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This paper addresses the critiques based on trade-offs and normativity presented in response to our target article proposing the Public Health Emergency Risk and Crisis Communication (PHERCC) framework. These critiques highlight the ethical dilemmas in crisis communication, particularly the balance between promoting public autonomy through transparent information and the potential stigmatization of specific population groups, as illustrated by the discussion of the mpox outbreak among men who have sex with men. This critique underscores the inherent tension between communication effectiveness and autonomy versus fairness and equity. In response, our paper reiterates the adaptability of the PHERCC framework, emphasizing its capacity to tailor messages to diverse audiences, thereby reducing potential stigmatization and misinformation. Through community engagement and feedback integration, the PHERCC framework aims to optimize the effectiveness of communication strategies while addressing ethical concerns. Furthermore, by involving affected communities in the communication strategy from the onset, the framework seeks to minimize ethical trade-offs and enhance the acceptance and effectiveness of public health messages. [ABSTRACT FROM AUTHOR]

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. [ABSTRACT FROM AUTHOR]

This paper problematizes the precision medicine approach embraced by the All of Us Research Program (US) and by Genomics England (UK) in terms of benefits distribution, by arguing that current "diversity and inclusion" efforts do not prevent exclusiveness, unless the framing and scope of the projects are revisited in public health terms. Grounded on document analysis and fieldwork interviews, this paper analyzes efforts to address potential patterns of exclusion upstream (from participating in precision medicine research) and downstream (from benefitting from precision medicine outputs). It argues that efforts for inclusion upstream are not corresponded downstream, and this unbalance jeopardizes the equitable capacities of the projects. It concludes that enhanced focus on socio-environmental determinants of health and aligned public health interventions as precision medicine outputs would be to the benefit of all and especially of those who are most at risk of (upstream as well as downstream) exclusion. [ABSTRACT FROM AUTHOR]

The article focuses on the intersection of genetics with moral, social, and political ideas; other topics include the influence of ideas about good genes, the impact of moral and political commitments on genetic research, and the role of genetics in perpetuating systemic forms of injustice.

Genomic screening at population scale generates many ethical considerations. One is the normative role that people's preferences should play in determining access to genomic information in screening contexts, particularly information that falls beyond the scope of screening. We expect both that people will express a preference to receive such results and that there will be interest from the professional community in providing them. In this paper, we consider this issue in relation to the just and equitable design of population screening programs like reproductive genetic carrier screening (RGCS). Drawing on a pluralistic public health ethics perspective, we claim that generating and reporting information about genetic variants beyond the scope of the screening program usually lacks clinical, and perhaps personal, utility. There are both pragmatic and ethical reasons to restrict information provision to that which fits the stated purpose of the program. [ABSTRACT FROM AUTHOR]

Long used as a tool for medical compliance and adhering to treatment plans, behavior contracts have made their way into the in-patient healthcare setting as a way to manage the "difficult" patient and family. The use of this tool is even being adopted by healthcare ethics consultants (HECs) in US hospitals as part of their work in navigating conflict at the bedside. Anecdotal evidence of their increasing popularity among clinical ethicists, for example, can be found at professional bioethics meetings and conversations and idea-sharing among practitioners on HEC social media. While there are a handful of papers gesturing toward a bioethical critique of behavior contracts of various types, the use of behavior contracts in the context of interpersonal conflict has not been vetted by bioethicists to determine their ethical legitimacy or efficacy. In this paper, we highlight a set of ethical concerns that we believe must be addressed before continuing or widespread implementation of behavior contracts to manage the "difficult" patient or family. [ABSTRACT FROM AUTHOR]

AbstractBioethics has dedicated itself to exploring and defending both reasons for and against certain aspects of clinical care, biomedical research and health policy, including what decisions must be made, who should make them, and how they should be made. In pediatrics, it’s widely acknowledged that parents’ reasons may matter pragmatically; attending to parents’ reasons is important if we want to work with families. Yet the conventional view in pediatric ethics is that parents’ reasons are irrelevant to whether a decision is permissible or impermissible according to accepted ethical standards. In this paper, we explore whether parents’ reasons matter ethically and, if so, in what way and for whom. First, we clarify what we mean by ‘reasons.’ Second, we provide an overview of how reasons are typically treated in medical decision-making and pediatric ethics. Third, we analyze a hypothetical pediatric case to illustrate how changing reasons can transform ethical analyses, including by contributing to where and how clinicians and ethicists draw the boundaries intrinsic to common pediatric ethical frameworks. We push back against the conventional view and argue that parents’ reasons matter ethically in several ways. We call for further research on the role of parents’ reasons in clinical ethics deliberation. [ABSTRACT FROM AUTHOR]

AbstractThis paper argues that bioethics as a field should broaden its scope to include the ethics of war, focusing on war’s public health effects. The “Introduction” section describes the bioethics literature on war, which emphasizes clinical and research topics while omitting public health. The section, “War as a public health crisis” demonstrates the need for a public health ethics approach by framing war as a public health crisis. The section, “Bioethics principles for war and public health” proposes six bioethics principles for war that address its public health dimensions: health justice, accountability, dignified lives, public health sustainability, nonmaleficence, and public health maximization. The section, “Justifying and applying bioethical principles” shows how these principles inform ethical analysis, including just war theory and military ethics. The section, “From principles to practice” envisions ways in which bioethicists can promote these principles in practice through research, teaching, and service. The “Conclusion” section urges bioethicists to engage with war as a public health crisis, including calling attention to war’s impact on civilians, especially women, children, and other vulnerable groups. [ABSTRACT FROM AUTHOR]

AbstractMuch of the debate over the definition and criteria for determining our death has focused on disagreement over the correct biological account of death, i.e., what it means for any organism to die. In this paper, we argue that this exclusive focus on the biology of death is misguided, because it ignores ethical and social factors that bear on the acceptability of criteria for determining our death. We propose that attention shift from strictly biological considerations to ethical and social considerations that bear on the determination of what we call “civil death.” We argue for acceptance of a neurological criterion for determining death on grounds that it is the most reasonable way to synthesize biological, ethical, and social considerations about our death.. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. [ABSTRACT FROM AUTHOR]

Abstract“Suffering” is a central concept within bioethics and often a crucial consideration in medical decision making. As used in practice, however, the concept risks being uninformative, ambiguous, or even misleading. In this paper, we consider a series of cases in which “suffering” is invoked and analyze them in light of prominent theories of suffering. We then outline ethical hazards that arise as a result of imprecise usage of the concept and offer practical recommendations for avoiding them. Appeals to suffering are often getting at something ethically important. But this is where the work of ethics begins, not where it ends. [ABSTRACT FROM AUTHOR]

This paper analyses the activities of five organizations shaping the debate over the global governance of genome editing in order to assess current approaches to public engagement (PE). We compare the recommendations of each group with its own practices. All recommend broad engagement with the general public, but their practices vary from expert-driven models dominated by scientists, experts, and civil society groups to citizen deliberation-driven models that feature bidirectional consultation with local citizens, as well as hybrid models that combine elements of both approaches. Only one group practices PE that seeks community perspectives to advance equity. In most cases, PE does little more than record already well-known views held by the most vocal groups, and thus is unlikely to produce more just or equitable processes or policy outcomes. Our exploration of the strengths, weaknesses, and possibilities of current forms of PE suggests a need to rethink both "public" and "engagement." [ABSTRACT FROM AUTHOR]

The application of artificial intelligence and machine learning (ML) technologies in healthcare have immense potential to improve the care of patients. While there are some emerging practices surrounding responsible ML as well as regulatory frameworks, the traditional role of research ethics oversight has been relatively unexplored regarding its relevance for clinical ML. In this paper, we provide a comprehensive research ethics framework that can apply to the systematic inquiry of ML research across its development cycle. The pathway consists of three stages: (1) exploratory, hypothesis-generating data access; (2) silent period evaluation; (3) prospective clinical evaluation. We connect each stage to its literature and ethical justification and suggest adaptations to traditional paradigms to suit ML while maintaining ethical rigor and the protection of individuals. This pathway can accommodate a multitude of research designs from observational to controlled trials, and the stages can apply individually to a variety of ML applications. [ABSTRACT FROM AUTHOR]

In this paper, we explore the recent creation of "iBlastoids," which are 3-D structures that resemble early human embryos prior to implantation which formed via self-organization of reprogrammed adult skin cells. We explore some of the ethical, philosophical, social, and regulatory issues related to this research, with focus particularly on what it means to "anticipate" research outcomes when using novel methods or when serendipitous discoveries are made. We defend the need for reflexive, anticipatory, and deliberative ethical and conceptual work by researchers working in emerging and contentious research domains, in collaboration with interdisciplinary scholars, as well as regulators, funders, and publics. [ABSTRACT FROM AUTHOR]

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. [ABSTRACT FROM AUTHOR]

AbstractA novel advantage of the use of machine learning (ML) systems in medicine is their potential to continue learning from new data after implementation in clinical practice. To date, considerations of the ethical questions raised by the design and use of adaptive machine learning systems in medicine have, for the most part, been confined to discussion of the so-called “update problem,” which concerns how regulators should approach systems whose performance and parameters continue to change even after they have received regulatory approval. In this paper, we draw attention to a prior ethical question: whether the continuous learning that will occur in such systems after their initial deployment should be classified, and regulated, as medical research? We argue that there is a strong prima facie case that the use of continuous learning in medical ML systems should be categorized, and regulated, as research and that individuals whose treatment involves such systems should be treated as research subjects. [ABSTRACT FROM AUTHOR]

This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics' (IAB's) selection of Qatar to host the 2024 World Congress of Bioethics. IAB's choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles. One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing? [ABSTRACT FROM AUTHOR]

Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice. [ABSTRACT FROM AUTHOR]

Conversational artificial intelligence (CAI) presents many opportunities in the psychotherapeutic landscape—such as therapeutic support for people with mental health problems and without access to care. The adoption of CAI poses many risks that need in-depth ethical scrutiny. The objective of this paper is to complement current research on the ethics of AI for mental health by proposing a holistic, ethical, and epistemic analysis of CAI adoption. First, we focus on the question of whether CAI is rather a tool or an agent. This question serves as a framework for the subsequent ethical analysis of CAI focusing on topics of (self-) knowledge, (self-)understanding, and relationships. Second, we propose further conceptual and ethical analysis regarding human-AI interaction and argue that CAI cannot be considered as an equal partner in a conversation as is the case with a human therapist. Instead, CAI's role in a conversation should be restricted to specific functions. [ABSTRACT FROM AUTHOR]

While experience often affords important knowledge and insight that is difficult to garner through observation or testimony alone, it also has the potential to generate conflicts of interest and unrepresentative perspectives. We call this tension the paradox of experience. In this paper, we first outline appeals to experience made in debates about access to unproven medical products and disability bioethics, as examples of how experience claims arise in bioethics and some of the challenges raised by these claims. We then motivate the idea that experience can be an asset by appealing to themes in feminist and moral epistemology, distinguishing between epistemic and justice-based appeals. Next, we explain the concern that experience may be a liability by appealing to empirical work on cognitive biases and theoretical work about the problem of partial representation. We conclude with preliminary recommendations for addressing the paradox and offer several questions for future discussion. [ABSTRACT FROM AUTHOR]

The article focuses on behavioral contracts adopted by healthcare ethics consultants (HECs) in hospitals across U.S. to navigate the conflict at the bedside. Topics discussed include scholarly papers published on advocating use of modality in regulation of human behavior, use of device proposed by Ronald Mann, behavioral contract pioneer, in 1970 in outpatient mental health context, and interpersonal conduct management between patients and family member in interaction with medical personnel.

In some views, philosophy's glory days in bioethics are over. While philosophers were especially important in the early days of the field, so the argument goes, the majority of the work in bioethics today involves the "simple" application of existing philosophical principles or concepts, as well as empirical work in bioethics. Here, we address this view head on and ask: What is the role of philosophy in bioethics today? This paper has three specific aims: (1) to respond to skeptics and make the case that philosophy and philosophers still have a very important and meaningful role to play in contemporary bioethics, (2) to discuss some of the current challenges to the meaningful integration of philosophy and bioethics, and (3) to make suggestions for what needs to happen in order for the two fields to stay richly connected. We outline how bioethics center directors, funders, and philosopher bioethicists can help. [ABSTRACT FROM AUTHOR]

The author comments on the article "Think Pragmatically: Investigators' Obligations to Patient-Subjects When Research Is Embedded in Care" by Stephanie Morain and Emily Largent which argue that investigators and possibly institutions have distinct ethical duties when conducting or participating in pragmatic trials. Topics include their arguments that there are at least six morally significant differences between explanatory and pragmatic trials and their suggestion to avoid a fiduciary framing.

The concept of personhood has been central to bioethics debates about abortion, the treatment of patients in a vegetative or minimally conscious states, as well as patients with advanced dementia. More recently, the concept has been employed to think about new questions related to human-brain organoids, artificial intelligence, uploaded minds, human-animal chimeras, and human embryos, to name a few. A common move has been to ask what these entities have in common with persons (in the normative sense), and then draw conclusions about what we do (or do not) owe them. This paper argues that at best the concept of "personhood" is unhelpful to much of bioethics today and at worst it is harmful and pernicious. I suggest that we (bioethicists) stop using the concept of personhood and instead ask normative questions more directly (e.g., how ought we to treat this being and why?) and use other philosophical concepts (e.g., interests, sentience, recognition respect) to help us answer them. It is time for bioethics to end talk about personhood. [ABSTRACT FROM AUTHOR]

In this paper, I take seriously calls for public engagement in human genome editing decision- making by endorsing the convening of a "Citizens Jury" in conjunction with the International Commission on the Clinical Use of Human Germline Genome Editing's next summit scheduled for March 6-8, 2023. This institutional modification promises a more inclusive, deliberative, and impactful form of engagement than standard bioethics engagement opportunities, such as comment periods, by serving both normative and political purposes in the quest to offer moral guidance on gene editing. In examining evidence from the Australian Citizens' Jury on Genome Editing convened in 2021, I argue that Citizens' Juries should work in tandem with governing institutions to preserve the role of expertise while ensuring that the diverse views of the public are incorporated into their final reports as well. First, early inclusivity allows "the people" to hold agenda setting power through helping to set resource priorities. This also makes a downstream deliberative event, such as the called for Global Citizens' Assembly, both more likely to occur and more influential on policy. Second, Jury's diverse composition promises substantive contributions to the Commission's work. Third, Citizens' Juries could help to cultivate the Commission's trustworthiness. [ABSTRACT FROM AUTHOR]

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]

This paper considers the responsibilities of the FDA with regard to disseminating information about the benefits and harms of e-cigarettes. Tobacco harm reduction advocates claim that the FDA has been overcautious and has violated ethical obligations by failing to clearly communicate to the public that e-cigarettes are far less harmful than cigarettes. We argue, by contrast, that the FDA's obligations in this arena are more complex than they may appear at first blush. Though the FDA is accountable for informing the public about the health risks and benefits of products it regulates, it also has other roles (and attendant responsibilities) that inform when and how it should disseminate information. In addition to being a knowledge purveyor, it is also a knowledge producer, an advisor to the public, and a practical agent shaping the material conditions in which people make health-related choices. In our view, those other roles call for caution in the way the FDA interprets and communicates the available evidence. [ABSTRACT FROM AUTHOR]

In this paper, we make the case that a person who is considering or has already made a decision that appears seriously harmful to that person should in some cases be judged incapable of making that decision because of the harmfulness of the decision. We focus on the English case of C of 2015. C refused life-saving dialysis. The hospital wanted her declared incompetent to make this decision under the English Mental Capacity Act of 2005. The Judge argued that the consequences for a person's welfare of their decision are irrelevant to the assessment of competence, a position labeled "internalism." This aligns with an assessment of decision-making competence on a strictly cognitivist model. However, internalism misrepresents decision-making. The outcomes of decision-making processes should be part and parcel of judgments of decision-making competence, and in some cases are necessary for any judgment of incompetence to be made. [ABSTRACT FROM AUTHOR]

Ever since the publication of Derek Parfit's Reasons and Persons, bioethicists have tended to distinguish between two different ways in which reproductive technologies may have implications for the welfare of future persons. Some interventions harm or benefit particular individuals: they are "person affecting." Other interventions determine which individual, of a number of possible individuals, comes into existence: they are "identity affecting" and raise the famous "non-identity problem." For the past several decades, bioethical debate has, for the most part, proceeded on the assumption that direct genetic modification of human embryos would be person affecting. In this paper, I argue that that genome editing is highly unlikely to be person affecting for the foreseeable future and, as a result, will neither benefit nor harm edited individuals. [ABSTRACT FROM AUTHOR]

The article presents the discussion on promise of international collaboration and sharing by bringing together bioethicists from throughout the world at the 2024 IAB conference. Topics include authors of the target paper suggest that Islamophobia is a problem in bioethics; and arrests, cell phone searches, beatings, and harassment of LGBQTI residents in Qatar.

Increasing privacy concerns are arising from expanding use of aggregated personal information in health practices. Conversely, in light of the promising benefits of data driven healthcare, privacy is being frequently dismissed as outdated, costly and ultimately egotistical. This paper aims to review the theoretical framework on privacy in order to overcome the often simplistic debate between the primacy of individual or collective interests. As a result, it is argued that although privacy can be understood as freedom of personal choice in matters of sharing intimacy, it is foundational to both community belonging and to social and political organizations at large. Ethical decisions on the use of data analytics technologies in health practices should also take into account the social effects of violating privacy. [ABSTRACT FROM AUTHOR]

Patients who experience difficulty making medical decisions are often referred to as "ambivalent." However, the current lack of attention to the nuances between a cluster of phenomena that resemble ambivalence means that we are not always recognizing what is really going on with a patient. Importantly, different kinds of "ambivalence" may call for different approaches. In this paper, we present a taxonomy of ambivalence-related phenomena, provide normative analysis of some of the effects of—and common responses to—such mental states, and sketch some practical strategies for addressing ambivalence. In applying lessons from the philosophical literature and decision theory, our aim is to provide ethicists and clinicians with the tools to better understand and effectively intervene in cases of ambivalence. [ABSTRACT FROM AUTHOR]

Abstract Some physicians refuse to perform life-sustaining interventions, such as tracheostomy, on patients who are very likely to remain permanently unconscious. To explain their refusal, these clinicians often invoke the language of “futility”, but this can be inaccurate and can mask problematic forms of clinical power. This paper explores whether such refusals should instead be framed as conscientious objections. We contend that the refusal to provide interventions for patients very likely to remain permanently unconscious meets widely recognized ethical standards for the exercise of conscience. We conclude that conscientious objection to tracheostomy and other life-sustaining interventions on such patients can be ethical because it does not necessarily constitute a form of invidious discrimination. Furthermore, when a physician frames their refusal as conscientious objection, it makes transparent the value-laden nature of their objection and can better facilitate patient access to the requested treatment. [ABSTRACT FROM AUTHOR]

Abstract For healthcare professionals and organizations, there is an emphasis on addressing moral distress and compassion fatigue among clinicians. While addressing these issues is vital, this paper suggests that the philosophical concept of agent-regret is a relevant but overlooked issue in healthcare. To experience agent-regret is to regret your harmful but not wrongful actions. This person’s action results in someone being killed or significantly injured, but it was ethically faultless. Despite being faultless, agent-regret is an emotional response concerning one’s agency in a situation that results in death or significant harm. In healthcare, many clinicians are likely to experience regret for faultless actions that significantly harm or cause the death of a patient. The recognition of agent-regret in healthcare is significant because it differs, conceptually and practically, from moral distress and compassion fatigue. Building on the work of Wojtowicz (2022), we should strive to understand clinicians’ agent-regret by recognizing their agency in the situation, not lessening or removing it. [ABSTRACT FROM AUTHOR]

In this paper, we contend with whether we still need traditional ethics education as part of healthcare professional training given the abilities of chatGPT (generative pre-trained transformer) and other large language models (LLM). We reflect on common programmatic goals to assess the current strengths and limitations of LLMs in helping to build ethics competencies among future clinicians. Through an actual case analysis, we highlight areas in which chatGPT and other LLMs are conducive to common bioethics education goals. We also comment on where such technologies remain an imperfect substitute for human-led ethics teaching and learning. Finally, we conclude that the relative strengths of chatGPT warrant its consideration as a teaching and learning tool in ethics education in ways that account for current limitations and build in flexibility as the technology evolves. [ABSTRACT FROM AUTHOR]

In this article, we explore the potential of enhancing academic prose and idea generation by fine-tuning a large language model (here, GPT-3) on one's own previously published writings: AUTOGEN ("AI Unique Tailored Output GENerator"). We develop, test, and describe three distinct AUTOGEN models trained on the prior scholarly output of three of the current authors (SBM, BDE, JS), with a fourth model trained on the combined works of all three. Our AUTOGEN models demonstrate greater variance in quality than the base GPT-3 model, with many outputs outperforming the base model in format, style, overall quality, and novel idea generation. As proof of principle, we present and discuss examples of AUTOGEN-written sections of existing and hypothetical research papers. We further discuss ethical opportunities, concerns, and open questions associated with personalized academic prose and idea generators. Ethical opportunities for personalized LLMs such as AUTOGEN include increased productivity, preservation of writing styles and cultural traditions, and aiding consensus building. However, ethical concerns arise due to the potential for personalized LLMs to reduce output diversity, violate privacy and intellectual property rights, and facilitate plagiarism or fraud. The use of coauthored or multiple-source trained models further complicates issues surrounding ownership and attribution. Open questions concern a potential credit-blame asymmetry for LLM outputs, the legitimacy of licensing agreements in authorship ascription, and the ethical implications of coauthorship attribution for data contributors. Ensuring the output is sufficiently distinct from the source material is crucial to maintaining ethical standards in academic writing. These opportunities, risks, and open issues highlight the intricate ethical landscape surrounding the use of personalized LLMs in academia. We also discuss open technical questions concerning the integration of AUTOGEN-style personalized LLMs with other LLMs, such as GPT-4, for iterative refinement and improvement of generated text. In conclusion, we argue that AUTOGEN-style personalized LLMs offer significant potential benefits in terms of both prose generation and, to a lesser extent, idea generation. If associated ethical issues are appropriately addressed, AUTOGEN alone or in combination with other LLMs can be seen as a potent form of academic enhancement. [ABSTRACT FROM AUTHOR]

Terminally ill patients in 10 states plus Washington, D.C. have the right to take prescribed medications to end their lives (medical aid in dying). But otherwise-eligible patients with neuromuscular disabilities (ALS and other illnesses) are excluded if they are physically unable to "self-administer" the medications without assistance. This exclusion is incompatible with disability rights laws that mandate assistance to provide equal access to health care. This contradiction between aid-in-dying laws and disability rights laws can force patients and clinicians into violating one or the other, potentially creating an underclass of patients denied medical care that is available to those with other (less physically disabling) terminal illnesses. The immediacy of this issue is demonstrated by a lawsuit in Federal court filed in August 2021, requesting assistance in self-administration for terminally ill patients with neuromuscular diseases. This paper discusses the background of this conflict, the ethical issues at the heart of the dilemma, and recommends potential remedies. [ABSTRACT FROM AUTHOR]

While the accumulation and increased circulation of genomic data have captured much attention over the past decade, privacy risks raised by the diversification and integration of omics have been largely overlooked. In this paper, we propose the outline of a framework for assessing privacy risks in multi-omic research and databases. Following a comparison of privacy risks associated with genomic and epigenomic data, we dissect ten privacy risk-impacting omic data properties that affect either the risk of re-identification of research participants, or the sensitivity of the information potentially conveyed by biological data. We then propose a three-step approach for the assessment of privacy risks in the multi-omic era. Thus, we lay grounds for a data property-based, 'pan-omic' approach that moves away from genetic exceptionalism. We conclude by inviting our peers to refine these theoretical foundations, put them to the test in their respective fields, and translate our approach into practical guidance. [ABSTRACT FROM AUTHOR]

The article presents the discussion on e-cigarettes not reducing the harms associated with tobacco consumption. Topics include public health ethics and population-level bioethics specifically focusing on the enormous burdens of noncommunicable disease; and field of public health law being the law in major social determinant of health.

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Instead, it has adopted a culture-based agenda through the framework of cultural competence to address disparities despite a paucity of supporting data. Cultural competence is ethnocentric in orientation and its content sustains biases that are long-standing in health care. Moreover, Cultural competence is based on a number of flawed assumptions and is not structured around a set of clearly stated ethical values. In this paper, we will demonstrate ways in which Cultural competence reflects embedded ethnocentrism, perpetuates entrenched biases, and fails to recognize the depth and breadth of systemic racism as these relate to the stated goal of Cultural competence—the mitigation of health disparities. In addition, we offer a reframed approach to health disparities in medical education. [ABSTRACT FROM AUTHOR]

Abstract Regulations implemented by World Athletics (WA) require female athletes with differences of sexual development to suppress their blood testosterone levels in order to participate in certain women’s sporting competitions. These regulations have been justified by reference to fairness. In this paper, we reconstruct WA’s understanding of fairness, which requires a “level playing field” where no athlete should have a significant performance advantage based on factors other than talent, dedication, and hard work over an average athlete in their category. We demonstrate that by placing regulations only on testosterone levels, while ignoring physical as well as socioeconomic advantages, WA consistently fails to meet its own definition of fairness. We then discuss several ways in which this definition could be met. Our analysis shows that a categorical system, in which athletes are divided into categories based on properties leading to significant performance advantages, is best suited for meeting WA’s definition of fairness. [ABSTRACT FROM AUTHOR]

The article focuses on the protection-inclusion dilemma in qualitative research findings. Topics include the disproportionate harm of the COVID-19 pandemic to racialized communities; the need to diversify study participant; and center marginalized perspectives, and the challenges of anonymizing qualitative data and representing the testimonies of underrepresented groups in research results.

The author discusses the study "Materialized Oppression in Medical Tools and Technologies" by Shen-yi Liao and Vanessa Cabonell. Topics include philosophers' role in our intellectual life, impact of social contexts on unbiased material objects, and why it took bioethics over half a century to reckon with racism.

The article informs the manage the difficult patient and family, contracts to manage challenging interactions with patients and families. It mentions the authors received nine open peer commentaries (OPCs) on their work, three of which were supportive of behavior contracts in their current form while six were highly critical. It suggests the OPCs are seen as an important step towards a field-wide dialogue on the implementation of behavior contracts.

The article focuses on three topics: unilateral withdrawal, technological creep, and the role of proportionality in extracorporeal membrane oxygenation (ECMO) policy. It argues that current ethical constructs do not justify unilateral withdrawal of life-sustaining therapy, but it raises concerns about justifying ECMO as a form of destination therapy and the application of the principle of proportionality to balance evolving technologies and patient outcomes while mitigating technological creep.

The authors discuss the target article by S. Y. Liao and V. Carbonell in the issue which give outcomes of how racial biases and associated harms arise in the cases of pulse oximeters and spirometers. Topics include approach recommended by Liao and Carbonell to addressing device injustice, an important step in understanding and addressing systemic harms which is missing from Liao and Carbonell's model, and things needed to address the overdetermined oppressive harms for some medical devices.

The article focuses on Positive and Negative Claims to Conscience in Reproductive Health Care. Topics discussed include this interesting and well-argued piece by Kyle Fritz (2021) focuses on conscientious objections by health care providers (HCPs) to abortion; and bioethicists who have written on conscientious objection interpret the category narrowly so that it only includes cases where HCPs conscientiously refuse to provide health care services.

The article identifies the broad range of ethical concerns and considerations regarding artificial womb technology (AWT). Topics discussed include potential benefits and harms of AWT, decision-making authority of parents, legal status and protections, and fairness of access and the fundamental source of basic legal rights for persons in the U.S.

The article informs the consistency of using polygenic testing in pregnancy is under debate. It mentions that some argue prenatal selection should be allowed based on likely cognitive ability within the normal range, others argue against. It highlights the prenatal selection against fetuses with sex chromosome anomalies is allowed in the context of fetal sex determination by noninvasive prenatal testing (NIPT) on social grounds.

The authors comment on the study "Algorithms for Ethical Decision Making in the Clinic," wherein L. Meier and colleagues describe their approach to developing machine intelligence to support ethical decision-making in the clinic. Topics include poorly defined problem statement and inadequate consideration of constraints, heterogeneity and representatives of data sources used for training, and programmability of the ethical framework.