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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]

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]

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.

The article discusses a framework for maternal-fetal therapy trials with restrictions on abortion, social justice and the ethics of research. Topics covered include the challenge of respecting and supporting reproductive autonomy in a context of constrained choice, a failure to fully attend to the interests and status of pregnant persons as ends in and of themselves. Also noted is the importance of fair distribution of access to a procedure that may mitigate prohibitive costs.

The author comments on an article by Katie Watson in this issue which is said to be a call to bioethicists to recognize the ways people may have undervalued the moral status of women in analytic frameworks and to deliberately integrate women into every analysis of abortion clinics. Topics include the significance of abortion experience to abortion ethics, suggestion by Watson on framing the need for abortion care, and suggestion from Watson for bioethicists to manage competing aims and methods.

The article presents responses to commentaries on the article on an ethical framework that address limitations of fetal therapy trials in 2022. Topics covered include the article's focus on research, and the need to equally consider the psychosocial and biomedical effects in fetal therapy trials. Also noted is the assumption that fetuses have interests after a pregnant person decides not to abort.

The article focuses on the ethical, legal, and social implications of achieving equity in genomic and precision medicine research. Topics include the need for transparency in scientific practice and data collection, the barriers to access and benefit from genomic applications for marginalized populations, and the importance of multidisciplinary expertise and community engagement to define equitable benefit.

Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for a given disease can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of including undocumented immigrants in research while ensuring their protection and confidentiality. Topics covered include the vulnerability of undocumented immigrants; the role of Institutional Review Boards (IRBs) in providing guidelines and support; and the responsibilities of researchers in conducting ethical and inclusive studies with this population.

The article focuses on framework for the ethical evaluation of conversational artificial intelligence (CAI) in psychotherapy. Topics discussed include finding the right balance between the status of a tool and an agent, understanding technologies as social phenomena and materialized artifacts created in complex processes.

The article focuses on the challenges faced by patients with rare diseases and the ethical dilemma of relying on advocacy for quality care and funding. Topics include the vulnerability and rareness of rare disease communities, the intersectional disparities faced by these communities, and the need for meaningful partnerships and engagement to address systemic inequities in healthcare.

The article focuses on addressing concerns raised by Conley et al. regarding the Australian Citizens' Jury on Genome Editing (ACJ) and the proposed Global Citizens' Assembly on Genome Editing (GCA).

The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We address the impact that the decision could have on abortion access and its consequences beyond abortion care. We posit that an abortion ban would, in effect, mean that anyone who becomes pregnant, including those who continue a pregnancy and give birth to healthy newborns and those with pregnancy complications or adverse pregnancy outcomes will become newly vulnerable to legal surveillance, civil detentions, forced interventions, and criminal prosecution. The harms imposed by banning or severely restricting abortion access will disproportionately affect persons of color and perpetuate structural racism. We caution that focusing on Roe as a decision that only protects ending a pregnancy ignores the protection that the decision also affords people who want to continue their pregnancies. It overlooks the ways in which overturning Roe will curtail fundamental rights for all those who become pregnant and will undermine their status as full persons meriting Constitutional protections. Such a singular focus inevitably obscures the common ground that people across the ideological spectrum might inhabit to ensure the safety, health, humanity, and rights of all people who experience pregnancy. [ABSTRACT FROM AUTHOR]

The Supreme Court seems poised to overrule Roe v. Wade and hold that there is no constitutional right to choose abortion. The reversal of Roe seems to run counter to public opinion in the United States—while many favor restrictions, a clear majority do not want Roe reversed and favor access to abortion early in pregnancy. The current Court's apparent willingness to run the risk of political pushback has a complex history. Scholars have long described the Court as a countermajoritarian institution, but in practice, as historians have shown, the Court tends not to stray too far from popular opinion. For a Court bent on reversing Roe and tackling a long list of other divisive topic, concerns about institutional legitimacy no longer appear to be an effective check. A post-Roe Court may be more unplugged from popular opinion, with unpredictable results for the future of the democracy. [ABSTRACT FROM AUTHOR]

The article focuses on the use of paradox of experience to describe epistemology of ill people's testimony in bioethical discourse which is misleading. Topics discussed include cancelation of the assets and liabilities to form the paradox, exclusion of disabled people by the actual conditions of bioethics, and exclusionary structures of bioethics.

This open peer commentary refers to the article "Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?" by Holly Fernandez Lynch, Arthur Caplan, Patricia Furlong and Alison Bateman-House, that was published within the issue. Topics discussed include tension between innovation and research, research and clinical ethics, and the U.S. Food and Drug Administration's Emergency Use Authorizations for COVID-19.

This open peer commentary refers to the article "Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?" by Holly Fernandez Lynch, Arthur Caplan, Patricia Furlong and Alison Bateman-House that was published within the issue. Topics discussed include efficiency of utilitarian thinking, data sharing, and prioritization of most promising research proposals.

The article presents the discussion on considering trauma-informed care and healthcare ethics consultations for PWUD in hospitals. Topics include increasing use of pharmaceutical opioids and unregulated opioids increasingly contaminated with highly potent fentanyl and the analogues; and growing rates of poverty and decreasing opportunities in many communities.

The article presents the discussion on favor of evidence-based policy development for expanding prenatal genetic testing. Topics include "severe" medical conditions categorized as such according to "actual patient goals and desires;" and beliefs regarding family planning laying the foundation for shared decision-making before, during, and after pregnancy.

The article presents a commentary on the article by Rachel Fabi and Daniel Goldberg published within the issue which contends that current priorities in the field of bioethics perpetuate injustices and inequities. Topics covered include what is required in creating greater equity related to bioethics research, how increased funding alone will not resolve the problem as indicated in Usha Lee McFarling's article published in "STAT News" and how the dilemma can be addressed.

The author comments on the article "The Ethics of Access: Reframing the Need for Abortion Care as a Health Disparity" by K. Watson, which asserted that bioethicists should consider endorsing such a reframing of the abortion access issue may seem viable when considering the changes in abortion access in a post Roe v. Wade context. Topics include the term "health disparity," the suggestion to reframe access to abortion as a health disparity, and support by the public for access to abortion.