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The medical profession contains five "spheres of morality": clinical care, clinical research, scientific knowledge, population health, and the market. These distinct sets of normative commitments require physicians to act in different ways depending on the ends of the activity in question. For example, a physician-scientist emphasizes patients' well-being in clinic, prioritizes the scientific method in lab, and seeks to maximize shareholder returns as a board member of a pharmaceutical firm. Physicians increasingly occupy multiple roles in healthcare and move between them frequently, creating the possibility of conflict between the ethical obligations of their various roles. This paper examines the entire moral landscape of medicine through the lens of role morality. It develops a novel framework that helps physicians recognize how their moral commitments depend on the nature and context of the situation, clarifies ethical conflicts that physicians face, and concludes with ideas for resolving these conflicts. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Russian military implicated in a systematic campaign of war crimes. Topics include Great Britain and the European Union placing sanctions upon a wide range of Russian individuals and institutions; and medical institutions having a longstanding history of cooperation with biomedical entities.

An editorial is presented on arguments for physician aid-in-dying (PAD) for psychiatric disorders. Topics discussed include permitting PPAD would not have negative policy and practice implications serious enough to outweigh the intended merits; conflicts with the practice of involuntary commitment in psychiatry; and parity argument has the following form: If PAD for terminal physical illness is justified on the basis of suffering.

The article presents a study on physicians' education under the Physician Payments Sunshine Act (PPSA) as well as its significance on the improvement of patient trust in the U.S. Discussed are issues on conflicts of interest (COI) in medical journals and studies on transparency at the medical care sector. Challenges on medical policy under the PPSA are explored.

Neonatal intensive care units represent simultaneously one of the great success stories of modern medicine, and one of its most controversial developments. One particularly controversial issue is the resuscitation of extremely preterm infants. Physicians in the United States generally accept that they are required to resuscitate infants born as early as 25 weeks and that it is permissible to resuscitate as early as 22 weeks. In this article, I question the moral pressure to resuscitate by criticizing the idea that resuscitation in this context “saves” a human life. Our radical medical advancements have allowed us to intervene in the life of a human before it makes sense to say that such an intervention “saves” someone; rather, what the physician does in resuscitating and treating an extremely preterm infant is to take over creating it. This matters, I argue, because “rescues” are much more morally urgent than “creations.” [ABSTRACT FROM PUBLISHER]

Shortly before and during the Second World War, Japanese doctors and medical researchers conducted large-scale human experiments in occupied China that were at least as gruesome as those conducted by Nazi doctors. Japan never officially acknowledged the occurrence of the experiments, never tried any of the perpetrators, and never provided compensation to the victims or issued an apology. Building on work by Jing-Bao Nie, this article argues that the U.S. government is heavily complicit in this grave injustice, and should respond in an appropriate way in order to reduce this complicity, as well as to avoid complicity in future unethical medical experiments. It also calls on other U.S. institutions, in particular the Presidential Commission for the Study of Bioethical Issues, to urge the government to respond, or to at least inform the public and initiate a debate about this dark page of American and Japanese history. [ABSTRACT FROM AUTHOR]

Various kinds of alcohol and drug testing, such as preemployment, routine, and for-cause testing, are commonly performed by employers. While healthcare organizations usually require preemployment drug testing, they vary on whether personnel will be subjected to further testing. Recently, a call has gone out for postincident testing among physicians who are involved in serious, preventable events, especially ones leading to a patient's death. This article will offer a number of counterarguments to that proposal and discuss an alternate approach: that health institutions can better improve patient safety and employees’ well-being by implementing an organizational policy of “speaking up” when system operators notice work behaviors or environmental factors that threaten harm or peril. The article will conclude with a description of various strategies that facilitate speaking up, and why the practice constitutes a superior alternative to mandatory alcohol and drug testing in the wake of serious, harm-causing medical error. [ABSTRACT FROM PUBLISHER]

The article discusses conflicts and tensions between health care professionals, patients and their families in ethics consultations. Topics discussed include legal regime governing surrogate decision making as highly complex, pregnancy exclusions impacting health care providers in the exercise of their autonomy and professional judgment and ethicist providing guidance based on patient rights, principles and the family's narrative.

The article comments on a proposed autonomous framework for responding to knowledge about human cognitive biases. Issues and concerns tackled are biased thinking among people in making decisions, vulnerability of bioethicists to cognitive distortions in judgment, fiduciary responsibilities of medicine when a patient refuses medical treatment, and the Socratic approach of reliance on reasons and arguments when responding to biased views.

The article examines the issue of professionally responsible clinical ethical judgments of futility in the Texas Advance Directives Act (TADA). Topics covered include how TADA is conservative in its trust and confidence in the professional integrity of physicians in making clinical judgments about what is medically inappropriate and of health care professionals who participate in the mandated review process by a medical or ethics committee.

[ABSTRACT FROM PUBLISHER]

The author discusses professionalism of physicians in the context of role morality when providing health care. He argues that moral significance of professionalism should be considered as function of role morality in solving the dual agency problem and its dangers in fostering professional actions. Also discussed are the professional responsibility and liability model, equality in the distribution of health care resources and structural injustice in access to health care.

The article offers information on the conscientious objection to abortion in life-threatening medical emergency and the criminal liability of such actions in the U.S. Topics discussed include the criminal homicide conviction for such instances, the requirements for medical professionalism in the U.S., and the medical associations that support conscientious objections.

The author suggests the adoption of a Humean perspective to help physicians deal with brain death in the intensive care setting. Topics covered include the complications of the bioethics of brain death, an overview of the arguments in Book II of the "Treatise of Human Nature," by David Hume and the commonly cited difficulties with brain death that families do not understand.