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Bioethicists influence practices and policies in medicine, science, and public health. However, little is known about bioethicists' views. We recently surveyed 824 U.S. bioethicists on a wide range of ethical issues, including topics related to abortion, medical aid in dying, and resource allocation, among others. We also asked bioethicists about their demographic, religious, academic, and professional backgrounds. We find that bioethicists' normative commitments predict their views on bioethical issues. We also find that, in important ways, bioethicists' views do not align with those of the U.S. public: for instance, bioethicists are more likely than members of the public to think abortion is ethically permissible but are less likely to believe compensating organ donors is. Our demographic results indicate the field of bioethics is far less diverse than the U.S. population—less diverse even than other academic disciplines—suggesting far more work needs to be done to build an inclusive field. [ABSTRACT FROM AUTHOR]

AbstractEthical questions about confidentiality arise when patients refuse to inform relatives who are at risk of a genetic condition. Specifically, healthcare providers may struggle with the permissibility of breaching confidentiality to warn patients’ at-risk relatives. In exploring this issue, several authors have converged around the idea that genetic cases differ from non-genetic cases (e.g., involving a threat of violence or the spread of an infectious disease) along two related dimensions: (1) In genetic cases, the risk of harm is already present in an at-risk third party, whereas in non-genetic cases, it is not; and (2) In genetic cases, the patient does not create a risk of harm to a third party, whereas in non-genetic cases, the patient does. I argue that these distinctions do not exclusively differentiate genetic from non-genetic cases and should not bear on the permissibility of breaching confidentiality. Instead, such determinations should be based on other considerations. [ABSTRACT FROM AUTHOR]

AbstractTo address the current lack of knowledge about clinical ethics fellowship programs (CEFPs), we surveyed all 36 programs in the U.S. and Canada. The number of CEFPs has grown exponentially over the last 40 years and far exceeds previous estimates. Commonalities among CEFPs include: 88.8% require an advanced degree or rarely accept applicants without one; 91.7% of programs do not restrict applicants to a specific background such as medicine or philosophy; and 88.9% of programs compensate fellows. CEFPs vary widely on numbers of fellows trained in the last 3 years (1–111), numbers of consultations performed by each fellow (0–450), and salaries paid ($0-$95,000). Less than half of programs meet CEFP standards established by ABPD. Nonpaying programs and larger programs tend to have lower admission standards and lower expectations for fellows. We hope these data will help inform CEFP standards that promote quality and consistency without stifling desirable diversity and innovation. [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]

AbstractWhen is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors (“children”). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or “endosex” females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from “cosmetic” labiaplasty to medicalized ritual “pricking” of the vulva, insofar as the procedure is not strictly necessary to protect the child’s physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit–risk calculations, but on a fundamental concern to respect the child’s privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter’s sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians’ widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity. [ABSTRACT FROM AUTHOR]

The article focuses on navigating ethical dilemmas in youth boarding at emergency departments, emphasizing strategies to respect developing autonomy while minimizing risks. Topics include the challenges of long ED stays for youth requiring higher care levels, ethical considerations in discharge decisions, and proactive management strategies to support adolescent autonomy and reduce harm.

The article discusses research by Lauris Christopher Kaldjian, reported in the American Journal of Bioethics, on the topics of the ongoing debate about definitions of death in medicine and bioethics, the motivations behind such debates, and the ethical implications of normothermic regional perfusion (NRP). Kaldjian argues that debates about death definitions are primarily driven by the desire to maximize organ procurement, highlighting concerns about the compatibility of NRP with circulatory.

The article offers information on the necessity for bioethicists and healthcare professionals to adopt a more radical and activist stance to effectively combat systemic racism in healthcare. Topics include the manifestations of systemic racism; historical examples of successful activism; and the call for active resistance to drive meaningful change in racial equity, diversity and inclusion within the medical field.

The article discusses ongoing efforts to enhance diversity, equity, and inclusion within the field of bioethics. Topics discussed include initiatives taken since 2018 to address diversity challenges, the creation of programs like the Sadler Scholars Initiative, and the role of anti-Black racism in bioethics.

The article examines the persistent ableist bias among bioethicists as revealed by the Views in Bioethics Survey, which shows a prevalent belief that blindness is inherently disadvantaging despite evidence to the contrary. Topics discussed include the discrepancy between bioethicists' views and the lived experiences of blind individuals, the persistent influence of the disability-as-deficit model, and the implications for addressing inequities in healthcare and telehealth accessibility.

An editorial is presented the potential impact of generative artificial intelligence (AI) tools, particularly large language models like ChatGPT, on scholarly publishing, examining how authors, peer reviewers, and editors might utilize AI in various stages of the publication process. It authors, editors of bioethics and humanities journals, discuss the implications of generative AI in scholarly publishing.

The article discusses a study on distinguishing ethical from diagnostic concerns about NRP-cDCD, conducted by Kyle E. Karches and Jason T. Eberl, published in the journal "The American Journal of Bioethics." It examines arguments by Bernat and Busch regarding the diagnostic certainty of death in NRP-cDCD, while also addressing ethical objections related to the intentionality of actions performed during NRP.

The article focuses on the relationship between general morality and medical ethics, asserting the necessity of a distinct ethical framework for medical professionals. Topics explored include the shortcomings of teleology in medical ethics and the complex interconnection of duties within the realms of medical practice and research.

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

The authors comments on an article by I. G. Cohen on ChatGPT's ethical implications for medical artificial intelligence (AI). Topics discussed include ChatGPT's general design as raising unique issues, key values and constant ethical concerns, and some of the least discussed but crucial values identified in the article.

The article discusses the ethical implications of artificial intelligence (AI) platforms enabled by large language models (LLMs) for medicine. Topics include expectations on chatbots in the area of mental health, bioethical questions raised by chatbots, and evolving socio-technological practices that raise new bioethical questions of AI-human interactions in psychotherapy.

The article discusses the potential uses of generative artificial intelligence (GenAI) in mental health. Topics include the notion of a third entity, or thirdness, enriching the traditional therapist-patient dyad, function of GenAI Models, and GenAI-patient interactions. Also mentioned are how ChatGPT may support Cognitive Behavioral Therapy (CBT) and responsible GenAI in mental health.

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 focuses on the concept of different "spheres of morality" in medicine, asserting that there is only one unified moral framework for all medical activities. Topics discussed include criticisms of the proposed spheres, disagreements regarding clinical care ethics, and objections to applying market-based ethics in medicine.

The article focuses on an alternative perspective on physicians' professional ethics, critiquing the "spheres of morality" framework and emphasizing the concept of practical identities. Topics discussed include the spatial metaphor's limitations, conflicts within individual roles, and the importance of internal moral norms for physicians.

The article focuses on the "spheres of morality framework," highlighting the varied roles physicians undertake, each guided by unique moral norms. Topics discussed include the proposed moral spheres, the incorporation of medical education and public accountability, and identified limitations such as the oversight of power dynamics and a singular focus on physicians without considering perspectives of other healthcare professionals.

The article focuses on the complexities of moral conflicts in healthcare, emphasizing the distinction between intrapersonal and interpersonal conflicts within various professional roles. Topics discussed include the unique fiduciary duty in clinical care, the necessity for institutional structures to address conflicts, and the prioritization of patients' well-being when navigating diverse roles in healthcare.

The authors comment on an article by S. Morain and E. Largent which discuss examples of pragmatic trials that challenge the fundamental assumption that research and clinical care are distinct activities. Topics include argument on expanding to whom duties related to research might extend, ethically significant aspects of the researcher-participant relationship that could provide guidance, and concepts that offer potentially complementary tools when a regulatory consent process is used.

Clinicians have good moral and professional reasons to contribute to pragmatic clinical trials (PCTs). We argue that clinicians have a defeasible duty to participate in this research that takes place in usual care settings and does not involve substantive deviation from their ordinary care practices. However, a variety of countervailing reasons may excuse clinicians from this duty in particular cases. Yet because there is a moral default in favor of participating, clinicians who wish to opt out of this research must justify their refusal. Reasons to refuse include that the trial is badly designed in some way, that the trial activities will violate the clinician's conscience, or that the trial will impose excessive burdens on the clinician. [ABSTRACT FROM AUTHOR]

Growing interest in embedded research approaches—where research is incorporated into clinical care—has spurred numerous studies to generate knowledge relevant to the real-world needs of patients and other stakeholders. However, it also has presented ethical challenges. An emerging challenge is how to understand the nature and extent of investigators' obligations to patient-subjects. Prior scholarship on investigator duties has generally been grounded upon the premise that research and clinical care are distinct activities, bearing distinct duties. Yet this premise—and its corresponding implications—are challenged when research and clinical care are deliberately integrated. After presenting three case studies from recent pragmatic clinical trials, we identify six differences between explanatory trials and embedded research that limit the application of existing scholarship for ascertaining investigator duties. We suggest that these limitations indicate a need to account for the implications of usual care and to move beyond a narrow focus on the investigator-subject dyad, one that better reflects the team- and institution-based nature of contemporary health systems. [ABSTRACT FROM AUTHOR]

The article focuses on the ethical considerations of withdrawing life-sustaining interventions, specifically extracorporeal membrane oxygenation (ECMO) and raises concerns about the authors' arguments regarding the criteria for determining a "good life" and the value of subjective judgments about one's own life. The author argues against conflating "the good life" with "a life worth living;" and emphasizing the subjective nature of assessing the meaningfulness and value of one's own life.

Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of withdrawal, including distributive justice, quality of life, patients' rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. [ABSTRACT FROM AUTHOR]

The authors discuss the article "Moral Distress: What Are We Measuring" by L. Kolbe and I. de Melo-Martin. Topics include the complicated construct of moral distress, why information from these instruments to measure moral distress is far from irrelevant, and realistic expectations for instruments that measure sources of moral distress.

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 author comments on an article by I. Cohen on the state of generative artificial intelligence (AI), particularly based on Large Language Models (LLMs), which raises critical challenges of diversity and inclusion. Topics discussed include the considerable cost of development and training, factors that will influence the outcomes of the AI model, and threat that may be posed by the widespread use of LLMs for medical purposes.

The author comments on the article "What Should ChatGPT Mean for Bioethics" by I.G. Cohen which highlights bioethical issues raised by the emergence of ChatGPT and generative artificial intelligence (AI). Topics include competitive advantage of companies that deploy generative AI, core principles of the World Health Organization's guidance on the Ethics and Governance of AI for Health to generative AI deployment, and requirement in deploying generative AI applications in healthcare.

The authors present a response to commentaries made on their article "Do Clinicians Have a duty to Participate in Pragmatic clinical Trials." They talk about their gratefulness for the commentaries that expand and further develop some of the arguments and ideas they offered in the article, concerns raised in the commentaries, and ways in which the authors can exercise moral suasion without compelling compliance.

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]

The authors comment on an article by A. S. Garland and colleagues about the challenge to conduct studies on clinical participation in pragmatic clinical trials (PCTs). Topics include the authors' claim that clinicians have a defeasible duty to participate in pragmatic research, their assertion that non-moral personal objections may be justified reasons for clinicians to not participate in PCTs, and practical considerations that are necessary to address to shape policy and practice.

The authors comment on the manuscript by A. Garland, S. Morain, and J. Sugarman on the obligations of clinicians to participate in pragmatic clinical trials (PCTs). Topics discussed include the purpose of the exception from the informed consent (EFIC) regulations instituted in 1996, the key difference between PCTs and EFIC studies, and the importance of the comparison with EFIC studies for further elaborating Garland's set of reasons against the obligation to participate in PCTs.

The author comments on the proposal by A. Garland, S. Morain, and J. Sugarman regarding the duty of clinicians to participate in pragmatic clinical trials (PCTs). Topics discussed include factor that removes the relationship between the clinician and the individual patient from its historically central place in the regulation of clinical behavior and the authors' proposal that there should be a rebuttable presumption in favor of PCTs.

The author comments on an article by A. Garland and colleagues which provides reasons for why clinicians ought to participate in pragmatic clinical trials (PCTs), also known as effective trials. Topics discussed include previous criticism against randomized controlled trials, enrollment criteria for effective trials in psychiatry, and requirements to build sustainable collaborations between researchers and clinicians.

The authors comment on the ethical challenges inherent in clinician participation in embedded research which were discussed in the issue. Topics include a novel framework designed that offers a unique opportunity to respond to potential problems raised by research in this setting, a primary concern of S. Morain and E. Largent regarding pragmatic clinical trials (PCT), and argument of A. Garland, S. Morain, and J. Sugarman on the duty of clinicians.

The authors comment on an article by S. Morain and E. Largent on investigators' obligations to patient-subjects when research is embedded in care. They discuss the suggestion by Morain and Largent to understand the ethical obligations in embedded research using electronic health record (EHR) data, one way to resolve issues while being responsive to the differences that Morain and Largent raise, and the issue of cost raised by Morain and Largent.

The article focuses on the need for a deeper analysis of racial justice in the field of bioethics, particularly in the context of genomics research and its implications for underserved communities, such as those in the Deep South.

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 article discusses about ethical complexity and emotional unrest regarding long-term Extracorporeal Membrane Oxygenation (ECMO) use. It further discusses about what moral arguments justify imposition of one view (ECMO should be stopped) over another (continue ECMO); how should ill feelings between a patient or patient's surrogate and staff members factor into considerations about appropriate use of the therapy and goals of care; and feasibility and availability of long-term ECMO treatment.

The article offers information on the ethics of the extracorporeal membrane oxygenation as a destination therapy (ECMO-DT). It further discusses about withdrawal of ECMO-DT over the objections of patients with decision-making capacity; clinicians and ethicists reconsider the moral permissibility of ECMODT in a capacitated patient; and also mentions that the repurposing of medications is foreseen and intentional.

The article discusses about extracorporeal membrane oxygenation (ECMO) dependent patients participation in decision-making regarding whether to continue life-sustaining treatments (LSTs). It further discusses about discussion of treatment withdrawal, despite permanent dependence on venovenous(VV)-ECMO and the inability to leave the intensive care unit (ICU); and the patient's indefinite dependence on ICU level care that serves as the basis for claim of treatment being medically inappropriate.

The article discusses about balancing extracorporeal membrane oxygenation as destination therapy (ECMO-DT) with transplant program. It further discusses about the complexities of prognostic uncertainty; the argument against withdrawal over the dissent of a patient or their family; Extracorporeal Life Support Organization (ELSO) guidelines regarding the use of mechanical devices to temporarily support heart or lung function; and physician recommendations to continue or withdraw treatments.

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.

The article focuses on presence of identified ethical concerns with behavioral contract as a clinical tool to manage aggression and agitation in settings of healthcare. Topics discussed include espoused zero tolerance" policies for violence in healthcare settings, use of coercive interventions in health care facilities, and need of addressing deficit of knowledge due to relation to workplace violence against medical professionals.

The article focuses on concerns regarding use of contracts to manage interpersonal conflict in settings of hospital, and mentions use of behavior contracts to manage the interpersonal conflict. Topics discussed include consequences for negative behaviors imposed by the contracts, unreasonable decorum for medical care demanded by contract, and role altered by the contract when imposed by clinical ethicists.

The author offers a perspective on the future of bioethics. He notes the role of philosophical bioethics in improving the actual practice in medicine, research and other areas. He refers to consequentialism and non-consequentialism or deontology as the dividing line in contemporary normative ethics. He calls for suspension of judgment to motivate philosophers to collaborate more and for bioethicists to avoid unnecessary disagreements or debates, but to give way to opportunities for convergence.

The article focuses on a complex ethical scheme in medical situations, advocating for a simpler, more practical approach based on the foundational principle of human dignity. Topics discussed include the importance of dignity as a unifying principle in various medical scenarios, such as clinical research, industry-funded research, and conflicts between clinical care and public health.