AbstractThe article [Title], written by [AuthorNames], was originally published electronically on the publisher ’s internet portal (currently SpringerLink) on [date of OnlineFirst publication] without open access. (Source: Journal of Bioethical Inquiry)
AbstractVisual research methods like photography and digital storytelling are increasingly used in health and social sciences research as participatory approaches that benefit participants, researchers, and audiences. Visual methods involve a number of additional ethical considerations such as using identifiable content and ownership of creative outputs. As such, ethics committees should use different assessment frameworks to consider research protocols with visual methods. Here, we outline the limitations of ethics committees in assessing projects with a visual focus and highlight the sparse knowledge on how researchers respond when they encounter ethical challenges in the practice of visual research. We propose a situated approach in relation to visual methodologies that encompasses a ne...
AbstractAdvance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical options, and cultural disparities. Given these issues, it is vital to increase the use of patient and healthcare provider conversations as an advance care planning t...
AbstractWhen healthcare professionals feel constrained from acting in a patient ’s best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in the ir actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. Appreciation of these dynamics may assist in cross-discipline sensitivity, enabling more constructive dialogue and collaboration. (Source: Journal of Bioethical Inquiry)
AbstractThe articles in this issue cover a wide range of topics, including the moral status of human embryos and human-animal chimeras and hybrids, the determination of death, theories of human cognition, and policies on the identity of mitochondrial donors. Despite this variety, there are two underlying questions that tie the articles together: what is a human being? And, what is the basis of moral status? First, I discuss these two questions and why they are important for bioethics. Then I provide summaries of the six articles in this issue and explain how each of them is connected to the questions of human nature and moral status.
AbstractMoral status ascribes equal obligations and rights to individuals on the basis of membership in a protected group. Substance change is an event that results in the origin or cessation of individuals who may be members of groups with equal moral status. In this paper, two substance changes that affect the moral status of human embryos are identified. The first substance change begins with fertilization and ends with the formation of the blastocyst, a biological individual with moral status comparable to that ascribed to human organs. The second substance change begins at implantation and ends late in embryological development with the formation of the human body, an organism with moral status as a human being. The bioethical implications of each substance change are explored. The Two Substance Change theory is contrasted with continuity theories, which recognize no substance change in embryological development and with fertilization-only substance change theories.
AbstractI have argued that substance ontology cannot be used to determine the moral status of embryos. Patrick Lee, Christopher Tollefsen, and Robert George wrote a Reply to those arguments in this Journal. In that Reply, Lee, Tollefsen, and George defended and clarified their position that their substance ontology arguments prove that the zygote and the adult into which it develops are the same entity that share the same essence. Here, I show the following: (A) Even using the substance ontology framework to which Lee, Tollefsen, and George subscribe, we cannot know when in development substance changes cease. Substance ontology cannot therefore be used to assign moral status to embryos. (B) The Lee, Tollefsen, and George substance ontology framework should not be applied to the study of development or to biological discourse in general, because this framework depends on premises that do not apply.
AbstractThe prospect of creating and using human–animal chimeras and hybrids (HACHs) that are significantly human-like in their composition, phenotype, cognition, or behavior meets with divergent moral judgments: on the one side, it is claimed that such beings might be candidates for human-analogous rights to protection and care; on the other side, it is supposed that their existence might disturb fundamental natural and social orders. This paper tries to show that both positions are paradoxically intertwined: they rely on two kinds of species arguments, “individual species arguments” and “group species arguments,” which formulate opposing demands but are conceptually interdependent. As a consequence, the existence of HACHs may challenge exactly those normative standards on which the protection of HACHs may eventually be based. This ethical paradox could constitute the ultimate source of the “moral confusion” that some authors have suspected HACHs to provoke.
AbstractThis article defends the criterion of permanence as a valid criterion for declaring death against some well-known recent objections. We argue that it is reasonable to adopt the criterion of permanence for declaring death, given how difficult it is to know when the point of irreversibility is actually reached. We claim that this point applies in all contexts, including the donation after circulatory determination of death context. We also examine some of the potentially unpalatable ramifications, for current death declaration practices, of adopting the irreversibility criterion.
AbstractOften drawing on the phenomenological tradition, a number of philosophers and cognitive scientists working in the field of “embodied cognition” subscribe to the general view that cognition is grounded in aspects of its sensorimotor embodiment and should be comprehended as the result of a dynamic interaction of nonneural and neural processes. After a brief introduction, the paper critically engages Lakoff and Johnson’s “conceptual metaphor theory” (CMT), and provides a review of recent empirical evidence that appears to support it. Subsequently, the paper underscores some of the limitations of CMT, points to some philosophical problems that require further attention, and explores possible implications for understanding and treating of mental disorders.
This note considers the decision of the Singapore Court of Appeal in ACB v Thomson Medical in which the plaintiff sought damages for the upkeep costs of a child conceived using sperm from someone other than her husband as a result of negligence by a fertility clinic. The Court held that upkeep costs could not be recovered as a matter of public policy, but recognised a new head of loss, namely damages for loss of genetic affinity. In a controversial ruling, the Court quantified these damages at thirty per cent of the upkeep costs of the child. While holding that punitive damages could be recovered outside the categories recognised in Rookes v Barnard, the Court rejected such an award on the facts of the case.
This note assesses the decisions of the Court of Justice of the European Union in Achbita v G4S Secure Solutions NV and Bougnaoui v Micropole SA, the first cases dealing with religious discrimination under the Equal Treatment Directive 2000/43. Both cases concerned Muslim women wishing to express their religious beliefs by wearing an Islamic headscarf while working in a private undertaking. The Court held that the employees’ dismissal could not be justified by reference to clients’ prejudices against the headscarf. However, dismissal could be justified if pursued on the basis of a corporate policy of ideological neutrality which prohibited all visible religious, political and philosophical symbols. This note criticises the latter part of the Court's decision for, inter alia, placing too much weight on an employer's freedom to run its business in spite of the grave effects this has on employees’ fundamental right to manifest their beliefs at work.
In 1989, the House of Lords first derived a ‘best interests’ test for the medical treatment of adults who lack capacity from the doctrine of necessity and, now codified, the test continues to apply today. The Mental Capacity Act 2005 sets out a non-exhaustive checklist of relevant considerations, but it gives no particular priority to the patient's wishes. There is also no formal expectation that the patient will participate directly in any court proceedings in which her best interests are to be determined. This article will consider the advantages and disadvantages of providing additional guidance to decision-makers in order to help them navigate both taking seriously the wishes of people who lack capacity and, at the same time, not abandoning patients who need help and support. More specifically, this article advocates formalising current best practice in the Court of Protection through the introduction of a series of rebuttable presumptions, or starting points.
The Court of Justice of the European Union (CJEU) increasingly faces societal value-conflicts in EU law disputes. For example, in EU copyright law, in the digital age, diverse fundamental values, as well as cultural and societal developments, are at stake. This article discusses the role of the CJEU in the European value discourse, using copyright law as a case study. The methodological approach used, critical discourse analysis, is seldom applied in jurisprudential studies, but is well suited for teasing out value-related aspects of case law. Exploratory research of seminal copyright cases suggests that the CJEU's discourse of the various values seems unnecessarily one-sided and shallow. A lack of discursiveness in the jurisprudence would diminish the legitimacy of the Court's decisions, and would not offer adequate guidance to national courts or private decision-makers, to whom the Court at the same time may be leaving more of the task of value reconciliation.
The article evaluates interview data on decision-making under public procurement law using Halliday's analytical model on compliance with administrative law. In this study, unlike other studies on administrative compliance, the decisions faced by public bodies are not routine; they relate to the award of complex, high-value contracts. Two contrasting decisions in the procurement process are discussed: the decision over the choice of procedure at the outset of the process, and the decision over the extent to which the public body should negotiate with the winning bidder towards the end of the process. The article considers the rationales behind decisions, and finds that, although public bodies are generally predisposed to comply, legal uncertainty means the relevance of commercial pressures and challenge risk impact heavily on approaches to compliance, even shaping understanding of what compliant behaviour actually is.