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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]

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]

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]

Secular clinical ethics has responded to the problem of moral pluralism with a procedural approach. However, defining this term stirs debate: H. Tristram Engelhardt Jr. has championed a contentless proceduralism (P1), while others, conversely, argue for a proceduralism that permits some content in the form of moral claims (P2). This paper argues that the content P2 permits ought to be expanded to include some metaphysical commitments, in an approach referred to as P2+. The need for P2+ is demonstrated by analyzing and rejecting three standards (the best interest or harm principle, internal reasonability, and the child's right to an open future) used by P2 to justify overriding religiously motivated refusals of treatment for children. These approaches fail because each maintains a neutral stance regarding the truth of religious belief. This paper drives at the broader thesis that the proceduralism of secular clinical ethics requires some moral and metaphysical commitments. [ABSTRACT FROM AUTHOR]

The article discusses paper builds on the conceptual tools from three interrelated philosophical debates that help structure important chaotic discussions about surrogates for living human brains and resolve practical issues related to regulatory matters. Topics include the evaluation of the practical and regulatory implications of the "goodness" of such surrogates created for research purposes; and a decision-maker has refrain from actions run the risk of causing harm to the public.

Beneficence is a foundational ethical principle in medicine. To provide benefit to a patient is to promote and protect the patient's wellbeing, to promote the patient's interests. But there are different conceptions of wellbeing, emphasizing different values. These conceptions of wellbeing are contrary to one another and give rise to dissimilar ideas of what it means to benefit a patient. This makes the concept of beneficence ambiguous: is a benefit related to the patient's goals and wishes, or is it a matter of objective criteria that constitute wellbeing? This paper suggests a unified conception of wellbeing for use in medicine to determine what counts as a benefit. Two components of wellbeing are identified: (1) objective functioning/health and (2) the patient's view of her own good. The paper explores how to apply, balance, and weigh these components in clinical situations to determine what counts as a benefit to a patient. [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]

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]

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 authors propose four general guidelines for using artificial intelligence (AI) in the bioethics classroom such as transparency, antidiscrimination, privacy, and accountability. They stress the need of professors and instructors to accept responsibility and outcomes for AI generated products. They also offer a suggestion to prepare the next generation of bioethicists.

The authors comment on an article by V. Rahimzadeh and colleagues on the role of large language models (LLMs) in ethics education. Topics discussed include how LLMs can support the learning process, how LLMs can best facilitate ethics education, and analysis of learning students how to use LLMs in the manner of Rahimzadeh and colleagues' case study.

A response by Douglas S. Diekema and Norman Fost about their article "Ashley Revisited: A Response to the Critics," is presented. They emphasize that their goal for writing the paper was to encourage people to examine ethical issues raised by Ashley's case. They respond to issues including growth attenuation and medial uncertainty.

This open peer commentary refers to the article "Toward a Framework for Assessing Privacy Risks in Multi-Omic Research and Databases," by Charles Dupras and Eline M. Bunnik, that was published within the issue. Topics discussed include artificial intelligence (AI) methodologies for analyzing biomedical data, human-like behavior of machines, and ethical concerns from the power of AI when applied to human tissue repositories.

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. [ABSTRACT FROM AUTHOR]

Detection of deception and confirmation of truth telling with conventional polygraphy raised a host of technical and ethical issues. Recently, newer methods of recording electromagnetic signals from the brain show promise in permitting the detection of deception or truth telling. Some are even being promoted as more accurate than conventional polygraphy. While the new technologies raise issues of personal privacy, acceptable forensic application, and other social issues, the focus of this paper is the technical limitations of the developing technology. Those limitations include the measurement validity of the new technologies, which remains largely unknown. Another set of questions pertains to the psychological paradigms used to model or constrain the target behavior. Finally, there is little standardization in the field, and the vulnerability of the techniques to countermeasures is unknown. Premature application of these technologies outside of research settings should be resisted, and the social conversation about the appropriate parameters of its civil, forensic, and security use should begin. [ABSTRACT FROM AUTHOR]

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly on hope, the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm. [ABSTRACT FROM AUTHOR]

The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide a brief review of the case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised, the weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them. [ABSTRACT FROM AUTHOR]

Comments on a study by R. M. Werner and colleagues, which examined issues relating to the use of deception by physicians to get an insurance company to pay for a medical procedure. Percentage of physicians in the U.S. who had supported misrepresentation of facts given to insurance companies; Ethical implications of the deceptive approach to health insurance; Arguments concerning the health care system in the U.S.

In the last several months, several major disciplines have started their initial reckoning with what ChatGPT and other Large Language Models (LLMs) mean for them – law, medicine, business among other professions. With a heavy dose of humility, given how fast the technology is moving and how uncertain its social implications are, this article attempts to give some early tentative thoughts on what ChatGPT might mean for bioethics. I will first argue that many bioethics issues raised by ChatGPT are similar to those raised by current medical AI – built into devices, decision support tools, data analytics, etc. These include issues of data ownership, consent for data use, data representativeness and bias, and privacy. I describe how these familiar issues appear somewhat differently in the ChatGPT context, but much of the existing bioethical thinking on these issues provides a strong starting point. There are, however, a few "new-ish" issues I highlight – by new-ish I mean issues that while perhaps not truly new seem much more important for it than other forms of medical AI. These include issues about informed consent and the right to know we are dealing with an AI, the problem of medical deepfakes, the risk of oligopoly and inequitable access related to foundational models, environmental effects, and on the positive side opportunities for the democratization of knowledge and empowering patients. I also discuss how races towards dominance (between large companies and between the U.S. and geopolitical rivals like China) risk sidelining ethics. [ABSTRACT FROM AUTHOR]

The article discusses the world-wide COVID-19 epidemic, an internal tension in the goals of medicine has come to the forefront of public debate. Topics include how to reform professional guidelines in order to avoid the self-defeat that London, England, fears; and to emphasize that openness and transparency need not be obstacles or dangers to the stability of medical institutions.

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 the relationship between bioethics and religion and on the paper "In Defense of Irreligious Bioethics" by Timothy F. Murphy. In the article the authors offer their opinions on bioethicists' ability to test religious assumptions and on several points which are raised and discussed in Murphy's article.

In this article the author discusses the responses to their paper "Stem Cell Tourism and the Power of Hope" contained within the current issue. They argue that broad bans against stem cell therapies may be counterproductive but that carefully targeted regulation of stem cell tourism should be encouraged. They note that a key aspect of the ethical questions revolve around the role of physicians in dissuading patients against pursuing unproven therapies and stem cell tourism.

Comments on a paper concerning the three stages in the lifestyle of bioethics. Discussion on the role of bioethics in directing the biomedical and bioscientific-research enterprise; Overview of reactive and proactive bioethics; Problems with bioethics as co-Principal Investigator.

The author comments on an article by V. Rahimzadeh and colleagues which discussed the virtues and vices of employing ChatGPT in ethics education for health professionals. Topics discussed include a classic dilemma picked by the authors in medical ethics, prima-facie principles relied on by ChatGPT in interpreting the case, and analysis of ChatGPT's handling of dilemmas in medical ethics.

The authors comment on the expanding development and use of virtual representations of objects, referred to as "Digital Simulacra" by M. K. Cho and N. Martinez- Martin. Topics discussed include ethical and legal concerns regarding digital clones, possible adverse effects of the presence of unethical experimentation, and advances that demand clear guidelines to ensure responsible and respectful usage.

A letter from the editor is presented in which he discusses the founding of the "American Journal of Bioethics (AJOB)" while working as an assistant professor at the University of Pennsylvania. He presents a historical overview of the events leading up to the publication of the "AJOB," including his meetings with "AJOB's" publisher MIT Press, and why he believes the "AJOB" has been such a success.

Comments on Frances Kamm's paper in response to Michael Sandel's article over the morality of enhancement technologies to improve human capacities. Criticism of Kamm's paper; Observation on the enhancement technologies debate; General socio-economic context of child-rearing.

The article focuses on complete ectogenesis and associated concerns related to artificial womb technology (AWT). Topics discussed include AWT as a substitute for abortion, benefits of AWT to facilitate continued gestation and childbirth and consequences of policy designed to avoid abortion by substituting AWT.

The author discusses the article "Privacy and Health Practices in the Digital Age" by M. Pyrrho and colleagues which recognize a tendency to oversimplify privacy in health, portraying it as an inevitable conflict between individual and collective interests. Topics include the two distinct categories of collective interests according to Pyrrho and colleagues, the difficulty of making informed choices about personal data in the digital age, and an overview of data protection regulation in Europe.

The article presents the discussion on trauma-informed approach to formulating hospital system policies and demonstrating the approach through discharge planning policy. Topics include supporting the trauma-informed principles of collaboration, mutuality, empowerment, and voice; and hospital systems showing concern about rising numbers of patients and families resistant to proposed discharge plans.

On February 3, 2010, a “Letter of Concern from Bioethicists,” organized by fetaldex.org, was sent to report suspected violations of the ethics of human subjects research in the off-label use of dexamethasone during pregnancy by Dr. Maria New. Copies of this letter were submitted to the FDA Office of Pediatric Therapeutics, the Department of Health and Human Services (DHHS) Office for Human Research Protections, and three universities where Dr. New has held or holds appointments. We provide a critical appraisal of the Letter of Concern and show that it makes false claims, misrepresents scientific publications and websites, fails to meet standards of evidence-based reasoning, makes undocumented claims, treats as settled matters what are, instead, ongoing controversies, offers “mere opinion” as a substitute for argument, and makes contradictory claims. The Letter of Concern is a case study in unethical transgressive bioethics. We call on fetaldex.org to withdraw the letter and for co-signatories to withdraw their approval of it. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss how to strike a balance in ensuring patients' rights to publicity and protecting health care providers' rights to privacy in cases where patients or their families post blogs in the medical setting. They present the case of a pediatric intensive care unit (PICU) patient whose ordeal was posted by her parents on social media to raise funds for her treatment as example. Also cited is how the blog raises key questions on topics like professional reputation.

The article presents the discussion on conceptual issue concerning ambivalence in medical decision-making. Topics include incurable neurodegenerative disease, surgery or chemo/radiation in the setting of a malignant brain tumor; and focusing on the inability for choosing an impossible situation ignoring the actual issue the individuals being confronting.

The article presents the discussion on exploring patient ambivalence in the context of medical decision-making. Topics include misalignment of patient goals with treatment plans, feelings of distress in the health care team, and other harms; and efforts neglecting a major facet of human psychology contributing to situations of patient ambivalence.

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 author reflects on the article "Research Exceptionalism," by J. Wilson and D. Hunter. In the article the author offers his opinions on several arguments and assumptions that are contained in Wilson and Hunter's article and on factors that he feels people should consider when assessing the case for the regulation of research.

The authors respond to comments about their article "Transplant tourism in China: A tale of two transplants." They mention that their point was to take issue with strong denouncements by the transplant community against the use of organs from executed prisoners in China. They discuss physicians' professional responsibilities to themselves, to their patients and to those that are not their patients.

The article presents a commentary on the paper by C. Grady and colleagues on the influence of ethics education on the moral action of practicing nurses and social workers. The commentary adds to the debate over the content and structure of ethics education. It emphasizes that having post-professional training ethics education had a positive impact on participants, even though the content of post professional training ethics education were known.

This open peer commentary refers to the article "Toward a Framework for Assessing Privacy Risks in Multi-Omic Research and Databases," by Charles Dupras and Eline M. Bunnik, that was published within the issue. Topics discussed include genomic exceptionalism, methylation and histone modification within epigenomics, and biology-intrusive and life-intrusive information.

This open peer commentary refers to the article "Toward a Framework for Assessing Privacy Risks in Multi-Omic Research and Databases," by Charles Dupras and Eline M. Bunnik, that was published within the issue. Topics discussed include normative approach of genetic exceptionalism, data security, and risk and discriminatory potential associated with epigenomic data in research.

In the United States, clinical HIV data reported to surveillance systems operated by jurisdictional departments of public health are re-used for epidemiology and prevention. In 2018, all jurisdictions began using HIV genetic sequence data from clinical drug resistance tests to identify people living with HIV in "clusters" of others with genetically similar strains. This is called "molecular HIV surveillance" (MHS). In 2019, "cluster detection and response" (CDR) programs that re-use MHS data became the "fourth pillar" of the national HIV strategy. Public health re-uses of HIV data are done without consent and are a source of concern among stakeholders. This article presents three cases that illuminate bioethical challenges associated with re-uses of clinical HIV data for public health. We focus on evidence-base, risk-benefit ratio, determining directionality of HIV transmission, consent, and ethical re-use. The conclusion offers strategies for "HIV data justice." The essay contributes to a "bioethics of the oppressed." [ABSTRACT FROM AUTHOR]

The author reflects on two components of beneficence and wellbeing in medicine. Topics discussed include two conflicting ways people have described wellbeing, or how someone is faring, good reasons to think that both conceptions are relevant to medicine, and four principles that ground the bioethical landscape.

The article presents the author's views on a research paper on the relevance of an ethical analysis of the Quantified Relationship (QR) and Quantified Self movement published in this issue. He opines on gamification, a formal aspect of QR. He comments on the need for consideration of privacy-related objections to QR.

As social media becomes increasingly popular, human subjects researchers are able to use these platforms to locate, track, and communicate with study participants, thereby increasing participant retention and the generalizability and validity of research. The use of social media; however, raises novel ethical and regulatory issues that have received limited attention in the literature and federal regulations. We review research ethics and regulations and outline the implications for maintaining participant privacy, respecting participant autonomy, and promoting researcher transparency when using social media to locate and track participants. We offer a rubric that can be used in future studies to determine ethical and regulation-consistent use of social media platforms and illustrate the rubric using our study team's experience with Facebook. We also offer recommendations for both researchers and institutional review boards that emphasize the importance of well-described procedures for social media use as part of informed consent. [ABSTRACT FROM AUTHOR]

In this article, I argue that (1) transgender adolescents should have the legal right to access puberty-blocking treatment (PBT) without parental approval, and (2) the state has a role to play in publicizing information about gender dysphoria. Not only are transgender children harmed psychologically and physically via lack of access to PBT, but PBT is the established standard of care. Given that we generally think that parental authority should not go so far as to (1) severally and permanently harm a child and (2) prevent a child from access to standard physical care, then it follows that parental authority should not encompass denying gender-dysphoric children access to PBT. Moreover, transgender children without supportive parents cannot be helped without access to health care clinics and counseling to facilitate the transition. Hence there is an additional duty of the state to help facilitate sharing this information with vulnerable teens. [ABSTRACT FROM AUTHOR]

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions. [ABSTRACT FROM AUTHOR]

The author discusses the need for healthcare ethics consultants to initially check internal behaviors and practices that have racist consequences to put anti-racism into action. Topics covered include the possible education of healthcare organizations and practitioners on racism in healthcare delivery and its lead into unfair health outcomes, and the review of policies that may reflect structural injustice. Also noted is the consideration of allied actions to form solutions to racism.