The ethically charged question of what constitutes appropriate levels of care is both inevitable and particularly complex in intensive care units (ICUs), where limited resources, uncertain prognosis, and potentially conflicting values among patients, families, and ICU professionals all cohabit. While various tools have been developed to support discussions and decision-making around levels of care, they are often developed without the individuals who will ultimately use them and they fail to address the lack of interprofessional collaboration and communication between ICU professionals, a factor known to contribute to inappropriate levels of care. Living labs and the living ethics stance, which aim both to enhance collaboration and communication, represent promising research orientations for addressing this issue. This paper reports the process and outcomes of a living ethics project, which took the form of a living lab, to address the issue of inappropriate levels of care in the ICU. Special emphasis is granted to the evaluation of outcomes by participating stakeholders. This study highlights that, although inappropriate levels of care is a deeply concerning issue for which concrete contextual solutions can be envisioned, engaging in a participatory research process can be particularly challenging for overburdened critical care professionals. This difficulty stems not only from the multifactorial and emotionally charged nature of the issue, but also from the demanding context in which ICU professionals operate.
Background Although interest in health disparities has expanded across medicine, the extent to which race and other social determinants of health are represented in orthopaedic research is unclear. Orthopaedics has traditionally emphasized biomechanical and procedural outcomes rather than structural or social drivers of inequity. This study maps how race and other determinants-gender, socioeconomic status, geography, and insurance-are represented within U.S. orthopaedic surgery journals. Methods A scoping review was performed following PRISMA-ScR guidelines. Searches in PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, and Web of Science (2014-2024) identified orthopaedic publications addressing health disparities. Eligible articles analysed or reported variables such as race, ethnicity, sex/gender, socioeconomic status, geography, or insurance. Two reviewers independently screened and charted data. Results Among more than 180,000 articles across sixty-nine orthopaedic journals, 333 (<0.5 per cent) met inclusion criteria. Race/ethnicity appeared most frequently (94 per cent), followed by sex/gender (77 per cent), insurance (39 per cent), socioeconomic status (29 per cent), and geography (24 per cent). Nearly half of the included articles were published in 2022 or later. Of race-related articles, 58 per cent included race only as a demographic descriptor, while 42 per cent analysed race as a primary focus. Conclusion Despite recent growth, health disparities remain minimally represented in orthopaedic literature, with most studies using race descriptively rather than examining structural inequity. Greater engagement with social determinants is needed to advance equitable musculoskeletal care and uphold core bioethical principles.
Solidarity plays an important role in response to pandemics, natural disasters, and humanitarian crises. It has both an intrinsic and instrumental value in global health. However, it can result in unintended consequences when not practiced properly. When the unintended consequences of acts of solidarity are perceived by the intended beneficiaries to be so unacceptable that they are spurned, such solidarity is objectionable. This paper introduces the concept of objectionable solidarity and illustrates its global bioethical implications using the example of COVID-19 vaccine donations. Objectionable solidarity raises bioethical concerns including avoidable mortality, erosion of trust in health systems, and unjust distribution of life-saving resources. The argument then traces the roots of objectionable solidarity to fractures in the ethics of global health solidarity, and discusses the triggers of objectionable solidarity. Finally, this paper employs examples from Afro-Caribbean approaches to COVID-19 vaccine solidarity-such as reciprocity, sacrificidality, noblesse oblige, cooperativity, and simultaneity-as bases on which guidelines for navigating the ethics of global health solidarity in pandemic settings can be built.
Molecular epidemiology (ME) is a field that integrates molecular biology techniques with traditional epidemiological methods to study the distribution, determinants, and dynamics of disease. In the context of HIV, ME involves analysing genetic sequences of the virus to understand patterns of transmission, evolution, and the relationships between social, behavioural, and biological factors that influence transmission. This holds great promise in the global effort to further reduce HIV transmission, although its use raises significant ethical issues. ME is not currently used in Australia's public health response to HIV, although experiences from other countries emphasize the importance of community consultation and support to avoid unintended negative consequences, such as deterring individuals from accessing sexual health services. This article explores the perspectives of twenty-three participants, recruited through HIV/sexual health-related organizations in Victoria, Australia, via nineteen semi-structured interviews and one focus group. Participants included people who regularly test for sexually transmissible infections (STIs) and people diagnosed with HIV and/or syphilis/gonorrhoea. Participants often reported vague or no prior understanding of ME (19/23; 82.6 per cent); however, many of those with vague or no understanding were supportive (16/19; 84.2 per cent). A subset of participants raised concerns, including those related to privacy risks, misuse of data, and the disproportionate impact on marginalized groups. These findings reinforce the need for meaningful community engagement and safeguards for potential ethical use of ME in Australia.
Research into the functioning of the human brain is essential both for the biological assessment of the species and for our self-comprehension. However, following the "neuroscientific turn" in several areas of research, such as psychology, philosophy, and AI, interdisciplinary collaboration in this area gave birth to an important phenomenon that is still active today: "neuro-hype" or "brain-hype." In this paper, we will inquire about one particular aspect of this widespread phenomenon: for-profit neuro-related products. Due to the lack of a vast and robust literature on the topic, the first aspect of our inquiry will concern products that have two major similarities with our focus topic: they are direct-to-consumer (DTC) health-related products, and they have a certain effect on consumer health. The second aspect of our inquiry will delve deeper into DTC neurotechnology by investigating how such products are advertised on major online platforms. In our analysis, we will consider both supplements and biomedical devices, taking into account their ratings, their cost, how they are made, their patent (if present), and will compare this information with the available research data on such objects or similar ones. Finally, this paper argues that while DTC neurotechnologies democratize access to brain health tools, they frequently fail to align with core bioethical principles-autonomy, beneficence, non-maleficence, and justice. These shortcomings highlight an urgent need for robust regulatory frameworks and ethical guidelines to ensure responsible development, equitable access, and transparent commercialization.
Disputes around puberty blockers and gender-affirming hormones for transgender and gender-diverse youth (TGDY) are often framed as disputes around evidence. Recent reviews, including NICE (2020) and the Cass Review (2024), have characterized the supporting evidence as "remarkably weak," prompting calls for further research and regulatory restrictions. This paper explains why producing more or "better" data is unlikely to resolve these disputes. Drawing on Kuhn's account of paradigms and the theory-ladenness of observation, I show that disagreements in paediatric gender medicine reflect not merely gaps in knowledge but deeper metaphysical and normative divergences about sex, gender, health, human development, and the legitimate goals of medical intervention. What counts as evidence, which outcomes matter, and how findings are interpreted depend on competing conceptual frameworks and value commitments. In this light, the proliferation of studies and continuing dissatisfaction with their results are symptomatic of a paradigmatic crisis, rather than a simple evidentiary deficit. This paper does not deny in any way the value of empirical research. It rather points out that appeals to "evidence" risk obscuring the normative dimensions of clinical judgment. Resolution will depend less on the accumulation of data than on explicit ethical deliberation, clinical experience, and engagement with the worldviews that shape what is taken to be meaningful knowledge. This paper first explains why repeated calls for stronger evidence persist despite a substantial empirical literature, by showing that these calls rest on divergent standards of evidential relevance. Second, it shows that the dispute is paradigmatic and as such cannot be adjudicated by data alone. This paper resolves an apparent impasse in the literature and clarifies the limits of data-driven resolution, with implications for clinical guideline development and evidence review processes.
The rapid integration of artificial intelligence (AI) in ophthalmology has produced remarkable diagnostic accuracy while simultaneously raising significant ethical and epistemic concerns. This article argues that the prevailing AI paradigm fosters a form of data-fetishism: the tendency to treat datasets and algorithmic outputs as objective truth, privileging measurable metrics over the patient's lived experience and clinical context. Inspired by Marx's concept of commodity fetishism, the analysis demonstrates how this phenomenon produces "algorithmic substitution": a process through which the clinical encounter is converted from an ethically engaged encounter into a data-centric transaction, subordinating beneficence to statistical optimization. Four interconnected manifestations are examined: (1) dataset bias, where the marginalization of rare diseases and non-Western populations constitutes an epistemic injustice; (2) citation bias, which reinforces academic power structures; (3) the "covidization" of research, illustrating metric distortion; and (4) language hegemony, resulting in the epistemic erasure of regional medical knowledge. Clinical evidence reveals that these biases produce systematic errors in high-stakes domains such as ocular oncology and retinal surgery. The analysis concludes that data-fetishism enables a "moral deskilling" of ophthalmologists, redirecting professional fidelity from the suffering patient to the optimized dataset. Preserving the fiduciary essence of medicine requires a reorientation towards epistemic justice, emphasizing representativeness, ethical design, and the maintenance of the clinical gaze.
Despite the physical proximity between Poland and Germany, there are differences between the two countries in terms of language, customs, healthcare systems, legal frameworks, and socio-economic conditions. These differences and the membership of both countries in the European Union make cross-border healthcare a complex bioethical field. This paper examines the key areas of healthcare provision that are influenced by the political and geographical circumstances between Poland and Germany. This work employs an exploratory approach to map ethical risks and challenges using literature reviews and diverse sources (policy documents, local media reports, etc.). Ethical analysis is rooted in various established frameworks. We outline six areas where patient and healthcare staff mobility may raise ethical issues: (1) access to termination of pregnancy, (2) implications of differing regulations on artificial reproductive technologies, (3) dental care, (4) patient mobility for planned treatments under Directive 2011/24/EU, (5) healthcare challenges in border regions, and (6) migration of healthcare staff. The German and Polish healthcare systems, rooted in principles of solidarity, aim to provide equal access to healthcare services. European Union regulations allow patients to receive treatment abroad, but this can strain state budgets, particularly in less affluent countries. Language barriers might also impact doctor-patient interactions and the process of gaining informed consent. Political and economic differences further complicate ethical dilemmas, affecting healthcare migration and treatment availability. Asymmetric resources might contribute to the growth of private healthcare, affecting integrated public services locally and internationally.
This study aimed to investigate and compare the longitudinal impacts of mandatory clinical ethics consultation (CEC) on resource use and ethical conflicts among critically ill neurologic and non-neurologic patients. It also sought to identify relevant predictive factors and determine family member satisfaction with CEC. This combined retrospective and prospective cohort study was conducted at a tertiary academic medical centre. During the eight-year study period, 1,150 adult patients participated in this study (437 neurological and 713 non-neurological). In both groups, the ICU length of stay and days of ventilator use significantly decreased each year. Secular trends in the incidence rates of ethical conflicts significantly decreased each year in neurological patients. Neurological patients exhibited a greater decrease in resource usage and significantly higher incidence rates of ethical conflicts than non-neurological patients. Family members of both groups expressed high levels of satisfaction and agreed that CEC was beneficial. In the local healthcare context, the implementation of CEC policies may reduce resource usage, ethical conflicts, and improve the knowledge base of CEC and clinical teams, helping them in approaching the distinct issues raised by various patient characteristics. However, these findings should be interpreted with caution as their applicability to other healthcare systems may vary.
This qualitative study aims to understand the moral attitudes of key stakeholders toward the development of somatic gene editing for inherited cardiomyopathy. Patients are waiting on effective treatment for inherited cardiomyopathies, including those caused by PLN and LMNA mutations. Somatic gene editing, particularly prime and base editing, is being explored as a potential therapeutic strategy. Development of these technologies requires insight into the perspectives of stakeholders directly affected by or involved in their translation. Semi-structured interviews were conducted with eighteen stakeholders in The Netherlands, including PLN and LMNA-mutation carriers, clinicians, laboratory researchers, and regulatory officers. Interview transcripts were thematically analysed to foster collaborative development of higher-order themes. Three central themes were identified. First, participants emphasized the importance of "the right treatment for the right person at the right time," reflecting a mixture of cautious pragmatism and hopeful anticipation of meeting patients' unmet medical need. Second, respondents highlighted potential societal benefits, like cost savings and technological spill-over, as justifications for continued development of somatic gene editing for inherited cardiomyopathy. Third, stakeholders expressed notable trust, not only in the promise of somatic gene editing itself but also in the broader process of scientific and clinical advancement. Respondents recognized somatic gene editing as a potential root cause fix, but attitudes spanned from considering it the superior option to maintaining a more ambivalent stance. Importantly, expressed concerns were framed as challenges to overcome rather than grounds for rejection. This convergence of optimism and trust across stakeholder groups underscores a rare degree of alignment between patients, professionals, and regulators; an alignment that demands careful stewardship if enthusiasm is to translate into responsible development and implementation of somatic gene editing for inherited cardiomyopathy.
This short paper will argue that one of the most pressing issues related to the attention economy is the subjugation of cognitive capacity to conditions of neuro-capitalism, including through psychological discipline, biopolitically-weaponized mindfulness, and transhumanist interventions. In so doing, it will also consider how traditional concepts of the human fail to account for the myriad ways humans interact with technologies that may enhance or diminish their capacity to contribute to, and participate in, the attention economy. Collectively, these issues highlight an ethical obligation for those working within neuroscience to consider the biopolitical implications of their work within the capitalist paradigm of work intensification and cognitive optimization. Using the example of generative AI tools in the workplace, the paper will conclude that such innovations fall within the scope of cognitive enhancements when considered within the attention economy, where offloading cognitive load onto technology represents a productivity shortcut designed to extract more value from the human mind through human-machine teaming.
This paper proposes using the term "Bioethics-in-Science" (BiS) to denote and delineate a set of emerging methodological approaches entangling bioethical inquiry directly within scientific practice. Drawing inspiration from Van Rensselaer Potter's original vision of bioethics as a collaborative bridge between biology and ethics, BiS represents a community of practice aiming to contribute to bioethical inquiry in three key ways. First, it reframes the relationship between ethics and science by treating scientific practice as inherently value-laden and recognizing scientists' relevant ethical expertise. Second, it develops methods-including ethics notebooks, collaborative workshops, and conceptual mapping-which facilitate a shift from mere external evaluation towards continuous ethical deliberation within research environments. Third, it demonstrates how bioethical inquiry can actively contribute to improving scientific practice through the co-creation of knowledge and values. Through case studies from synthetic biology, neurodiversity research, and proteomics, we illustrate how BiS arose from and operates in practice, and examine the challenges of crossing disciplinary boundaries. As such, we position BiS as offering a pathway for bioethical inquiry to move beyond its peripheral position vis-à-vis the sciences and engage meaningfully with the normative dimensions of scientific knowledge production instead, ultimately contributing to both better ethics and science.
Background Clinical practice guideline (CPG) development is a time- and resource-intensive process, yet their uptake may be limited by concerns among clinicians that guidelines could be used against them in malpractice cases. The role of CPGs in surgical litigation remains unclear. Aim To empirically evaluate how CPGs are used in surgical civil law and determine whether cited guidelines are surgery specific. Methods A systematic review of California Civil Trial Court Orders (Westlaw) was searched for surgery-related cases from 2021-2024. Case dockets were reviewed for guideline-based recommendations in expert testimony and in the Summary of Motion documents. Results A total of 192 cases were reviewed with eighty-three meeting inclusion criteria. CPGs were cited in three of eighty-three surgical malpractice cases (3.6 per cent), none of which were surgery specific. Conclusion CPGs appear to be rarely cited in surgical civil court cases and when referenced, they relate to non-surgical aspects of care. However, their violation may provide courts with decisive grounds for legal deliberation. Further studies evaluating a larger number of settlement cases using insurance company data would be invaluable to fully understand the role of surgical and non-surgical guidelines in shaping surgical medicolegal proceedings.
Accepting a reductionist view of personal identity threatens the moral authority of advance directives-a challenge often referred to as the personal identity problem of advance directives. According to this view, when cognitive deterioration reaches the point where advance directives would typically come into play the author of the directive will have ceased to exist in the relevant sense. As a result, the advance directive can no longer be said to express that person's wishes but only those of a former, numerically different self, rendering the directive without purpose. Building on the principle that like cases should be treated alike, this paper argues that the implications of the personal identity problem extend beyond advance directives. In particular, it examines how a consistent application of the argument calls into question common assumptions about posthumous bodily rights-especially the widely held view that individuals hold fundamental rights over their body after death, including decisions about organ donation.
This paper examines the "expressivist objection" to physician-assisted dying (PAD) laws, which argues that limiting eligibility to terminal or incurable conditions expresses a discriminatory message devaluing such patients' lives. It critiques three common responses-abolishing PAD, removing medical criteria, and consequentialist justification-as inadequate. Instead, the author proposes that legally protecting healthcare professionals' conscientious objection can counterbalance this expressive harm. By accommodating conscientious objectors, the legal system actively affirms that the lives of incurably or terminally ill patients remain worthy of respect and preservation. This expressivist rationale grounds conscientious objection as a legal right rather than a mere permission, offering a key mechanism to address the moral residue generated by PAD legislation. Furthermore, this expressivist rationale addresses concerns about the reasonableness, genuineness, and professional ethics of conscientious objection. Finally, the paper provides a principled defence of conscience protections that preserves value pluralism without undermining access to PAD or abandoning the clinical foundations of PAD.
This paper presents results from a key informant survey exploring ethical, legal, and social issues (ELSI) as perceived by professionals working in the U.S.-based private sector human genomics industry. Drawing on a structured survey of 111 participants-including researchers, executives, policy leads, and communications specialists-this study examines how industry insiders assess emerging ethical concerns across domains such as data privacy, race and ancestry, sociogenomics, commercialization, and government partnerships. The survey instrument was developed based on a prior interview phase and reflects concerns raised directly by professionals in the field. Quantitative responses were analysed for levels of concern and consensus, while open-text responses provided further insight into areas of divergence and organizational context. Respondents expressed high concern and consensus about lack of diversity in datasets, fragmented privacy regulation, and potential genomics collaborations with governments implicated in human rights abuses, though significant disagreement emerged around the appropriate use of race categories and socio-genomic applications. This preliminary exploration offers a glimpse into perspectives from a difficult sample population, and suggests entry points for future collaboration, policy, and critical scholarship.
With prison populations expanding and aging, palliative care (PC) is an urgent concern. People in prison (PIP) face chronic illness, mental health conditions, and social vulnerabilities, creating ethical and psychosocial challenges to dignified end-of-life (EOL) care. This scoping review mapped key ethical and psychosocial domains in the provision of PC in prisons. PubMed, Web of Science, and ScienceDirect were searched using the strategy: Population-individuals in prison; Concept-ethical and/or psychosocial issues in PC; Context-PC provision in prisons across regions and healthcare models. Data were coded inductively, organized into ethical and psychosocial domains, and synthesized narratively. Sixteen studies were included, mainly conceptual analyses (n=10), most from North America (n=11). Ethical domains included structural neglect of PIP with life-limiting illness, barriers to compassionate release, compromised autonomy, denial of death in prison culture, and inadequacies in care quality and access. Psychosocial domains encompassed stigma, mistrust, isolation, existential suffering, and fractured social bonds. PIP-led hospice models offered companionship but raised tensions around labour, confidentiality, and the normalization of death in custody. Prison-based PC requires systemic reforms, staff training, family and advocacy involvement, and legal safeguards to ensure equitable, compassionate, and dignified EOL care.
The decriminalization of surgical and medical abortion in many Australian jurisdictions has led to discussions about the systemic and moral barriers to accessing abortion services. This article reflects on Conscientious Objection (CO), as one of such barriers in abortion services in Australia. Two broad positions are identified in the moral disagreement between a patient's legal right to abortion and a doctor's right to conscientiously object to providing such service: (1) pro-conscientious protection and (2) anti-conscientious protection. While each of these positions motivates different courses of action that may independently count as right, a fundamental ethical challenge is resolving the disagreement in ways that both positions are jointly satisfiable. This article argues that (1) and (2) are prima facie flawed as they may perpetuate medical paternalism, psycho-social and moral distress, medical abandonment, moral standing diminution, and reproductive injustice, which considerably impact both patient and physician to varying degrees. This article suggests an Ethic of Solidarity (ES) as an important relational anthropological frame that inspires some compromise in the moral disagreement. When the virtues of solidarity, such as cooperation, sharing, and reciprocity, are applied to the dilemma between respecting a patient's right or doctor's professional conscience in abortion service encounters, inclinations toward interchangeable compromises emerge. This article concludes that an ES is worth taking seriously in the CO debate in Australia and beyond.
This paper argues that viewing informed consent as an autonomous action is problematic because it is based on an idealized conception of the person and of autonomy. Instead, informed consent should be viewed as the objective activity of real, concrete persons. In this activity, an individual, acting as a subject, authorizes a specific object for a particular purpose. A person's choice is fundamentally constrained by the reality of both the object and the subject (the individual themselves). Accordingly, individuals must understand the nature of the object and its relevance to their own situation in order to make appropriate decisions. However, since cognitive activity is fundamentally constrained by practical conditions, there is no assurance that individuals can achieve sufficient understanding when making a consent decision. Therefore, the cognitive goal of informed consent should not be to ensure complete understanding in advance but to maximize the likelihood that sufficient understanding will be achieved. The appropriate cognitive threshold must also vary according to the actual circumstances of each individual. On this basis, the paper proposes a more complete informed consent process consisting of three stages: pre-consent communication, post-consent verification, and consent process optimization.
Fatāwā are a key source for Islamic bioethics scholarship. When developing Islamic bioethical frameworks and conducting research in this field, the inherent biases of this juridical tool and the limitations of fatwa-based literature reviews should be recognized and addressed. In this paper, I describe key normative constraints and methodological limitations of fatwa and discuss their associated implications and remedies. I focus on how fatwa prioritizes context over text and how researchers often see part of the whole when using fatwa to identify Islamic bioethical norms, and how publication biases and related limitations can affect comprehensive fatwa reviews.