Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees
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Camb Q Healthc Ethics · Oct 2019
From Awareness to Prognosis: Ethical Implications of Uncovering Hidden Awareness in Behaviorally Nonresponsive Patients.
Long-term patient outcomes after severe brain injury are highly variable, and reliable prognostic indicators are urgently needed to guide treatment decisions. Functional neuroimaging is a highly sensitive method of uncovering covert cognition and awareness in patients with prolonged disorders of consciousness, and there has been increased interest in using it as a research tool in acutely brain injured patients. When covert awareness is detected in a research context, this may impact surrogate decisionmaking-including decisions about life-sustaining treatment-even though the prognostic value of covert consciousness is currently unknown. This paper provides guidance to clinicians and families in incorporating individual research results of unknown prognostic value into surrogate decisionmaking, focusing on three potential issues: (1) Surrogate decisionmakers may misinterpret results; (2) Results may create false hope about the prospects of recovery; (3) There may be disagreement about the meaningfulness or relevance of results, and appropriateness of continued care.
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This paper explores how Finnish research ethics deals with matters of justice on the levels of practical regulation, political morality, and theoretical studies. The bioethical sets of principles introduced by Tom Beauchamp and James Childress in the United States and Jacob Dahl Rendtorff and Peter Kemp in Europe provide the conceptual background, together with a recently introduced conceptual map of theories of justice and their dimensions. The most striking finding is that the internationally recognized requirement of informed consent for research on humans can be ideologically tricky in a Scandinavian welfare state setting.
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This paper considers the relevance of the concept of "eugenics,"-a term associated with some of the most egregious crimes of the twentieth century-to the possibility of editing human genomes. The author identifies some uses of gene editing as eugenics but proposes that this identification does not suffice to condemn them. He proposes that we should distinguish between "morally wrong" practices, which should be condemned, and "morally problematic" practices that call for solutions, and he suggests that eugenic uses of gene editing fall into this latter category. ⋯ These morally good eugenic interventions include some uses of preimplantation genetic diagnosis. The author argues that we should think about eugenic interventions in the same way that we think about morally problematic interventions in public health. When we recognize some uses of gene editing as eugenics, we make the dangers of selecting or modifying human genetic material explicit.
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According to a familiar distinction, neuroethics incorporates the neuroscience of ethics and the ethics of neuroscience. Within neuroethics, these two parts have provoked distinct and separate lines of inquiry, and there has been little discussion of how the two parts overlap. In the present article, I try to draw a connection between these two parts by considering the implications that are raised for ethics by scientific findings about the way we make moral decisions. The main argument of the article is that although neuroscience is "stretching" ethics by revealing the empirical basis of our moral decisions and, thereby, challenging our present understanding of the dominant ethical theories, substantial further questions remain regarding the impact that neuroscience will have on ethics more broadly.
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Camb Q Healthc Ethics · Jul 2018
A Closer Look at the Junior Doctor Crisis in the United Kingdom's National Health Services: Is Emigration Justifiable?
This article attempts to tackle the ethically and morally troubling issue of emigration of physicians from the United Kingdom, and whether it can be justified. Unlike most research that has already been undertaken in this field, which looks at migration from developing countries to developed countries, this article takes an in-depth look at the migration of physicians between developed countries, in particular from the United Kingdom (UK) to other developed countries such as Canada, Australia, New Zealand, and the United States (US). This examination was written in response to a current and critical crisis in the National Health Service (NHS), where impending contract changes may bring about a potential exodus of junior doctors.