J Bioeth Inq
· 2025 Sep · PMID 40794268
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Recent medical research involving human-monkey chimeras, human brain organoids in rats, and the transplantation of a gene-edited pig heart and gene-edited pig kidneys in living human beings have intensified the debate ab...Recent medical research involving human-monkey chimeras, human brain organoids in rats, and the transplantation of a gene-edited pig heart and gene-edited pig kidneys in living human beings have intensified the debate about whether we should create human-animal chimeras for biomedical purposes and, if so, how we should treat them. Influential views in the debate frequently appeal to assumptions regarding how people will react to such chimeras. It has, for example, been argued that the most important objection against creating such chimeras is that this will result in inexorable moral confusion about species boundaries and will, as a result, threaten the social order. But is this indeed the case? We conducted three empirical studies to examine laypeople's views on the creation and treatment of various types of human-animal chimeras. Our studies indicate that laypeople find typical cases of xenotransplantation (i.e., the transplantation of an animal organ into a human patient) morally unproblematic. They assign the same moral status to humans with animal organs as to non-chimeric humans. By contrast, they sometimes (but not always) assign slightly higher moral status to animals with human organs than to non-chimeric animals. Overall, however, there is little indication of chimera technology blurring the line between humans and animals, and thus of the technology causing moral confusion.
A long-standing debate has persisted on whether reciprocity reasonably justifies the priority rules in organ allocation as some countries (e.g., Israel, Singapore, Chile, and China) have adopted this priority policy base...A long-standing debate has persisted on whether reciprocity reasonably justifies the priority rules in organ allocation as some countries (e.g., Israel, Singapore, Chile, and China) have adopted this priority policy based on reciprocity. This paper reviews the ethical dilemmas and challenges of incorporating reciprocity into a priority system by considering the following five aspects: (1) It exacerbates the risk of incorporating moral values in the organ allocation context. (2) It is incompatible with the reciprocity inherent in the gift- or gratitude-based relationship in organ allocation. (3) The concept of "reciprocity," which easily extends the idea of "moral desert," could, thus, exacerbate social inequalities. (4) In the context of incentives instead of rewards, priority rules in organ allocation need not involve the obligation of reciprocity. (5) Reciprocity acceptability does not invariably translate into efficacy. In sum, reciprocity is not an appropriate moral rationale for being established as a priority rule in organ allocation, and alternatives such as altruism or charity (virtue)-though associated with several feasibility and fairness-related concerns-seem preferable.
Rural communities experience well-documented systemic disparities in health access and outcomes in comparison to urban populations. However, the ethical dimensions of these disparities have received only limited attentio...Rural communities experience well-documented systemic disparities in health access and outcomes in comparison to urban populations. However, the ethical dimensions of these disparities have received only limited attention, and ethical issues related to rural health research have received even less. With the COVID-19 pandemic casting new light on these inequities, we conducted a scoping review to determine how much has been written on ethical issues in rural health research and which ethical issues are most prevalent. Four overarching ethical themes emerged through the search: resource inequity, underrepresentation, the benefits of community-based research, and challenges related to participant autonomy. Additionally, the search revealed a dearth of articles on ethical issues in rural health research, particularly in the United States. Thus, we propose four recommendations to revitalize and guide ethics discussions of research in rural communities, including growing the literature on ethical issues in rural U.S. communities, encouraging collaboration between rural health and bioethics researchers, improving recognition of rural heterogeneity, and addressing new issues in light of COVID-19. Acting on these recommendations would expand and support rural research efforts and ultimately help ameliorate rural-urban health inequities.
Essex R, Mainey L, Gonzales-Walters F
… +2 more, Gurnett P, Weldon SM
J Bioeth Inq
· 2026 Mar · PMID 40775549
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Codes of ethics have a long history in healthcare and, for many, are important documents. Codes however have also been extensively criticized for a range of reasons, from the guidance they provide to their meta-ethical a...Codes of ethics have a long history in healthcare and, for many, are important documents. Codes however have also been extensively criticized for a range of reasons, from the guidance they provide to their meta-ethical assumptions. This review sought to explore the theoretical literature to critically examine the function of codes in healthcare, with a particular focus on their strengths and shortcomings in relation to these functions. A systematic search was combined with a critical interpretive review. The final sample included twenty-four papers. Results of this synthesis suggest that codes fulfil multiple purposes, from providing guidance on ethical issues, to assertions about acceptable and unacceptable behaviour, to establishing and maintaining the status and identity of the professions. Codes also fulfil a number of social purposes, conveying information to the public and others. The extent to which a code does each of these things varies substantially however. We discuss these functions in relation to the many critiques that have been advanced in relation to these documents. We then put these findings into conversation with the broader literature on codes and discuss the challenges that this presents for normative analysis, namely in needing to first identify what a code should do before assessing its shortcomings. If the primary purpose of a code of ethics is to provide guidance, many fail here, the devil is in the detail however. To what extent should codes provide guidance?
Brittain N, Higgins N, Barber M
… +3 more, Choi W, Carter A, Gardner J
J Bioeth Inq
· 2026 Mar · PMID 40773130
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The rapid growth in psychedelic research raises novel ethical challenges for both research and psychedelic-assisted therapy. Despite these challenges, there is no consensus among researchers, clinicians, patients, and re...The rapid growth in psychedelic research raises novel ethical challenges for both research and psychedelic-assisted therapy. Despite these challenges, there is no consensus among researchers, clinicians, patients, and regulators on how these ethical issues may be avoided or managed. This study aimed to identify key ethical issues in psychedelic research and practice in the literature. A scoping review was performed, identifying fifty-one relevant articles. Content analysis revealed five main ethical concerns in the literature: 1) standards of practice, 2) equity, 3) integrity, 4) cultural appropriation, and 5) epistemic justice. A consultation workshop highlighted several key concerns that were neglected in the literature: 1) post-trial care, 2) lack of consensus on models of care and psychedelic practitioner competencies, and 3) how current research and its associated ethical issues will be translated into practice. Based on these findings the following future directions are recommended: designing clear competency frameworks, increased consultation with Indigenous and priority populations (e.g. ethnic and cultural minorities, under-served groups), guidelines for Indigenous recognition, management of post-trial care in clinical trials, and adequate governance of psychedelic prescribing practices.
J Bioeth Inq
· 2025 Sep · PMID 40760302
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There has been much discussion about the tactics used by the Israeli Defence Forces (IDF) and government in the conflict in Gaza following October 7, 2023, which have caused, among other things, systematic destruction of...There has been much discussion about the tactics used by the Israeli Defence Forces (IDF) and government in the conflict in Gaza following October 7, 2023, which have caused, among other things, systematic destruction of hospitals and schools, the deaths of large numbers of civilians, including women and children, mass starvation, and denial of humanitarian aid. The Israeli government and IDF have sought to justify their actions using ethical arguments, many of which relate to their proclaimed role as the representatives of the Jewish state and of Jewish culture and history. Arguing from the extensive corpus of Jewish ethical thought, extending back thousands of years, this article poses a simple question: Are the above actions by the Israeli government and IDF in Gaza consistent with the ethical tradition of Judaism and the obligations that flow from it? To answer this question, key texts are analysed, especially the Hebrew Bible and the Talmud, and multiple arguments are examined, taking into account the complexities of context and diverse interpretive theories. The paper is presented in two parts, the first discussing the question and methodological issues and the second providing the data and conclusions. We conclude that the alleged acts of the Israeli government and IDF in Gaza are clearly and directly contrary to the Judaic tradition of ethics as it has developed over the millennia. The conduct of the war cannot truthfully be presented in any meaningful sense as representing, or indeed, consistent with, Jewish culture or ethics. These findings have potentially far-reaching consequences, including for the claimed status of Israel as a Jewish state, the relationship between criticism of the government of Israel and the scourge of antisemitism, and the identity of Jewish people both within and outside Israel.
In a world where physicians are experiencing unprecedented burn-out, our communities are progressively losing trust in the medical system, and healthcare costs continually increase to astronomical levels without improvin...In a world where physicians are experiencing unprecedented burn-out, our communities are progressively losing trust in the medical system, and healthcare costs continually increase to astronomical levels without improving outcomes, it seems clear that we need to make changes in how we care for our patients. Current healthcare conditions can evoke nostalgia for an idealized past, where physicians were valued members of their communities, making house calls, doing all they could to comprehensively support their neighbours in health and life. As a young physician who envisioned such a career where I could apply my years of hard work and studying towards helping those around me in their moments of greatest need, I often feel that the system we have built thwarts this ideal at every turn. Here I share a story from my intern year of training that marked me, demonstrating just how disconnected we are becoming from our patients. My story involves a clinical situation with which I believe many can relate, highlighting the dire need for us clinicians to care with more humanity.
J Bioeth Inq
· 2025 Sep · PMID 40758253
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The impact of AI on liberal democratic social and political systems has emerged as the crucial issue of our times. So is the need to regulate general AI systems. The alliance of newly elected president Trump with the own...The impact of AI on liberal democratic social and political systems has emerged as the crucial issue of our times. So is the need to regulate general AI systems. The alliance of newly elected president Trump with the owners and CEOs of the technological sector of the U.S. economy-Elon Musk first and foremost-adds extra urgency to the issue. Digital or platform capitalism has engendered what is known as "surveillance" societies. The centralized and unchecked business model it relies on poses serious existential threats to our collective futures. There is widespread consensus today, not only in academia but also in progressive social circles, that we need both traditional and algorithmic sources of resistance to monopolies and the centralization of technological powers. We also need more experimentation with alternative ways of developing and governing the AI dimension of our lives.
Gabathuler F, Würth K, Hodel M
… +3 more, Glässel A, Biller-Andorno N, Schwind B
J Bioeth Inq
· 2026 Mar · PMID 40730741
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RATIONALE: Persons with chronic pain report that their voices are marginalized in healthcare, despite efforts to achieve person-centred care. AIMS AND OBJECTIVES: This study aims to explore the healthcare experiences of...RATIONALE: Persons with chronic pain report that their voices are marginalized in healthcare, despite efforts to achieve person-centred care. AIMS AND OBJECTIVES: This study aims to explore the healthcare experiences of persons with chronic pain through the lens of epistemic injustice to advance person-centred care. METHOD: A secondary analysis of cross-sectional interviews with twenty German-speaking Swiss participants, originally collected as part of the DIPEx Switzerland project, was conducted. Data were examined using thematic analysis. RESULTS: Results revealed two overarching themes. Under Epistemic Challenges, participants felt dismissed, misunderstood, or relegated to passive roles by a system privileging quantifiable measures over subjective experiences. This overreliance on objective data fosters epistemic injustice by discounting patient testimonies and perpetuating systemic inadequacies. Under Epistemic Opportunities, participants reported more effective knowledge exchange when their expertise was acknowledged, empathy was shown, and professionals recognized their own limitations. CONCLUSIONS: Findings underscore the need to balance objective assessments with patients' subjective perspectives, recognizing persons with chronic pains as legitimate collaborators. By integrating their lived expertise, healthcare systems may mitigate epistemic injustices and provide more empathetic, effective care.
Why is healthcare "special" to the extent that it should be distributed more equally than other social goods, as a matter of justice? Norman Daniels claims that healthcare is special because it protects the normal range...Why is healthcare "special" to the extent that it should be distributed more equally than other social goods, as a matter of justice? Norman Daniels claims that healthcare is special because it protects the normal range of opportunities available to us, and therefore can be subsumed under a principle of justice which establishes that opportunity ought to be equally distributed. I argue that subsuming healthcare under such a principle leads to de facto discrimination against certain people in virtue of their healthcare needs. This is because-as a critical discussion of health and healthcare needs importantly illustrates-much of the healthcare that people need simply cannot or does not protect normal species function and therefore does not protect opportunity. And so, such healthcare needs go unfairly unmet on Daniels' view. Instead, I suggest that we ought to subsume healthcare under a principle of equally distributing the social bases of self-respect. Though the healthcare that many of us need cannot protect opportunity, it can still protect our sense of self-respect; as such, those who need such care are entitled to it as a matter of justice on the self-respect view. The self-respect view thus avoids de facto discrimination and ultimately meets healthcare needs more fairly. And because it does so by eschewing a controversial conception of health and healthcare, instead appealing to a conception that appears freestanding with respect to the doctrines that citizens might reasonably disagree about, it better satisfies the requirements of public justification.
J Bioeth Inq
· 2025 Dec · PMID 40694171
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Since standard measures of health effect ascribe negative value to disabilities, it is commonly believed that a cost-effective scheme for allocation of healthcare resources discriminates against people with disabilities....Since standard measures of health effect ascribe negative value to disabilities, it is commonly believed that a cost-effective scheme for allocation of healthcare resources discriminates against people with disabilities. It is still a question for discussion, however, when and why such discrimination is justified. In this paper I account for the central normative substance of this disability discrimination problem, and I defend the claim that it is more justifiable to discriminate against disabled people based on lifespan considerations than on assessments of their reduced quality of life. I term this the asymmetry intuition. Based on some prior attempts to explain the asymmetry intuition, I offer the Reasonable Impartial Interest Argument as the best possible way to defend it. If my argument is sound, this moves us a step further towards a cost-effective priority setting that does not unjustly discriminate against people with disabilities.
J Bioeth Inq
· 2025 Sep · PMID 40690122
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It is now possible for AI systems to generate novel inventions without meaningful human direction and control. Should such inventions be patented? The prevailing consensus, confirmed in recent test cases and official gui...It is now possible for AI systems to generate novel inventions without meaningful human direction and control. Should such inventions be patented? The prevailing consensus, confirmed in recent test cases and official guidance, is that patent law only covers inventions by natural persons (i.e., humans). This, however, sometimes creates an odd situation in which AI-generated inventions cannot be patented, nor can the humans responsible for those systems gain patent rights indirectly through the operation of the law. In this article, we argue against this prevailing consensus. We present five reasons for thinking that AI-generated inventions should be patentable and that AI systems should be legally recognized as inventors. In making this argument, we do not claim that modern AI systems have acquired some significant legal or moral status that is equivalent to humans. Our argument is more practical in nature. We argue that failing to recognize AI inventorship will have negative repercussions for economic development and innovation, at a time when AI assistance is needed.
Bioethics has become a crucial discipline in higher education. This study aims to understand the institutionalization of bioethics within this field and examine documented initiatives related to its integration. To achie...Bioethics has become a crucial discipline in higher education. This study aims to understand the institutionalization of bioethics within this field and examine documented initiatives related to its integration. To achieve this, a systematic mapping was conducted using Petersen and Kitchenham's methodology, analysing 444 relevant articles. The results indicate a higher concentration of studies addressing the institutionalization of bioethics at the undergraduate level (40.5 per cent), with fewer publications focused on the postgraduate level (19.4 per cent). Most of the studies are concentrated in the health sciences (81.3 per cent), while the remainder are distributed among the social sciences, humanities, biological sciences, and engineering. The analysis revealed a significant lack of studies on comparative practices and the use of replicated experiences (2 per cent), as well as limited evidence on the institutionalization of bioethics research in higher education (10.3 per cent). These gaps underscore the need for further research in these areas. Additionally, the integration of active methodologies and educational technologies has enhanced bioethics programmes (21.4 per cent), fostering more interactive and engaged learning environments. This study highlights a critical gap in the implementation of bioethics based on empirically validated experiences. It proposes the development of an implementation model that adapts these experiences to different educational contexts. Cooperation between institutions and the creation of research networks are recommended as key strategies for sharing best practices, thereby facilitating the more effective and widespread integration of bioethics across various educational settings.
J Bioeth Inq
· 2025 Sep · PMID 40569539
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A lot of the language we use to refer to AI, including in healthcare, uses terminology that originally and literally applies to humans and human relationships. Such terminology includes both non-evaluative terms, like "l...A lot of the language we use to refer to AI, including in healthcare, uses terminology that originally and literally applies to humans and human relationships. Such terminology includes both non-evaluative terms, like "learning," "memory," or "intelligence," and evaluative terms, like "trust" or "responsibility." In this article I focus on the latter type and the way it is applied specifically to the case of medical AI. Focusing on the discussion of "responsibility gaps" that, according to some, AI generates, I will suggest that such terminology is revealing of the nature of healthcare professional obligations and responsibility prior to and independently of the assessment of the use of AI tools in healthcare. The point I make is generalizable to AI as used and discussed more broadly: the language used to refer to AI often tells more about humans and human relationships than about AI itself and our relationship with it. In healthcare, whatever else AI will allow us to do, it can prompt us to reflect more thoroughly on professional responsibility and professional obligations.
Though the idea of assent emerged in the 1980s and adaptation in paediatrics has become more common practice, adolescent end-of-life care adds a multi-faceted layer of increased complexity to the assent process. In the c...Though the idea of assent emerged in the 1980s and adaptation in paediatrics has become more common practice, adolescent end-of-life care adds a multi-faceted layer of increased complexity to the assent process. In the current era of moral pluralism, medical decisions must account for much more than clinical considerations: they must abide by legal standards of decision-making which usually prioritize parental preferences. In the case of an adolescent at the end of life, there remains much room for improvement when disagreements arise. Conflict abounds between the parent or other legal decision-maker and healthcare team in situations where the parent prefers not to disclose the severity of the adolescent's illness or the healthcare team believes continuing lifesaving therapies are not in the adolescent's best interest. These dilemmas challenge how we solicit adolescents' preferences (assent) and their options for refusal (dissent). Disagreements create tension and weaken communication between the family and providers. Healthcare workers struggle to fulfil their professional obligations and retain their professional identities when values collide. We explore the moral distress healthcare workers face navigating conflict amongst various stakeholders involved in the adolescent's end-of-life care. Strategies to minimize moral distress are also provided.
J Bioeth Inq
· 2025 Dec · PMID 40540144
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Even though the last war between Tangata Whenua and the Crown ended over 150 years ago, Tiriti obligations and the rights of Tangata Whenua remain largely unaddressed. Significant disparities persist, with limited discou...Even though the last war between Tangata Whenua and the Crown ended over 150 years ago, Tiriti obligations and the rights of Tangata Whenua remain largely unaddressed. Significant disparities persist, with limited discourse on effective solutions. The recently introduced Principles of the Treaty of Waitangi Bill highlights enduring challenges in honouring Te Tiriti o Waitangi. This manuscript examines Te Ao Māori (the Māori worldview) and Western worldviews in Aotearoa, exploring their profound cultural differences and implications for relationships between Tangata Whenua and Tangata Tiriti. We highlight the holistic, interconnected nature of Te Ao Māori, rooted in whakapapa, and contrast this with the rationalism and compartmentalization of Western traditions. To bridge these worldview differences, we propose a relationship framework grounded in Te Tiriti o Waitangi to promote equitable, respectful partnerships. This framework addresses power imbalances and advocates for a two-worldview methodology that honours the mana of both perspectives. By integrating these approaches, we identify pathways for building stronger, inclusive relationships. This pluriversal approach respects the integrity of both worldviews and offers a foundation for coexistence rooted in mutual respect.
J Bioeth Inq
· 2025 Dec · PMID 40531300
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Social egg freezing (SEF) refers to the act of a woman's voluntary decision to preserve her eggs for future use. It is considered an expression of her right to bodily autonomy, allowing her to make decisions about her ow...Social egg freezing (SEF) refers to the act of a woman's voluntary decision to preserve her eggs for future use. It is considered an expression of her right to bodily autonomy, allowing her to make decisions about her own reproductive capacity. As a form of exercising personal rights, SEF is aimed at preserving or extending fertility. Owing to the difference in attributes between it and the traditional "medical act," SEF has sparked significant controversies in the academic world that remain unresolved. These debates stem from uncertainty and are often framed through the lens of consequentialist theory-focusing on potential social, ethical, or medical outcomes. For SEF, a more appropriate position should be taken, based on the theory of rights. This perspective centres on the individual's legitimate claim to exercise bodily autonomy, particularly in relation to their reproductive potential. SEF is essentially a specific claim by a woman to exercise her right to control her own body as a means of realising her autonomy over her own eggs. To avoid the abuse of SEF, necessary legal regulations should be put in place.
Both minors enrolled in human subject research and their parents often receive compensation for the former's participation. While considerable literature addresses the ethics of such compensation, the existing literature...Both minors enrolled in human subject research and their parents often receive compensation for the former's participation. While considerable literature addresses the ethics of such compensation, the existing literature does not yet consider the challenge of minors and parents who may have divergent views regarding how such compensation should be expended. Since parents generally have broad legal authority over both monetary and in-kind compensation received by their children, ensuring that compensation earmarked for minor subjects are actually expended in accordance with the subjects' interests may prove challenging. This paper assesses the existing legal and ethical landscape in this area and proposes several potential mechanisms through which researchers and IRBs might address this largely overlooked dilemma.
J Bioeth Inq
· 2025 Sep · PMID 40504451
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The increasing prevalence of AI in all facets of human lives raises profound questions of ethics, policy, and law. Interactions with AI in situations that traditionally involve humans demonstrate the growing sophisticati...The increasing prevalence of AI in all facets of human lives raises profound questions of ethics, policy, and law. Interactions with AI in situations that traditionally involve humans demonstrate the growing sophistication and adaptivity of the technology. For this very reason, we may demand some basic rules of engagement from these interactions-AI should not deceive humans into believing it is human or that it has human-like capacities and should be transparent about its artificial status. Law increasingly makes these demands. We may further question as a matter of practical ethics, if not law, whether even "well-trained" AI should be used at all in intimate or personal interactions with humans. This essay seeks to explore these issues by reference to a series of examples in which AI seeks to mimic or interpret humans: AI influencers on social media, AI companions, AI mental health therapy chatbots, and AI emotion detection tools.