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The authors comment on the proof-of-concept study by L. Meier and colleagues, published within the issue wherein they built an algorithm to aid technical decision making. Topics include the failure of the study authors to convincingly describe the problem that they are trying to solve, their failure to explain why an artificial intelligence (AI) driven system is the appropriate tool to aid ethical decision-making, and the approach of the project to problem-solving.

The article informs about Chickenpox, exogenous boosting, and harmful injustices is a stimulating contribution to the growing vaccination ethics literature. Topics include benefits of varicella vaccination that they discuss, and key argument depends on a claim about social ontology and consequent obligations is contestable; and practical consequences for the maintenance of protection over a lifetime, including significant implications for the delivery of routine vaccination programs.

For many years the prevailing paradigm for medical decision making for children has been the best interest standard. Recently, some authors have proposed that Mill’s “harm principle” should be used to mediate or to replace the best interest standard. This article critically examines the harm principle movement and identifies serious defects within the project of using Mill’s harm principle for medical decision making for children. While the harm principle proponents successfully highlight some difficulties in present-day use of the best interest standard, the use of the harm principle suffers substantial normative and conceptual problems. A medical decision-making framework for children is suggested, grounded in the four principles. It draws on the best interest standard, incorporates concepts of harm, and provides two questions that can act as guide and limit in medical decision making for children. [ABSTRACT FROM AUTHOR]

The article presents insights on a paper on policy development for health care decision making in critical-care settings. Topics covered include the use of professional organization policy statements (POPS) among clinicians, the challenges faced in decision-making such as triage and unilateral decisions to limit life-prolonging interventions and the different opinions for defining shared decision making.

The article explores the role of autonomy in decision-making for prenatal testing. It highlights the many genetic counseling codes of practice and ethics emphasize the importance of supporting patients' autonomous decisions. It mentions the autonomy is considered especially important in prenatal testing due to historical concerns about eugenics and coercion. It explore the arguments for and against non-medical trait NIPT.

The article discusses concept of DMC is linked to the principle of respect for autonomy (Appelbaum 2007, 1834) and the justification of involuntary treatment. While involuntary treatment might have been historically justified by welfare concerns (e.g. protection from harmful consequences), the standard view now is that it is only justified when a person has lost the ability to act autonomously.

The article presents the discussion on instrumental paternalism carving a pathway to competent refusal of medical intervention. Topics include offering options within the standard of care and in the specific context of patients' lives; and handling finances at a minimal level and providing for food, shelter, and clothing.

The article presents insights on a paper on policy development for health care decision making in critical-care settings. Topics covered include the need to focus on individuals' participation in decision making through education, the reference given to the case of a 55-year-old man who suffered from a severe hemorrhagic stroke with bleeding and the belief that policymaking is the not the primary problem for limiting critical care treatments.

The article presents insights on a paper on policy development for health care decision making in critical-care settings. Topics covered include the argument for an organizational-level policymaking for the rationing problem, the sample given to show how procedures for fair allocation of health care resources can be adapted and the factors influencing potential policymaking processes.

The article presents insights on a paper on policy development for health care decision making in critical-care settings. Topics covered include the ethical considerations to inform the establishment of defensible critical care limits to life-sustaining treatments, the extent to which the American Thoracic Society (ATS) Policy Statement aligns with the ethical principles and the proposed engagement of affected individuals in an open dialogue.

The article presents insights on a paper on policy development for health care decision making in critical-care settings. Topics covered include the argument for a meso-level policy development process, the role of informed or rational democratic deliberation in determining who will use an intensive care unit (ICU) bed and the aggressive life-sustaining care demanded by surrogates. Also mentioned is the importance of finding ways to minimize biases and errors in critical care settings.

The authors comment on an article by Lukas J. Meir and colleagues which offered the promise of a pathway for resolving clinical bioethical problems using an artificial intelligence (AI) interface. They discuss the issues that arise in evaluating whether the AI program, METHAD accomplishes the intended initial goal and possible role of fuzzy cognitive maps (FCMs) such as the ones used in METHAD in the enacting of ethics consultations.

The article offers information on Lewis Carroll's poem "The Walrus and the Carpenter" from his Through the Looking Glass, and "The time has come to talk of many things" but of the proposal in the target article of "reestablishing the relationship between theological and secular bioethics. Topics include prevailing ethic has practical virtuous judgement and Hippocrates' belief that medical decision making was best left to the doctor.

The article focuses on the personal transformation and advance directives. Topics discussed include dementia can inspire both personally and cognitively transformative experiences (Paul 2014), resulting in major changes to one's beliefs, values, preferences, and overall demeanor; and empirical studies show that when someone undergoes a sufficiently salient personal transformation, especially one that affects their moral attributes, they are likely to be regarded.

The article stresses the need to prioritize frontline workers during the COVID-19 pandemic. Topics discussed include the best way to manage pandemics such as COVID-19, difference between pandemics and typical mass casualty events like mass shootings or earthquakes, and ethical argument for priority to healthcare personnel on the frontlines.

The article offers information on the assessing of organ transplant candidates. It mentions the rising of number of transplant surgeries in the U.S. and also highlights the goals of a psychosocial pre-transplant evaluation to identify patient's level of neuropsychiatric and cognitive functioning in order to address current psychiatric issues and also promote fairness and equal access to care.

The article focuses on the process of Peer review whereby editors send submitted manuscripts for evaluation by experts. Topics discussed include pre-publication and post-publication review conducted by journals, acceptance of articles for publication and use of plagiarism software by editors for reviewing articles.

The article discusses that the standard paradigm of individual informed consent in research ethics focuses on an individualized conception of autonomy. It mentions that the informed consent process for research is founded in the ethical principle of respect for persons and is intended to provide potential participants an opportunity to make an informed decision about research participation.

The article focuses on commentaries that addresses new approaches to bioethics praxis, compliance/adherence and terminology and used terms like surveillance technology and self-acting medical devices (SAMD). It refers to the potential for digital pills to provide the best chance of maintaining or improving individuals' health by enhancing abilities to take their medications as prescribed.

In this article the author talks about advance directives and transformative experience. Topics discussed include clinicians distrust advance directives does not provide a particularly compelling reason to reject advance directives; and medical ethics is better understood as an effort to improve medical practice than as a justification of existing practice.

In this article the author talks about understanding advance directives as a component of advance care planning. Topics discussed include advance care planning, understood as a process, has well-established clinical benefits for patients and families, including improved communication between family members and clinicians, increased patient and family satisfaction, reduced family member stress and anxiety, and increased use of hospice care.

The authors describe their experience in solving medical ethical dilemmas and legal risks of severe COVID-19. Topics discussed include an overview of cases of COVID-19 patients, dilemma of principles of clinical ethics and legal risks, and convalescent plasma research as a promising treatment for severe COVID-19 patients.

Digital medicine is a medical treatment that combines technology with drug delivery. The promises of this combination are continuous and remote monitoring, better disease management, self-tracking, self-management of diseases, and improved treatment adherence. These devices pose ethical challenges for patients, providers, and the social practice of medicine. For patients, having both informed consent and a user agreement raises questions of understanding for autonomy and informed consent, therapeutic misconception, external influences on decision making, confidentiality and privacy, and device dependability. For providers, digital medicine changes the relationship where trust can be verified, clinicians can be monitored, expectations must be managed, and new liability risks may be assumed. Other ethical questions include direct third-party monitoring of health treatment, affordability, and planning for adverse events in the case of device malfunction. This article seeks to lay out the ethical landscape for the implementation of such devices in patient care. [ABSTRACT FROM AUTHOR]

When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key questions. I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a “think list” of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution. [ABSTRACT FROM AUTHOR]

Biomedical diagnostic science is a great deal less successful than we've been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term's ambiguous meaning. Then I frame central questions that remain answered in this context with respect to informed consent, autonomy, and truth-telling. Finally, I show that while considerable attention in this area is given to making sure not to provide biological care to patients without a need, comparatively little is given to the competing, ethically central task of making sure never to obstruct access to biological care for those with diagnostically confusing biological conditions. I suggest this problem arises from confusion about the philosophical value of vagueness when it comes to the line between biological and psychosocial needs. [ABSTRACT FROM AUTHOR]

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]

Two potentially lifesaving protocols, emergency preservation and resuscitation (EPR) and uncontrolled donation after circulatory determination of death (uDCDD), currently implemented in some U.S. emergency departments (EDs), have similar eligibility criteria and initial technical procedures, but critically different goals. Both follow unsuccessful cardiopulmonary resuscitation and induce hypothermia to “buy time”: one in trauma patients suffering cardiac arrest, to enable surgical repair, and the other in patients who unexpectedly die in the ED, to enable organ donation. This article argues that to fulfill patient-focused fiduciary obligations and maintain community trust, institutions implementing both protocols should adopt and publicize policies to guide ED physicians to utilize either protocol for particular patients, in order to address the appearance of conflict of interest arising from the protocols' similarities. It concludes by analyzing ethical implications of incentives that may influence institutions to develop the expertise required for uDCDD but not EPR. [ABSTRACT FROM AUTHOR]

The author presents a response to insights about his paper on policy development for health care decision making in critical-care settings. Topics covered include the importance of enabling the maintenance of trust among parties in decision making, the capacity of health professional organizations in developing authoritarian policy statements for critical care and the use of the scope of customary critical care practices plus as part of a dispute resolution process.

The article offers further reasons why unrealistic optimism in patients' decisions should be respected as maintained in the article by Blumenthal-Barby and Ubel in 2018. Topics discussed include unrealistic optimism's potential in supporting a person's motivation, and pursuit and possible achievement of personal goals, and its tolerance in the health domain, but not in other life domains. Also noted is the difficult ascertainment of the effect of patients' beliefs on their treatment outcomes.

The author discusses hope versus denial, self-deception, and unrealistic optimism in the context of health care in the article by Blumenthal-Barby and Ubel in 2018. Topics covered include the issues of allowing patients to undergo inferior treatment with little understanding of success chances and of innumeracy in patients, and Americans' concerns on health care availability and affordability. Also noted is the unclear "significant misunderstanding" threshold for patients on their prognosis.

The article comments on the article "When parents refuse: Resolving entrenched disagreements between parents and clinicians in situations of uncertainty and complexity" by J. Winters. It provides an overview of two frameworks developed for use when there are disagreements between clinicians and parents about clinical treatment decisions for children. It introduces a tool that aims to break down steps of ethical deliberation to minimize mistakes of value bias, reductionism or omission.

The article comments on the article "The harm principle cannot replace the best interest standard: Problems with using the harm principle for medical decision making for children" by J.C. Bester. It mentions that frequency with which reasonableness occurs invites an immediate clarification about the nature of any harm consensus in bioethics. It cites cases to illustrate that indeterminacy has a potential effect of allowing a decision maker to flexibly draw on one or more guiding principles.

The author comments on a case study published in the periodical, focusing on forced calorie restrictions on a patient in clinical setting and its ethical aspects. Topics discussed include the complications due to morbid obesity, the ethical principle of autonomy which allows patients to make decisions about their own health, and the negative decisions that patients make which come in conflict with the provider's obligation to provide treatment.

The article offers information on deceased uterus transplantation and the ethical issues related to it. Topics discussed include the importance of consent and surrogate decision making in the transplantation process; the recovery of composite tissues from deceased donor to be used in vascularised composite allografts (VCAs); and the preferences regarding organ donation that individuals hold.

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership. [ABSTRACT FROM AUTHOR]

End-of-life medical decision making presents a major challenge to patients and physicians alike. In order to determine whether it is ethically justifiable to forgo medical treatment in such scenarios, clinical data must be interpreted alongside patient values, as well as in light of the physician's ethical commitments. Though much has been written about this ethical issue from religious perspectives (especially Christian and Jewish), little work has been done from an Islamic point of view. To fill the gap in the literature around Islamic bioethical perspectives on the matter, we derive a theologically rooted rubric for goals of care. We use the Islamic obligation for Muslims to seek medical treatment as the foundation for determining the clinical conditions under which Muslim physicians have a duty to treat. We next link the theological concept of accountability before God (taklīf) to quality-of-life assessment. Using this construct, we suggest that a Muslim physician is not obligated to maintain or continue clinical treatment when patients who were formerly of, or had the potential to be, mukallaf (the term for a person who has taklīf), are now not expected to regain that status by means of continued clinical treatment. [ABSTRACT FROM AUTHOR]

The article discusses ethical aspects linked with emergency and transplant medicine. Topics include guidelines provided by the U.S. Food and Drug Administration (FDA) which states that researchers planning to use exception from informed consent (EFIC) should consult representatives of concerned communities; prohibition of declaring patient dead in using uncontrolled Donation after Circulatory Determination of Death (uDCDD) protocol and the use of uDCDD and EPR in concurrent clinical situations.

The article offers insights on the proposal for unrestricted prenatal genome sequencing. Topics covered include the idea that professional organizations and insurance providers should not restrict women from receiving information about reproductive risk, the respect shown by the proposal for individuals with disabilities and the challenge of engaging prospective parents about prenatal testing and parenthood.

The article offers insights on the proposal for unlimited whole genome prenatal screening. Topics covered include the intricacies of the ethics of screening, the model for an ethically acceptable way of using unlimited whole genome prenatal screening and the suggested principle for demarcating what health care is to do in the prenatal testing case as when other testing possibilities are considered.

The question of whether clinical ethics consultants may engage in patient advocacy in the course of consultation has not been addressed, but it highlights for the field that consultants' allegiances, and the boundaries of appropriate professional practice, must be better understood. I consider arguments for and against patient advocacy in clinical ethics consultation, which demonstrate that patient advocacy is permissible, but not central to the practice of consultation. I then offer four recommendations for consultants who engage in patient advocacy, and consider the implications of this issue for the field.1 [ABSTRACT FROM AUTHOR]

Health and Social Justice (Ruger 2009a) developed the 'health capability paradigm,' a conception of justice and health in domestic societies. This idea undergirds an alternative framework of social cooperation called 'shared health governance' (SHG). SHG puts forth a set of moral responsibilities, motivational aspirations, and institutional arrangements, and apportions roles for implementation in striving for health justice. This article develops further the SHG framework and explains its importance and implications for governing health domestically. [ABSTRACT FROM AUTHOR]

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians' experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5] [ABSTRACT FROM AUTHOR]

The author argues that doctors and decision aids should provide comparative risk information to patients to improve quality or rationality of decisions and to avoid bias. He addresses the controversy of providing comparative risk information when the goal of communication is to support informed decision-making, and disagrees with the disclosure of comparative risk information to women considering tamoxifen for breast cancer prevention.

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.

Physicians make some medical decisions without disclosure to their patients. Nondisclosure is possible because these are silent decisions to refrain from screening, diagnostic or therapeutic interventions. Nondisclosure is ethically permissible when the usual presumption that the patient should be involved in decisions is defeated by considerations of clinical utility or patient emotional and physical well-being. Some silent decisions - not all - are ethically justified by this standard. Justified silent decisions are typically dependent on the physician's professional judgment, experience and knowledge, and are not likely to be changed by patient preferences. We condemn the inappropriate exclusion of the patient from the decision-making process. However, if a test or treatment is unlikely to yield a net benefit, disclosure and discussion are at times unnecessary. Appropriate silent decisions are ethically justified by such considerations as patient benefit or economy of time. [ABSTRACT FROM AUTHOR]

The article discusses the notion that applied bioethics often causes harm that could be avoided through the application of a kind of decision analysis based on utilitarianism. The meaning of the term, applied bioethics, is explained. The article also discusses examples of bad outcomes of applied bioethics.

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive—together with the physician—at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary. [ABSTRACT FROM AUTHOR]

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.

The article offers information on developing ethical criteria for health-promoting nudging is a valuable exercise. It mentions the ends of nudging being legitimate is glossed as the nudged option is medically superior; and also mentions the desired goal in having an organ donation opt-out system is not improving the health of the nudgees.