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Journal of Medical Ethics

Nathan Emmerich, Bert Gordijn
This paper focuses on the practice of injecting patients who are dying with a relatively high dose of sedatives in response to a catastrophic event that will shortly precipitate death, something that we term 'crisis sedation.' We first present a confabulated case that illustrates the kind of events we have in mind, before offering a more detailed account of the practice. We then comment on some of the ethical issues that crisis sedation might raise. We identify the primary value of crisis sedation as allowing healthcare professionals to provide some degree of reassurance to patients, their families and the professionals who are caring for them...
April 20, 2019: Journal of Medical Ethics
Florence Ashley
Although informed consent models for prescribing hormone replacement therapy are becoming increasingly prevalent, many physicians continue to require an assessment and referral letter from a mental health professional prior to prescription. Drawing on personal and communal experience, the author argues that assessment and referral requirements are dehumanising and unethical, foregrounding the ways in which these requirements evidence a mistrust of trans people, suppress the diversity of their experiences and sustain an unjustified double standard in contrast to other forms of clinical care...
April 15, 2019: Journal of Medical Ethics
Aaron J Ancell, Walter Sinnott-Armstrong
Robert Card criticises our proposal for managing some conscientious objections in medicine. Unfortunately, he severely mischaracterises the nature of our proposal, its scope and its implications. He also overlooks the fact that our proposal is a compromise designed for a particular political context. We correct Card's mischaracterisations, explain why we believe compromise is necessary and explain how we think proposed compromises should be evaluated.
March 14, 2019: Journal of Medical Ethics
Thomas Ploug, Soren Holm
In a recent article in the Journal of Medical Ethics, Neil Manson sets out to show that the meta-consent model of informed consent is not the solution to perennial debate on the ethics of biobank participation. In this response, we shall argue that (i) Manson's considerations on the costs of a meta-consent model are incomplete and therefore misleading; (ii) his view that a model of broad consent passes a threshold of moral acceptability rests on an analogy that misconstrues how biobank research is actually conducted and (iii) a model of meta-consent is more in tune with the nature of biobank research and enables autonomous choice...
March 14, 2019: Journal of Medical Ethics
Joona Räsänen
Should a person who feels his legal age does not correspond with his experienced age be allowed to change his legal age? In this paper, I argue that in some cases people should be allowed to change their legal age. Such cases would be when: (1) the person genuinely feels his age differs significantly from his chronological age and (2) the person's biological age is recognised to be significantly different from his chronological age and (3) age change would likely prevent, stop or reduce ageism, discrimination due to age, he would otherwise face...
March 14, 2019: Journal of Medical Ethics
Alwalaa Althagafi, Chris Ekong, Brian W Wheelock, Richard Moulton, Peter Gorman, Kesh Reddy, Sean Christie, Ian Fleetwood, Sean Barry
BACKGROUND: The Supreme Court of Canada removed the prohibition on physicians assisting in patients dying on 6 February 2015. Bill C-14, legalising medical assistance in dying (MAID) in Canada, was subsequently passed by the House of Commons and the Senate on 17 June 2016. As this remains a divisive issue for physicians, the Canadian Neurosurgical Society (CNSS) has recently published a position statement on MAID. METHODS: We conducted a cross-sectional survey to understand the views and perceptions among CNSS members regarding MAID to inform its position statement on the issue...
March 12, 2019: Journal of Medical Ethics
Angela Ballantyne, G Owen Scaefer
No abstract text is available yet for this article.
March 12, 2019: Journal of Medical Ethics
Rachel Horton, Anneke M Lucassen
Gyngell and colleagues consider that the recent Nuffield Council report does not go far enough: heritable genome editing (HGE) is not just justifiable in a few rare cases; instead, there is a moral imperative to undertake it. We agree that there is a moral argument for this, but in the real world it is mitigated by the fact that it is not usually possible to ensure a better life. We suggest that a moral imperative for HGE can currently only be concluded if one first buys into an overly deterministic view of a genome sequence, and the role of variation within in it, in the aetiology of the disease: most diseases cannot simply be attributed to specific genetic variants that we could edit away...
March 12, 2019: Journal of Medical Ethics
Kimberly Sue, Dinah Applewhite
As resident physicians practicing Internal Medicine in hospitals within the USA, we are confronted on a daily basis with patients who wish to leave the hospital floor to smoke a cigarette. While many physicians argue that hospitals should do everything in their power to prevent patients from smoking, we argue that a more comprehensive and nuanced approach is needed. In part 1 of this perspective piece, we outline the various forms of smoking bans in hospital settings, applauding the development of indoor smoking bans while questioning the move towards stricter, campus-wide smoking bans...
March 7, 2019: Journal of Medical Ethics
Govind Persad, Holly Fernandez Lynch, Emily Largent
Recognising that offers of payment to research participants can serve various purposes-reimbursement, compensation and incentive-helps uncover differences between participants, which can justify differential payment of participants within the same study. Participants with different study-related expenses will need different amounts of reimbursement to be restored to their preparticipation financial baseline. Differential compensation can be acceptable when some research participants commit more time or assume greater burdens than others, or if inter-site differences affect the value of compensation...
March 7, 2019: Journal of Medical Ethics
Diego Real de Asúa, Katarina Lee, Peter Koch, Inmaculada de Melo-Martín, Trevor Bibler
Although shared decision-making is a standard in medical care, unilateral decisions through process-based conflict resolution policies have been defended in certain cases. In patients who do not stand to receive proportional clinical benefits, the harms involved in interventions such as cardiopulmonary resuscitation seem to run contrary to the principle of non-maleficence, and provision of such interventions may cause clinicians significant moral distress. However, because the application of these policies involves taking choices out of the domain of shared decision-making, they face important ethical and legal problems, including a recent challenge to their constitutionality...
March 6, 2019: Journal of Medical Ethics
Natalie Cohen
There have been multiple factors involved in the decline of the anatomy course's central role in medical education over the last century. The course has undergone a multitude of changes, in large part due to the rise in technology and cultural shifts away from physical dissection. This paper argues that, as the desire of medical schools to introduce clinical experiences earlier in the curriculum increased, anatomy courses began implementing changes that would align themselves with the shifting culture towards incorporating humanistic values early on in the medical curriculum...
March 2, 2019: Journal of Medical Ethics
Gert Helgesson, William Bülow, Stefan Eriksson, Tove E Godskesen
Sometimes participants in research collaboration die before the paper is accepted for publication. The question we raise in this paper is how authorship should be handled in such situations. First, the outcome of a literature survey is presented. Taking this as our starting point, we then go on to discuss authorship of the dead in relation to the requirements of the Vancouver rules. We argue that in principle the deceased can meet the requirements laid down in these authorship guidelines. However, to include a deceased researcher as author requires a strong justification...
March 1, 2019: Journal of Medical Ethics
Peter Mills
No abstract text is available yet for this article.
February 28, 2019: Journal of Medical Ethics
Tommaso Bruni, Mackenzie Graham, Loretta Norton, Teneille Gofton, Adrian M Owen, Charles Weijer
Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. After describing each issue, we propose potential solutions which would make a patient's participation in research compatible with her rights and interests...
February 25, 2019: Journal of Medical Ethics
Amani Sampson, Laura L Kimberly, Kara N Goldman, David L Keefe, Gwendolyn P Quinn
Uterus transplantation is an emerging technology adding to the arsenal of treatments for infertility; specifically the only available treatment for uterine factor infertility. Ethical investigations concerning risks to uteri donors and transplant recipients have been discussed in the literature. However, missing from the discourse is the potential of uterus transplantation in other groups of genetically XY women who experience uterine factor infertility. There have been philosophical inquiries concerning uterus transplantation in genetically XY women, which includes transgender women and women with complete androgen insufficiency syndrome...
February 25, 2019: Journal of Medical Ethics
William Simkulet
Opposition to induced abortion rests on the belief that fetuses have a moral status comparable to beings like us, and that the loss of such a life is tragic. Antiabortion, or pro-life, theorists argue that (1) it is wrong to induce abortion and (2) it is wrong to allow others to perform induced abortion. However, evidence suggests that spontaneous abortion kills far more fetuses than induced abortion, and critics argue that most pro-life theorists neglect the threat of spontaneous abortion and ought to do more to prevent it...
February 22, 2019: Journal of Medical Ethics
Elizabeth Fenton
In 'Obesity, equity and choice' ( J Med Ethics 2018;0:1-7. doi:10.1136/medethics-2018-104848), Timothy Wilkinson argues that preventive regulations to address obesity, such as taxes on sugary drinks, are at worst inequitable and at best fail to increase or improve equity. He concludes that we do not yet have good reasons to adopt them. I argue that equity considerations are not as problematic for preventive regulations as Wilkinson suggests.
February 22, 2019: Journal of Medical Ethics
Akira Akabayashi, Eisuke Nakazawa, Nancy S Jecker
In the January edition of the Journal of Medical Ethics , Fujita and Tabuchi (hereafter, Authors) responded that we misunderstood the 'facts' in our previous article. Our article's method was twofold. First, it appealed to normative analysis and publicly accessible materials, and second, it targeted a policy-making approach to public funding. We specifically did not focus on the Center for iPS Cell Research and Application or induced pluripotent stem stock projects. The Authors raised five criticisms, including transparency of our interpretation of public funding policy...
February 18, 2019: Journal of Medical Ethics
Jane Johnson, Chris Degeling
Emerging infectious diseases (EIDs) remain a significant and dynamic threat to the health of individuals and the well-being of communities across the globe. Over the last decade, in response to these threats, increasing scientific consensus has mobilised in support of a One Health (OH) approach so that OH is now widely regarded as the most effective way of addressing EID outbreaks and risks. Given the scientific focus on OH, there is growing interest in the philosophical and ethical dimensions of this approach, and a nascent OH literature is developing in the humanities...
February 16, 2019: Journal of Medical Ethics
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