue is whether there are any moral obligations in a virtual world and if so what they might be. -/- Our reasons for being good are fundamental to understanding what it is that makes us moral or indeed (...) whether any of us truly are moral. Plato grapples with this problem in book two of The Republic where Socrates is challenged by his brothers Adeimantus and Glaucon. They argue that people are moral only because of the costs to them of being immoral; the external constraints of morality. -/- Glaucon asks us to imagine a magical ring that enables its wearers to become invisible and capable of acting anonymously. The ring is in some respects analogous to the possibilities created by online virtual worlds such as Second Life, so the dialogue is our entry point into considering morality within these worlds. These worlds are three dimensional user created environments where people control avatars and live virtual lives. As well as being an important social phenomenon, virtual worlds and what people chose to do in them can shed light on what people will do when they can act without fear of normal sanction. -/- This paper begins by explaining the traditional challenge to morality posed by Plato, relating this to conduct in virtual worlds. Then the paper will consider the following skeptical objection. A precondition of all moral requirements is the ability to act. There are no moral requirements in virtual worlds because they are virtual and it is impossible to act in a virtual world. Because avatars do not have real bodies and the persons controlling avatars are not truly embodied, it is impossible for people to truly act in a virtual world. We will show that it is possible to perform some actions and suggest a number of moral requirements that might plausibly be thought to result. Because avatars cannot feel physical pain or pleasure these moral requirements are interestingly different from those of real life. Hume’s arguments for why we should be moral apply to virtual worlds and we conclude by considering how this explains why morality exists in these environments. (shrink)

Some bioethicists are concerned about other bioethicists being paid by corporations. These concerns make sense if you have a particular view about what the most important role of a bioethicist should be. If you believe that a bioethicist should be a moral critic, attempting to expose wrongdoing, then being paid by corporations might compromise this role. It’s plausible to suppose that this can be a role for bioethicists but it’s unreasonable to insist that all bioethicists should be moral critics.

The discussion of whether psychopaths are morally responsible for their behaviour has long taken place in philosophy. In recent years this has moved into scientific and psychiatric investigation. Responsibility and Psychopathy discusses this subject from both the philosophical and scientific disciplines, as well as a legal perspective.

Intensive care units are not always able to admit all patients who would benefit from intensive care. Pressure on ICU beds is likely to be particularly high during times of epidemics such as might arise in the case of swine influenza. In making choices as to which patients to admit, the key US guidelines state that significant priority should be given to the interests of patients who are already in the ICU over the interests of patients who would benefit from (...) intensive care but who have not been admitted. We examine four reasons that in principle might justify such a prioritization rule and conclude that none is convincing. We argue that the current location of patients should not, in principle, affect their priority for intensive care. We show, however, that under some but not all circumstances, maximizing lives saved by intensive care might require continuing to treat in the ICU a patient already admitted rather than transferring that patient out of the unit in order to admit a sicker patient who would also benefit more from intensive care. We conclude that further modelling is required in order to clarify what practical policies would maximize lives saved by intensive care. (shrink)

Kerstein and Bognar (2010) and Persad, Wertheimer, and Emanuel (2009) defend specific principles for the allocation of health care resources, but their choice of principles is influenced by the exa...

Chinese authors are the third most frequent submitters to the JME. However, as will be apparent from the content published in the journal, relatively fewer papers from China are accepted. That is not due to a lack of important scholarship in China. We recently contributed to a highly successful conference with Professor Xiaomei Zhai at Peking Union Medical College, Beijing and were impressed by the increasing awareness, analysis and progress of medical ethics in China, including in the area of organ (...) transplantation. However, few of these presentations make it into print. It is therefore important to make the criteria that inform editorial judgements as transparent as possible. There are several reasons why the acceptance rates for the JME are higher in some countries than others. Some of them are related to different views about what constitutes medical ethics or research. In some contexts, articles are not recognised as research unless they are empirical and the bulk of papers submitted from some countries have no ethical argument. Philosophical traditions vary across countries and papers that are primarily exegetical, in the sense that they describe what a famous philosopher would say about an issue, usually do not make it into the JME. There are other journals that accommodate different views about what counts as research or ethics, so authors should match their papers to the content that a journal publishes. However, academic journals can be opaque about how authors should pitch their papers so as to maximise their chances of publication. …. (shrink)