Bioethics and Medical Ethics Commons^™

Does Holding Healthcare Providers Accountable For Every Mistake Improve Patient Safety, Or Does It Hinder Open Reporting And Learning?, Amir Arshia Emam Jomeh, Eleanor Roy

Journal of Health Ethics

Medical errors are a major cause of death and harm in healthcare, yet most go unreported due to fear of punishment. This essay explores whether holding healthcare workers fully accountable for every mistake improves safety or creates a harmful blame culture. Using the case of Dr. Hadiza Bawa-Garba, it shows how individual punishment can overlook deeper system failures, such as staff shortages and poor communication. The essay compares this with Denmark’s non-punitive reporting system, which encourages healthcare professionals to report errors without fear, leading to real improvements in patient safety. Blame cultures, on the other hand, discourage openness and violate …

Who Should Be Held Accountable In Technology-Induced Medical Errors? Evaluating The Roles Of Healthcare Providers, Technology Developers, And Hospital Systems, Eleanor Roy, Amir Arshia Emam Jomeh

Journal of Health Ethics

The integration of technologies such as artificial intelligence, electronic health records, and automated diagnostic systems has significantly altered clinical practice. While these tools enhance efficiency and diagnostic accuracy, they have also introduced new forms of medical error, raising complex questions about responsibility. This article examines the ethical dimensions of accountability in technology-induced harm by evaluating the roles of healthcare providers, technology developers, and hospital systems. Drawing on the four pillars of medical ethics; autonomy, beneficence, non-maleficence, and justice, it explores the overlapping responsibilities of each stakeholder and the challenges that arise when harm occurs. Through analysis of the Therac-25 radiation …

Capacity Determination And False Beliefs: A Case Study On The Application Of Evaluation Frameworks With Resulting Recommendations, Dessislava S. Fessenko

Journal of Health Ethics

False beliefs may interfere with medical decision-making by casting doubt about the patient’s decision-making capacity. The latter is typically assessed against a set of established criteria requiring the patient’s cognitive aptness for self-governance. I argue that a capacity determination solely based on these criteria may prove insufficient when the patient entertains false beliefs. I further illustrate how alternative evaluation frameworks are better suited to assess the impact of false beliefs on the patient’s state of mind, values, overall worldviews and pursuit of wellbeing, and therefore, for the actual moral significance of false beliefs. It appears prudent to integrate these alternative …

The Impact Of Medical Ethics On Healthcare Professionals And Patient Outcomes In Resource-Poor Settings: A Focus On Ethical Challenges And Solutions, Amir Arshia Emam Jomeh, Eleanor Roy

Journal of Health Ethics

Background: Developing countries face major challenges to their healthcare system such as resource scarcity and reduced patient autonomy amongst women. The strained healthcare system often leads doctors to compromise ethical protocols and reduce their standard of care.

Aims: To explain why medical ethics are important for healthcare professionals in the context of resource-poor countries.

Findings: Many healthcare professionals lack adequate knowledge of medical ethics in developing countries. In addition, doctors make difficult decisions such as patient prioritization and resource allocation without clear ethical guidance or protocols. Women also face diminished patient autonomy in developing countries, which has been linked to …

Should Medical Assisted Suicide Be Legalised Worldwide? A Critical Examination Of Ethical Justifications And Challenges In Contemporary Healthcare, Eleanor Roy, Amir Arshia Emam Jomeh

Journal of Health Ethics

The legalisation of medical assisted suicide (MAS) is a complex ethical issue at the intersection of autonomy, non-maleficence, and justice. This paper critically examines whether MAS should be legalised worldwide, evaluating ethical justifications, regulatory challenges, and societal risks. A primary argument in favour of MAS is patient autonomy, allowing individuals to make informed end-of-life decisions, particularly in cases of terminal illness and intractable suffering. MAS is also framed as a harm-reduction strategy, preventing patients from resorting to unsafe methods of suicide.

However, ethical concerns regarding coercion, socioeconomic disparities, and the "slippery slope" effect present significant opposition. Case studies from jurisdictions …

The Ethical Justification Of Application Of Long-Acting Reversible Contraception In Patients With Intellectual Disabilities, Kelly Savitri

Journal of Health Ethics

This paper explores the ethical justification for the use of Long-Acting Reversible Contraception (LARC) in patients with intellectual disabilities, particularly in scenarios where patients cannot provide informed consent. The tension between respecting autonomy and ensuring beneficence presents a complex challenge for healthcare providers. Drawing on historical context, current reproductive justice issues, and evolving societal attitudes towards individuals with intellectual disabilities, this essay argues for a semi-discrete model that recognizes the need to prioritize patient health and safety while valuing their autonomy. By examining the implications of both past and present practices, this study highlights the necessity for healthcare providers to …

Reproductive Autonomy In Immunological Intervention: Ethical Boundaries In Maternal-Fetal Immune Therapy, Marium Z. Rizvi

Journal of Health Ethics

Recent advances in immunology have broken barriers in reproductive medicine through immune-modulating therapies that support fertility and pregnancy. Treatments such as intravenous immunoglobulin (IVIG) and intralipid infusions are increasingly offered to patients with Recurrent Implantation Failure (RIF) or Recurrent Pregnancy Loss (RPL), conditions that result in miscarriages and failed IVF treatments (Pillarysetti et al., 2023). Maternal-fetal immunology reveals a delicate interplay between immune tolerance and defense: the maternal system must accept a genetically foreign fetus while preserving immunological protection. Disruptions in this balance are implicated in implantation disorders and pregnancy failure. As a result, immune-based therapies have emerged as promising …

Toward A More Accountable And Inclusive Vision Of Health Ethics: Navigating Complexity In Contemporary Clinical Practice, Peter A. Depergola Ii

Journal of Health Ethics

Editor's introduction to Vol. 21, No. 1 of the Journal of Health Ethics.

The Ethics Of Student Attrition In Healthcare Education Programs, Kent Haina Jr, Peter A. Depergola Ii

Journal of Health Ethics

Student attrition is a problem in healthcare education programs, but there is little in the literature regarding the organizational ethics of lowering it. Some argue that lowering attrition is unethical, because it would lower academic and professional standards, potentially impacting patient care. Others say students deserve to make decisions about when to leave a course of study. However, these arguments ignore inequities in attrition, as well as the conflicts of interest in, and moral obligations of colleges and universities. Lowering attrition rates in healthcare education programs is inherently ethical because it levels the playing field for underrepresented minorities that disproportionately …

The Ethical Impermissibility Of Implanting Embryos That Carry The Genetic Markers For Deafness, Cat Mastalerz

Journal of Health Ethics

Preimplantation genetic diagnosis is a reproductive procedure that involves testing embryos conceived by in vitro fertilization for genetic conditions, including cystic fibrosis, Duchenne’s muscular dystrophy, and controversially deafness. This paper examines the ethical dilemma surrounding parents using this technology to select for and choose to implant an embryo that carries the genetic markers for deafness. Disability and impairment are discussed, followed by an in-depth analysis of the role of Deaf culture, including the perspective of hearing children of deaf adults. The effect of deafness on life opportunities is then viewed through the lens of the child’s right to an open …

Ethical Requirements For Achieving Fairness In Radiology Machine Learning: An Intersectionality And Social Embeddedness Approach, Dessislava S. Fessenko

Journal of Health Ethics

Radiodiagnostics by machine-learning (ML) systems is often perceived as objective and fair. It may, however, exhibit bias towards certain patient sub-groups. The typical reasons for this are the selection of disease features for ML systems to screen, that ML systems learn from human clinical judgements, which are often biased, and that fairness in ML is often inappropriately conceptualized as “equality”. ML systems with such parameters fail to accurately diagnose and address patients’ actual health needs and how they depend on patients’ social identities (i.e. intersectionality) and broader social conditions (i.e. embeddedness). This paper explores the ethical obligations to ensure fairness …

Exploring Chatgpt’S Clinical Ethics Ability: A Pilot Study, Daniel Jenkins, Christian Vercler, Andrew Barnosky, Janice Firn

Journal of Health Ethics

Background: Artificial Intelligence (AI), particularly public models like ChatGPT, has revolutionized the generation of human-like thought processes and text. Across healthcare, the integration of AI in decision-making processes is increasingly pervasive. However, the application of AI in ethical decision-making remains relatively unexplored.

Methods: Ethics consultation notes from a tertiary academic medical center were de-identified. We trained ChatGPT using three separate ‘chats’ with one, two, or five unique notes and asked it to produce an ethical analysis/discussion and recommendations for a test case. We conducted this same series again but gave ChatGPT only the ethical analysis/discussion and recommendation sections from the …

Ethical And Legal Questions With Street Medicine, Gordon Wong

Journal of Health Ethics

The homeless problem has been worsening in the U.S. for many years. Homeless residents have many health issues. Yet their healthcare needs are difficult to be met. To address this problem, the federal government and state governments are encouraging the implementation of Street Medicine programs by providing funding and changing regulations. However, due to the unique characteristics of this population, there are many ethical and legal issues related to delivering care to them. These issues have not been well discussed. This paper attempts to highlight the ethical and legal issues in Street Medicine. The goal is to call the attention …

Advances In Biomedical Research And Treatments: What Is Acceptable?, Michael L. Clancy, Khalid M. Iskandarani, Mitchell C. Mccrea

Journal of Health Ethics

This study investigated the technology acceptance (TA) of twenty-first century biomedical treatments by adults in the United States. A new TA instrument was created, using five distinct levels: (1) Healing and Prevention, (2) Replacement Organs, (3) Enhancements-Medical, (4) Enhancements-Discretionary, and (5) Transhumans. An on-line survey produced 353 usable responses, which showed distinct patterns for each of five biomedical treatment levels. There was clear support for Levels 1–3, but very strong opposition to Levels 4–5. The TA finding draws the line between which human interventions are acceptable versus others that should be prohibited through public policies and medical guidelines.

Late Have I Loved Thee: Reintroducing The Journal Of Health Ethics Twenty Years Later, Peter A. Depergola Ii

Journal of Health Ethics

The Editor-in-Chief provides an overview of Volume 20, Issue 1.

Examining The Ethics Behind Icu Admission During The Covid-19 Pandemic, Brian Eclarinal

Journal of Health Ethics

During the COVID-19 pandemic surge, the demand for ICU beds far exceeds its supply in the hospitals. The healthcare team had to confront themselves with an ethical dilemma of distributing the limited beds to patients who required ICU admission and therefore needed to prioritize. This paper examines various ethical theories and principles that were used during the pandemic in assigning patients to ICU beds and proposes an algorithm to aid in decision making for ICU bed assignment in order to achieve a fair allocation of this scarce resource.

Why The West Should Help China Reduce Unrecognized And Preventable Covid-19 Deaths, George A. Gellert

Journal of Health Ethics

In an era marked by a ruinous war between a democratic state and a totalitarian regime, political volatility, rightward looking isolationism and nationalism, and heightened competition and disputes between China and the West, it is perhaps difficult to discern why the West should supply China with COVID-19 vaccines and therapeutics, as well as epidemiological assistance in order to mitigate a potentially unrecognized COVID-19 crisis in that nation. This commentary considers three arguments against Western and international indifference to the plight of China as it transitions to COVID-19 endemicity.

Ethical Considerations Surrounding Vaccine Development During A Public Health Crisis, Syed Arsalan Akhter Zaidi, Kainat Saleem, Rahul Bollam, Bushra Zaidi

Journal of Health Ethics

Epidemics and Pandemics have been plaguing mankind since many centuries, and are a cause of major healthcare expense in modern times. The novel coronavirus pandemic of 2019-2020 spread worldwide faster than many previous pandemics, including EBOLA in 2017. Although personal protective equipment, and social distancing slowed the outbreak, a vaccine is needed to ensure global immunization and to stop this deadly outbreak. Developing a vaccine in times of a public health crisis comes with a lot of ethical considerations, including overlooking proper informed consent, the issue of using placebo in control arm of trials, extended timelines of development of vaccines, …

A Framework For Personal Respiratory Ethics, Ian W. Goddard

Journal of Health Ethics

The Covid-19 pandemic raises the need for an ethical framework that addresses the unique ethical challenges and questions arising from airborne infectious diseases. For example, are we ever ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein proposes pathways to answers grounded in ethical norms and the moral principles of non-harm, beneficence and respect for personal autonomy. REF is a personal ethics wherein your ethical duty to increase your respiratory hygiene efforts—such as by donning a mask—is proportional to your estimation of an increase in the likelihood that your respiratory effluent …

Covid Remains 2023, Sheila P. Davis

Journal of Health Ethics

Editor's introduction to Vol. 19, Issue 1 of the Journal of Health Ethics

Ethical And Moral Imperatives Of 2022, Sheila P. Davis Phd

Journal of Health Ethics

Editor's introduction to the Journal of Health Ethics vol. 18, no. 2

Applying Lessons Learned: Nursing Facility Administrators’ Operational And Ethical Challenges During Covid-19, Mary Eleanor R. Wickersham

Journal of Health Ethics

Operational and ethical challenges for nursing homes across the United States during the COVID-19 pandemic were daunting, that experience perhaps only a forecast of future epidemics that nursing home administrators and operators may face. This article describes administrator-identified challenges and focuses on how nursing homes might learn from their experiences by increasing flexibility to meet evolving needs, improving quality assurance and disaster planning, using ethics policies and ethical decision-making processes to work through difficult decisions, and leading the way in creating new policies that will make nursing home care safer and more appropriate for patients with ever changing needs.

Theory Building As Integrated Reflection: Understanding Physician Reflection Through Human Communication Research, Medical Education, And Ethics, Andrea Vicini, Ashley P. Duggan, Allen F. Shaughnessy

Journal of Health Ethics

Grounded in a presupposition that a single explanatory framework cannot fully account for the expansive learning processes that occur during medical residency, the article examines developing physicians’ reflective writing from three disciplinary lenses. The goal is to understand how the multi-dimensional nature of medical residency translates into assembling educational experiences and constructing meaning that cannot be fully explained through a single discipline. An interdisciplinary research team across medical education, communication, and ethics qualitatively analyzed reflective entries (N=756) completed by family medicine residents (N=33) across an academic year. Results provide evidence for moving toward an integrated thematic explanation across disciplines. The …

Discussing The Injustice Of The Covid-19 Vaccine Pass Imposed On Medical Consultation In Public Hospitals In Hong Kong, Fung Kei Cheng

Journal of Health Ethics

The COVID-19 pandemic has devastated public health, economy and social life all over the world, especially wherever a vaccine pass scheme has been implemented. Many countries have begun to relax schedules to return to normal activities. In contrast, Hong Kong continues to tighten the utilisation of a vaccine pass for medical services in order to boost vaccination rates. Such a practice not only significantly challenges ethical and operative concerns but also threatens health equity and social justice for healthcare decision-makers and practitioners, consequently hurting public health and community well-being. This discussion analyses the various arguments, reviews vaccine hesitancy and suggests …

Ethical Considerations Of Telehealth: Access, Inequity, Trust, And Overuse, Monica O'Reilly-Jacob, Andrea Vicini, Ashley P. Duggan

Journal of Health Ethics

In the U.S. healthcare system, telehealth is increasingly present and demands ethical assessment. On the one hand, telehealth increases access to healthcare services for some at-risk populations (e.g., people suffering from mental illness and addictions) and in specific contexts (e.g., rural). On the other hand, telehealth widens the digital divide and can lead to overuse of services. Furthermore, because it is still unclear how telehealth influences trust between patients and primary care clinicians, connecting relationship science and human communication research can inform critical reasoning. Finally, healthcare policy is advancing toward the wide adoption of telehealth. Hence, it is urgent to …

Financial Incentives And Healthcare: A Critique Of Michael Sandel, Mark Peacock

Journal of Health Ethics

The use of financial incentives in healthcare calls for ethical examination. Michael Sandel's influential work represents such examination and is subject to critical analysis in this paper. Sandel focuses on monetary payments to persuade patients to lose weight, give up smoking etc. but also on the much-discussed case of giving drug addicts money in return for their consent to be sterilized. He offers two separate objections to financial incentives, one based on coercion, the other on corruption. I argue that Sandel's corruption objection to commodification is insufficient to ground the objection he has to financial incentives in healthcare. Whatever strength …

Ethical Implications Of Covid-19 Surveillance In Karnataka Using Nancy Kass Framework, Apurva Jain, Lakshya Arora

Journal of Health Ethics

Numerous public health hurdles, including pandemics such as COVID-19, have led to concerns about community health practices in relation, necessitating the application of an ethical perspective. International research ethics guidelines are only used in a restricted range of contexts of public health. As a result, a variety of frameworks have been established to assist ethical analysis of public health concerns. In this study, we have used the Nancy Kass framework for analyzing COVID-19 surveillance in Karnataka state of India, which is a six-step approach that can assist public health practitioners in evaluating the ethical consequences of interventions, policy initiatives, services, …

Reciprocity And Priority Allocation System For Organ Transplant: An Ethical Analysis, Gordon Wong, Chong Ho Yu

Journal of Health Ethics

How to increase the supply of organs donations for transplant is a critical issue in healthcare. Although recently xenotransplantation has received much publicity, it may be years before this becomes clinically viable. The Reciprocity and Priority Allocation (RPA) System currently used in Israel and a few other countries may be a reasonable approach to increase organ donation in the foreseeable future. For this approach to be accepted by the public, a robust analysis on its ethical implications is needed. This paper applies two formal ethics frameworks to analyze the implication of the RPA system.

2022: Global Ethical Think Tank, Sheila A. Davis Phd

Journal of Health Ethics

Editor's introduction to Volume 18, Number 1 of the Journal of Health Ethics.

Agency And Health Policies, Rodrigo Lopez Barreda

Journal of Health Ethics

In the current medical ethics literature, the concept of agency is receiving growing attention. Nevertheless, many of those definitions are narrow in scope. This article intends to provide a deeper understanding of this concept, allowing for its use in clinical practice and public health policies. First, it revises the current concept of agency and some of its shortcomings. Then, the article presents two philosophical accounts of agency, identifying three relevant features, namely time-extended organised planfulness, endorsement of their own actions, and identification with the activity. Lastly, the article depicts how those features may help in the application of agency …