J Bioeth Inq
· 2025 Dec · PMID 41264179
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Irreversible alterations to the form and function of youths' physical bodies before sexual maturity, and particularly, the potential foreclosure of youths' fertility options via long-term puberty suppression, is a reason...Irreversible alterations to the form and function of youths' physical bodies before sexual maturity, and particularly, the potential foreclosure of youths' fertility options via long-term puberty suppression, is a reason oft-raised in resistance to the provision of puberty blockers (PBs) for minors. Despite the pervasiveness of such assertions by lawmakers and other authorities, the concept of the foreclosure of transgender youths' future has been subject to surprisingly little philosophical scrutiny in bioethical literature. Joel Feinberg's "right to an open future" theory provides a foundation for other discussions about childcare decision-making, such as the choice to raise children in a particular religion or to foster their musical talents over their sporting ones. However, relatively fewer attempts have been made to apply Joel Feinberg's "right to an open future" theory to paediatric transgender medical decision-making. In this article, I consider the relevance of Feinberg's theory to the context of pubertal suppression for transgender youth and advance in this article reasons why transgender youth should be allowed to make their own decisions about the commencement of puberty suppression to a maximally feasible degree, in order to safeguard their physical health, mental health, autonomy, and capacity for future self-fulfilment.
Many countries have implemented taxes on junk food, believing this to have beneficial health outcomes. The Health Protection Argument maintains that (1) junk food is harmful to health; (2) consumers should reduce their c...Many countries have implemented taxes on junk food, believing this to have beneficial health outcomes. The Health Protection Argument maintains that (1) junk food is harmful to health; (2) consumers should reduce their consumption; (3) taxation is an effective means of achieving this goal, and governments should implement effective measures. Consequently, governments should tax junk food for health reasons. However, the premises in this argument are problematic. The definition of junk food and the causal relationship between junk food consumption and health outcomes remain ambiguous. Without clear health standards and justified public reasons, governments should not implement restrictive measures to reduce junk food consumption. Furthermore, the effectiveness of taxation as a policy tool, as well as the justification for prioritizing tax interventions over alternative measures, calls for closer evaluation. Therefore, the conclusion that governments should impose taxes on junk food is not sufficiently justified on health grounds.
This article investigates ethical hazards associated with argumentative shifts following the emergence of combined non-inferiority and efficiency/revenue facilitation (NERF) endpoints, with particular attention to resear...This article investigates ethical hazards associated with argumentative shifts following the emergence of combined non-inferiority and efficiency/revenue facilitation (NERF) endpoints, with particular attention to research on artificial intelligence (AI) in health and medicine. The study presented here adopts a Toulmin argumentative analysis approach to investigate the dominant persuasive logics of twenty-three health AI trials evaluating NERF endpoints. In so doing, the article demonstrates how the argumentative logics of NERF trial reports shifts away from health outcomes as the putative evidence base for adopting novel interventions toward an argumentative model that prioritizes economic benefits over patient benefits. Ultimately, the article argues that new logic of NERF endpoints is consistent with and risks accelerating the harms to patient care that arise from increased financialization of the healthcare sector. If the use of NERF endpoints and attendant logics continue to grow unchecked, they could result in significant harms to patient health and well-being.
African traditional medicine provides treatment for various illnesses and is widely used across Africa since it is readily available and affordable. Concepts of informed consent, however, are grounded in a Western ethica...African traditional medicine provides treatment for various illnesses and is widely used across Africa since it is readily available and affordable. Concepts of informed consent, however, are grounded in a Western ethical tradition that foregrounds the individual's rights to autonomy and bodily integrity. This study aimed to explore whether the basic elements of informed consent-information disclosure, comprehension, voluntariness, and agreement-are observed in traditional medicine practice in KwaZulu-Natal province, South Africa. Semi-structured in-depth interviews were conducted with eight traditional healers-four nyanga and four sangoma, and thematic content analysis was applied to the transcribed and translated data. Four major themes emerged from this analysis: 1) the practice of traditional medicine in KwaZulu-Natal; 2) the importance and amount of information disclosure by traditional healers; 3) methods used to obtain consent or agreement from patients and the voluntariness of this process; 4) the benefits of and barriers to obtaining informed consent in African traditional medicine. The study found that African traditional healers do indeed disclose information on diagnosis, risks, benefits, and treatment options to their patients.
Robertson LJ, Higgins NL, Maier MJ
… +2 more, Carter A, Gardner JG
J Bioeth Inq
· 2025 Dec · PMID 41217705
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Following the recent surge in neurotechnology innovation and commercial investment, numerous academic bodies, government bodies, multilateral organizations, and industry leaders have produced ethical guidelines to govern...Following the recent surge in neurotechnology innovation and commercial investment, numerous academic bodies, government bodies, multilateral organizations, and industry leaders have produced ethical guidelines to govern neurotechnology innovation. Many highlight the need for new regulations to protect the rights and welfare of vulnerable individuals, while others warn about unnecessarily impeding innovation that provides urgent treatments to intractable conditions. Consensus on appropriate governance of neurotechnological innovation remains elusive. To fill this gap, we conducted a scoping review of the academic literature concerning the governance of neurotechnology development, identifying the ethical issues addressed, highlighting gaps or underdeveloped areas of neurotechnology governance, and the country in which they were developed. Fifty-one academic articles from the peer-reviewed literature were extracted, selecting those that referred to neurotechnologies and presented normative ethical guidelines or frameworks for their governance. We identified six common ethical themes (justice, beneficence and nonmaleficence, privacy and brain data, autonomy and informed consent, and, identity, dignity, and moral status) and six governance strategies proposed to address these themes (social responsibility and accountability, interdisciplinary collaboration, public engagement, scientific integrity, epistemic humility, legislation and neurorights). Discussions surrounding these themes lacked adequate consideration of diverse viewpoints, such as from the Global South, and were often underdeveloped, lacking both practical specificity and guidance to help developers balance competing priorities. Specifically, animal ethics and binding governance approaches were not adequately addressed, while neurorights were given undue consideration. Future guidelines should engage with these areas to aid in the development of more comprehensive and specific governance documents.
Not only is excessive consumption of sugar-sweetened beverages (SSB) harmful for health but it also constitutes a significant burden on Australia's healthcare system, with widespread social, economic, and ethical implica...Not only is excessive consumption of sugar-sweetened beverages (SSB) harmful for health but it also constitutes a significant burden on Australia's healthcare system, with widespread social, economic, and ethical implications. Peak health authorities in Australia and the Grattan Institute have advocated strongly for implementing a tax on SSB to reduce its consumption, based on evidence of compelling health and economic benefits. However, beverage and sugar industries heavily oppose the tax. This article analyses the implementation of an SSB tax in Australia using a set of widely accepted public health ethics principles: effectiveness, proportionality, necessity, least infringement, equity, and transparency. By navigating the moral framework of key ethical issues, this article argues that Australia is justified in implementing an SSB tax, thus adding a nuanced ethical dimension to this important public health policy debate.
While everyone, parents and non-parents alike, benefit from children, parents alone incur the cost of bearing and raising them. Johan Bester argues that, since society tasks parents with the labourious and financially bu...While everyone, parents and non-parents alike, benefit from children, parents alone incur the cost of bearing and raising them. Johan Bester argues that, since society tasks parents with the labourious and financially burdensome task of raising children, and children are a social good, society has an obligation to help ease the burden of parenting by offering direct financial compensation to parents. While I agree that society should do much more to support parents, I am not convinced that the support should include direct financial payment to parents. After setting out Bester's arguments for this position and distinguishing it from a similar argument in political science, I offer a series of concerns: parenting is unlike socially beneficial employment-type work; Bester's argument may extend in problematic directions; financial incentives may harm the parent-child relationship; and there are other ways to promote parenting. Despite being critical, the purpose of this paper is to invite further discussion among bioethicists on how society can support parents in the important task of parenting.
This paper addresses bioethical considerations in end-of-life healthcare. It explores Islamic bioethical concepts of karāma and ḥurma, framing them as homeomorphic equivalents to categories of human dignity in Western bi...This paper addresses bioethical considerations in end-of-life healthcare. It explores Islamic bioethical concepts of karāma and ḥurma, framing them as homeomorphic equivalents to categories of human dignity in Western bioethics. Karāma refers to the inherent honour bestowed by God upon every human being, as distinct from honour as a component that can be accrued; ḥurma signifies the inviolability and sanctity of the human body. The two concepts are related and when combined can be mapped onto Sulmasy's categorizations of intrinsic and attributed dignity. The third category proposed by Sulmasy, inflorescent dignity-human grace and virtue expressed in observable behaviour-is demonstrated through the historical narrations of how Prophet Muhammad faced his last days. The paper notes how these Islamically-grounded notions of dignity are reflected in empirical studies of Muslim populations and uses a case scenario to demonstrate how they can manifest in end-of-life care decisions for Muslim populations.
In this essay, we discuss the results of scientific dogmatism and the backlash it has created in society. We cite various examples from the pandemic to highlight our case. We argue that dogmatism will ultimately put the...In this essay, we discuss the results of scientific dogmatism and the backlash it has created in society. We cite various examples from the pandemic to highlight our case. We argue that dogmatism will ultimately put the scientific paradigm in crisis and a different approach is needed to address populism. We further argue science is more digestible when emotional faculties of individuals are considered first. We use a philosophical approach to also describe the dangers of dogmatism and the interplay between technocracy and populism.
J Bioeth Inq
· 2026 Mar · PMID 41144168
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In the near future, the electronic health record (EHR) is likely to include patients' genetic information, in addition to other clinical information and administrative data. This warrants some preparatory thought. Presen...In the near future, the electronic health record (EHR) is likely to include patients' genetic information, in addition to other clinical information and administrative data. This warrants some preparatory thought. Presently, in many jurisdictions, adolescents can self-access their EHR, as an acknowledgment of their relative autonomy in areas concerning their health. The foreseeable routine integration of genetic information into the EHR could result, inter alia, in adolescents' inadvertent exposure to misattributed parentage findings emerging from genetic investigations, creating clinical challenges and ethical difficulties. The article reviews policy on the underexplored area of sharing genetic (non-)relatedness information with adolescents. It then considers the clinical perspective of adolescents revealing genetic non-relatedness through the EHR. Next, the article comparatively investigates adolescents' health privacy and EHR-access laws and policies across several jurisdictions. After that, it analyses applicable ethical principles, such as minors' right to know their genetic origins; parents' (contentious) right to know that their child is genetically unrelated to them; the best interests of the child; and minors' autonomy. Finally, we offer an implementable model in which the minor makes an informed choice of consent option, genetic results are segregated from other EHR data, differential access is applied to genetic information; and pre-disclosure medical counselling for adolescent patients is mandated.
This paper argues for a re-balancing of decision-making power in health systems away from metrocentric and technocratic norms and a fundamental re-shaping towards democratic and participatory models of governance. These...This paper argues for a re-balancing of decision-making power in health systems away from metrocentric and technocratic norms and a fundamental re-shaping towards democratic and participatory models of governance. These changes are understood as critical to the objective of improving healthcare access and delivery in regional, rural, and remote communities. In articulating this argument, we highlight the highly political nature of how we structure and govern healthcare delivery, which is imbued with value judgments. We critique currently dominant neo-liberal approaches to healthcare governance that frame the "voices" of local communities as optional inputs into the system, rather than active agents in decision-making processes. From health justice and spatial justice perspectives, public participation in governance may be an important factor to enable improved access to regional, rural, and remote health services and to promote community self-determination.
The Boldt scandal, one of the largest documented cases of research misconduct globally, caused significant institutional failures in research oversight. These systemic issues at Justus Liebig University in Gießen, German...The Boldt scandal, one of the largest documented cases of research misconduct globally, caused significant institutional failures in research oversight. These systemic issues at Justus Liebig University in Gießen, Germany played a critical role in enabling widespread data falsification and ethical violations. Benno von Bormann, a former collaborator of Joachim Boldt involved in the misconduct, subsequently authored the semi-fictional novel Das Hospital, which depicts hierarchical power dynamics and ethical dilemmas within a hospital setting. This book review examines how von Bormann's narrative parallels the documented institutional weaknesses that facilitated the Boldt scandal. By comparing insights from the University of Gießen's investigation report, as summarized in publicly available sources, and the themes in Das Hospital, a unique interdisciplinary analysis of institutional responsibility is offered. The twin-pronged approach sheds light on the systemic conditions that may encourage unethical research behaviours, potentially leading to corresponding patterns of research withdrawals in areas and disciplines where such practices are notably prevalent. This study concludes by revisiting approaches to enhance transparency, accountability, and cultural changes in research management. This underscores the importance of combining literary analysis with factual examination of institutions to tackle ongoing issues in upholding research integrity.
Waiting time for elective surgery in public health systems has long been a focus for health institutions and governments. Such focus, and existing ethics literature, tends to hover at a policy or systems level. However,...Waiting time for elective surgery in public health systems has long been a focus for health institutions and governments. Such focus, and existing ethics literature, tends to hover at a policy or systems level. However, long waiting lists also create ethical challenges at the level of individuals' clinical practice. This project expands the focus of the elective surgery waiting list discussion from the macro systems level to the micro clinician level. We put forward a framework of values driving clinicians' ethical practice in this area, based on a literature review and iterative ethicist-led discussions with eighteen key surgical staff in one hospital network in metropolitan Melbourne, Australia. While sensitive to population-level values at play, clinicians' primary moral orientation was towards the individual patients they cared for. This orientation saw clinicians implement additional values in their practice including supporting patient autonomy through informed consent, maximizing benefits to individuals by considering patients holistically, minimizing harms to individual patients related to time spent waiting, and consistency of decision-making within teams and departments. By articulating values that can be translated into action within clinicians' sphere of agency, the framework aims to support ethical practice among surgical staff working within a constrained and imperfect system.
Intelligent assistive technology (IAT) is being developed to enable safe and autonomous ageing at home and is associated with supporting quality of life. These anticipated benefits must be balanced against potential unin...Intelligent assistive technology (IAT) is being developed to enable safe and autonomous ageing at home and is associated with supporting quality of life. These anticipated benefits must be balanced against potential unintended negative effects. This scoping review aims to identify and summarize the key ethical dimensions and frameworks discussed in the relevant scholarly literature. Furthermore, we examine whether the ethical dimensions identified can be derived from the four principles of bioethics, suggesting that, when properly specified, principlism could serve as a systematic framework for evaluating IAT. Thus, our review has two aims: identifying the ethical dimensions and frameworks currently discussed and investigating whether these frameworks can be structured according to the four principles or if additional principles are necessary. A systematic search across the databases PubMed, Web of Science, EMBASE, Belit, and PhilPapers, plus a manual search identified 535 publications, from which twenty-three studies were included. The results show twenty-one heterogeneous ethical dimensions, with similar matters considered across different categories. The review shows that key expectations and promises of developing and using IAT in this context mostly relate to the possibility of safely ageing at home and reducing healthcare costs. While assigning these ethical dimensions to the four principles of bioethics, it became clear that although all aspects discussed could be subcategorized, some ethical concerns might lose visibility or be inadequately addressed. We, therefore, conclude that the four principles generally provide a sufficient basis for evaluating these technologies.
As priority setting committees become commonplace in contemporary welfare states, it becomes increasingly important to understand how they operate. This article contributes to our understanding of contemporary priority s...As priority setting committees become commonplace in contemporary welfare states, it becomes increasingly important to understand how they operate. This article contributes to our understanding of contemporary priority setting by examining how the Danish Medicines Council (DMC) makes and justifies its decisions, as well as the role of different (and perhaps conflicting) concerns and values in these decisions. We conducted seventeen interviews with DMC members and observed three DMC meetings spanning five days. Firstly, we find that health-related effect is the most crucial factor in DMC members' recommendations of newly proposed medicines and that discussions of effects take precedence over other considerations in council deliberations. Secondly, we find that the ability of DMC members to adequately assess the effect of newly proposed medicines is often significantly limited by poor data quality and a lack of sufficient documentation, which shifts the DMC's task from making recommendations on an informed basis to providing estimated assessments of the expected effect. In these circumstances of uncertainty about effect, recommendations are influenced by considerations such as the age of patients and the rarity of the disease. This raises significant moral issues in which the DMC has no particular expertise.
Our experience in day-to-day medical practice suggests that the nature of the doctor-patient relationship (DPR) is considerably influenced by the attitudes of the individual patient and doctor. The DPR will also be signi...Our experience in day-to-day medical practice suggests that the nature of the doctor-patient relationship (DPR) is considerably influenced by the attitudes of the individual patient and doctor. The DPR will also be significantly influenced by the social environment, including the healthcare system in which it develops. In addition, cultural influences on the DPR and its overriding ethical principles cannot be ignored. Moreover, the DPR cannot escape the influence of various coincidences. We argue that it is preferable that a doctor-seeking-the-Mean model be practiced, whereby doctors do not treat their patients in a uniform, normative, and skilful manner but rather try to achieve the Mean in key aspects of the DPR-which is highly individualized, changeable over time, and subject to social trends and chance. For Confucius, the Mean is a virtue that enables one to respond flexibly to changing circumstances and realize one's goals without excess or deficiency; it is an attempt to fully understand all the diverse and conflicting views and positions before making the highest quality decision that best suits one's need to achieve the goals at any given moment. We believe that the doctor-seeking-the-Mean model can fully fulfil the role of a platform for realizing the goals of healthcare.
BACKGROUND: Despite recent regulatory reforms to improve the safety of cosmetic procedures in Australia, treatments involving non-ionizing radiation (NIR)-such as laser, intense pulsed light and radiofrequency-remain lar...BACKGROUND: Despite recent regulatory reforms to improve the safety of cosmetic procedures in Australia, treatments involving non-ionizing radiation (NIR)-such as laser, intense pulsed light and radiofrequency-remain largely unregulated in most states and territories. Recent reviews have concluded that there is a lack of evidence of adverse effects, and insufficient evidence has also been cited as a barrier to regulatory reforms. We sought to characterize adverse effects from cosmetic treatments involving NIR reported in Australian media and to analyse associated regulatory themes. METHODS: We searched for Australian news media disseminated between 2008-2023 reporting adverse effects from cosmetic treatments involving non-ionizing radiation (NIR). Identified case reports were coded and analysed to explore adverse effects and associated regulatory insights. RESULTS: One hundred unique media reports were identified that described ninety-five cases. One in five involved permanent effects with burns and scarring most frequently reported (sixty-five and fifty-four cases respectively). Reports concerned women more than men (eighty vs eight cases), most commonly following laser (sixty cases) or IPL (twenty-nine cases) treatment and in non-clinical rather than clinical settings (sixty vs eighteen cases). Six practitioners collectively accounted for almost one third of cases. Significant regulatory gaps were identified, including insufficient mechanisms for addressing poor professional practice, and barriers to consumers seeking compensation including minimum injury thresholds and uninsured providers. CONCLUSIONS: Media reports have documented cases of serious and permanent injuries following cosmetic NIR treatments in Australia. Nationally consistent regulations should be considered to ensure standards of care, protect consumers, and reduce barriers to redress.