Biomedical Ethics

Complete ectogenesis (CE), if technologically realized, would portend a radical decoupling of fetal development from the female body, thereby dismantling the biological and cultural nexus between gestation and kinship. This paper argues that a Confucian approach offers a fruitful framework for critically assessing CE, as it appropriately shifts attention from the moral status or isolated interests of individual entities (such as the fetus, women, or parents) to the quality of relationships—especially the parent-child relationship. From this perspective, CE represents not merely (...) a technical innovation with certain drawbacks, but a morally significant disruption of the relational virtues upon which a good human life depends. When chosen by couples capable of natural reproduction, CE involves the voluntary relinquishment of one of the embodied conditions through which profound parent-child love is ordinarily cultivated, thereby jeopardizing the foundations of human flourishing. The paper concludes by addressing a couple of potential objections to this Confucian critique. (shrink)

Contemporary biomedical ethics has been shaped largely by principle-based and outcome-oriented frameworks, yet these approaches insufficiently account for the role of character in clinical judgement and professional formation on which their fruitful use depends. This paper develops a systems-aware virtue-ethical framework for medical education in which professionalism is understood as a sustained mode of professional agency arising from the coordinated exercise of cultivated moral and epistemic character, clinical competence, and practical wisdom within institutional conditions. Drawing on neo-Aristotelian virtue ethics and (...) interdisciplinary research in philosophy, psychology, and medical education, the framework integrates virtue ethics, professional identity formation, flourishing, role modelling, and institutional analysis. It explains how professional character and competence are cultivated longitudinally, integrated through practical wisdom, and either enabled or constrained by educational and healthcare environments. Role modelling is repositioned as one mechanism within a broader pedagogy of character formation rather than as a pedagogical identity to be formally adopted. The paper concludes that medical education should attend simultaneously to the formation of practitioners and to the institutional conditions under which professional agency can be exercised and sustained. Character education should be understood as a central ethical and formative dimension of medical training, providing a more adequate foundation for professionalism than approaches focused primarily on rules, outcomes, or wellness. (shrink)

The notion of planetary health considers human life and health in the context of biospheric processes. Humans are interconnected with all life on Earth through the evolution from a common ancestor and have developed within omnipresent symbioses with other organisms, and in interactions and nutrients exchanges within the biosphere. Situating human life within the ecological processes and interconnectedness of life on the planet necessitates an expanded perspective on health, and I explore four interpretative contexts: biomedical, biopsychosocial, environmental and ecological. Planetary (...) health is nevertheless also an attempt to conceptualize recent technological interferences with planetary homeostatic processes, resulting in changes of hydrological and atmospheric processes. The expansion of industrial civilization has transformed land and ocean ecosystems, introducing new forms of toxicity and pollution, and destroyed habitats of other forms of life, resulting in diminishing abundance and diversity of life. This predicament has an indisputable ethical dimension, which I explore in my contribution. By grounding human condition as that of biological beings - who share vulnerability, finitude, and interdependence with other forms of life - as primary and central to ethical considerations, I focus on the notions of harm, responsibility, and justice, which reveal also the political dimension of human life. Bringing into dialogue the perspectives of environmental and indigenous ethics, I consider the meaning of ethical concepts such as dignity, personhood, and rights in the ecological context of life, and their implications for medicine. Based on ethical obligation to prevent harm, I argue for a legal transformation to defend the interests of life. (shrink)

Urine toxicology testing among birthing people in the United States remains a clinical practice often informed more by personal values and conscious and unconscious biases, than by medical evidence and ethical obligations. As empirical evidence addressing harms and benefits of toxicology testing in pregnancy grows, and national organizations are taking a moral stance around clinical practice, no published structure explicitly positions the evolving data within an ethical framework. We draw on a model of applied ethics to inform a set of (...) concrete recommendations about what clinicians ought to do with regards to the practice of urine toxicology testing of pregnant patients. These methods facilitate a relationship between empirical data regarding toxicology testing in pregnancy and ethical norms. Our findings serve as a practical guide for clinicians and policymakers seeking clinical guidance around urine toxicology testing in pregnancy as well as a model for future translation of theoretical approaches into clinical action. (shrink)

This article offers a Hohfeldian analysis of the right to die and asks what follows, normatively and institutionally, once the relevant incidents are distinguished. It argues that debates about assisted dying frequently conflate four questions: whether choosing death is morally permitted (licence), whether others must not interfere with that choice (negative claim-right), whether a valid request can alter others’ normative situation (normative power), and whether anyone owes assistance (positive claim-right). The paper maps major objections to the incident they primarily target (...) and shows that many familiar objections to assisted dying bear most directly on duties of assistance rather than on the underlying permission or the claim against interference. Substantively, it defends a universal moral licence to die and, where competence, voluntariness, and adequate information are satisfied, a corresponding negative claim-right against unjustified interference. Its institutional conclusion is more limited than a direct duty on any particular physician to provide assisted death: what can be justified more securely is a right to make a request that must be assessed under public criteria and, in jurisdictions authorising assisted dying, routed to willing and licensed providers. Separating public validity review from plural provision models, the paper argues, can reduce coercion and conscience-based conflict while preserving access. (shrink)

In a recent article Gomez-Virseda and coauthors criticize my previous work on methodology in bioethics and argue that bioethics is a discipline. While I think that Gomez-Virseda and co-authors misconstrue my argument, state the obvious, and fail to address pressing questions to their argument, I am most thankful for the inspiration and opportunity to elaborate on why methodology matters for consolidating bioethics’ professional standing, to improving its quality, ascertaining its academic and educational importance, and to advancing its trustworthiness and social (...) impact. (shrink)

Drawing on a genealogical analysis of the distinction between zoē (biological life as organic functioning) and bios (a distinctively human way of life shaped by meaning, orientation, and evaluative practice), the article reconceives bioethics as bios ethikos: ethical reflection on the conditions under which forms of life become meaningful and inhabitable. It introduces the notion of the existential remainder to describe the ethically significant dimensions that persist when institutional deliberation leaves aspects of lived existence under-articulated. The article proposes a renewed (...) structural orientation grounded in the heuristic formula T = PEWS + C. Ethical thinking (T) is distributed across four interrelated domains of lived existence: Person, Earth, Work, and Society (PEWS), while the addition of C designates the creative openness that resists full institutional codification. PEWS-oriented evaluation may be operationalised through more integrative assessment tools, while maintaining vigilance toward the irreducible horizon of existential creativity. Bioethics, thus reconceived, becomes not only the regulation of life, but reflection on whether the governance of life sustains the conditions under which life can remain meaningfully lived. (shrink)

Psychiatric advance directives (PADs) are statements that allow people with mental disorders to express their preferences and wishes in anticipation of future crisis situations in which the patient’s decision-making capacity may be compromised due to their mental disorder. The fundamental value of PADs is the promotion of self-determination and personal autonomy. Although PADs have common elements, they may differ across countries in their content, development process and legal status. Italy does not have a specific regulation regarding PADs; however, we argue (...) that important indications may be drawn from Law No. 219/2017 regulating informed consent, advance directives and shared care planning (SCP). Moving from the international context and empirical evidence regarding barriers and facilitators to the implementation of PADs, the paper provides a key for interpreting SCP in the psychiatric field. The discussion highlights the importance of an interdisciplinary collaboration among bioethics, law, and clinics to improve the quality and consistency of care for people with mental disorders. (shrink)

Modern healthcare faces a mismatch in terms of supply and demand which makes careful priority setting imperative. The debate on priority setting in healthcare has focussed on pharmaceuticals and other tangible medical interventions. This article instead looks at the time that healthcare professionals have at their disposal. How should healthcare professionals divide their time between tangible medical interventions and communication with patients? What communicative goals should be prioritised? This normative analysis focusses on situations which involve time consuming communication between professionals (...) and patients, which cannot easily be carried out alongside other medical interventions or is itself the main intervention as in psychotherapy. The arguments brought forth are applicable across the healthcare panorama and apply to all healthcare professions. It is argued that there are many different communicative goals which cannot be reduced to one type. Some recommendations are given and defended regarding the priority setting of different communicative goals. For reasons of value coherence and formal equality, all patients should be given a baseline amount of time for communication and time beyond that should be prioritised based on healthcare needs. If accepted, the arguments here highlight that a substantive part of healthcare’s (time) resources should be spent on communicative tasks. Indeed, it is time that we take time for communication seriously. (shrink)

A central tenet of health equity is that access to healthcare should be responsive to need rather than patients’ socioeconomic status. The idea that ability to pay can enable some people to access faster, better, or more healthcare strikes many egalitarians as clearly objectionable. This paper argues that this view is more complicated than may initially appear. While there are egalitarian reasons to oppose private healthcare, these are often less decisive than they may initially appear and prohibiting private healthcare on (...) egalitarian grounds is likely to run afoul of egalitarianism’s liberal commitments. There are several important theoretical hurdles to pass through for a successful egalitarian argument against private healthcare, which this paper aims to highlight. (shrink)

Paul Ricoeur’s ethics comprises three distinct moments where it is possible to recognize the influences of Aristotle, Kant, Rawls and an original ricoeurian moment of practical wisdom, where the concept of phronesis is rehabilitated. When reflecting on medical practices, Ricoeur distinguishes, in continuity with his triadic ethics, three levels of judgment: the prudential and ethical level concerning the singularity of the clinical encounter that is essential for establishing a pact of trust, the formal and moral level where deontological codes emerge (...) and the reflexive level where the two previous judgments become legitimated. Our aim with this paper is, through Paul Ricoeur´s ethics, to perspective deontology and deontological codes as a broader set of implicit philosophical and anthropological conceptions, rooted in the clinical encounter, that constitute a theoretical and foundational background for medical rules and norms. (shrink)

The rise of right-wing political movements supported by key players from big tech is transforming Western societies. This so-called techno-feudalism also implies challenges for bioethics. Racist agendas, intentional misinformation on health topics such as vaccinations, banned words and research topics in public institutions, and the massive funding of questionable biomedical research projects undermine health equity, patient safety, and autonomy. This new sociopolitical situation exacerbates a long-standing issue in healthcare that bioethics hitherto mostly failed to address adequately: societal power asymmetries that (...) shape the roles and relationships of actors in healthcare and biomedical research. Although attempts have been made to reflect upon this issue, e.g. in feminist or postcolonial bioethics, there is no coherent bioethical approach that fundamentally focuses on power asymmetries as a lens of bioethical inquiry. In this article, I therefore introduce critical bioethics, an approach that takes epistemic lenses from critical theory, especially the so-called Frankfurt School. These epistemic lenses—totality and embeddedness, instrumental reason, dialectics and emancipation—allow us to uncover the societal causes for ethical issues in healthcare and biomedical research. Based on this methodological foundation, critical bioethics addresses health inequity as a result of power asymmetries by understanding individuals as fundamentally embedded in a concrete socioeconomic context. Through the lens of instrumental reason, it addresses the connection between disruptive technological innovations and economic interests in terms of commodification and solutionism. By using dialectics as a method to uncover contradictions in the way bioethics understands its principles, it provides an emancipatory perspective for normativity that separates it from affirmative forms of bioethical thinking that simply reproduce the suppressive status quo. (shrink)

Patient-centered care (PCC) is widely endorsed in contemporary medicine, yet philosophical analyses often approach it through concept-first approaches that define patienthood in advance—typically in terms of autonomy, holistic personhood, or rational agency—and then assess clinical practice by reference to these ideals. This paper argues that such an approach can obscure how patienthood is configured in practice. We develop a tool-first approach that treats cognitive, communicative, and material tools as analytically primary for understanding how patients are individuated in clinical reasoning. The (...) argument is grounded in an ethnographic case study conducted in a specialized cancer hospital, focusing on outpatient clinics in medical oncology, colorectal surgery, and palliative care. Rather than treating ethnography as descriptive background, we use it to identify tools-in-use that structure what becomes salient, actionable, and patient-relevant in situated encounters. Across these settings, distinct configurations of tools generate systematically different modes of patienthood. In oncology, staging systems and expectation management configure patients as therapeutic trajectories oriented toward uncertain futures. In surgery, anatomical diagrams and probabilistic framings individuate patients as operative bodies embedded in structured decision spaces. In palliative care, symptom scales, narrative practices, and informational scaffolding configure patients as experiential subjects and epistemic agents. We analyze these differences as instances of structural plurality: patterned, tool-mediated modes of patient individuation that are internally coherent yet irreducible to a single model. On this account, ethical ideals commonly associated with PCC—such as autonomy, shared decision-making, and informed consent—can be understood less as prior normative standards applied to practice, and more as contingent achievements that depend on how tools structure salience, understanding, and possibilities for agency in clinical contexts. (shrink)

This article argues that Plato was a pioneer of the philosophy of health. It examines the psychosomatic interrelationship between soul (psychē) and body (sōma) primarily in the Charmides and the Timaeus, with selective references to other dialogues, notably the Republic and Phaedrus. The central claim is that Plato’s account of the psychosomatic interrelationship can be adequately understood only when its sociopolitical dimension is taken into account. Although this emphasis is relatively novel in contemporary scholarship, it was commonplace in Plato’s milieu (...) to conceive of human beings as members and citizens of the city-state (polis). The article further argues that Plato’s approach to psychosomatic phenomena extends beyond states of pain or disease and instead encompasses a holistic vision of health and human flourishing. Accordingly, this study aims to deepen the current understanding of Plato’s philosophy of health. Given that the philosophy of health is an emerging interdisciplinary field, the article also seeks to contribute to its conceptual development. (shrink)

The current state of medical practice is going through tremendous and rapid changes. There is an increasing prevalence of burnout among physicians, where they are questioning the value of practicing medicine. There is also a growing frustration among patients over reduced access to physicians, feeling rushed at appointments and generally feeling that they are not being heard. These conditions point to a sense among doctors and patients that the doctor-patient relationship is compromised without a viable pathway to repair this vital (...) connection. In this paper, I want to show how applying philosophy, particularly, Martin Heidegger’s discussion of angst and death can help to show a way for doctors to have a deeper ontological understanding of their patients’ conditions, which can provide a bridge for doctors to re-establish a deep doctor-patient relationship. I will use vertigo as a paradigm condition of a disorder in which doctors have a poor understanding of their patients’ condition. This leads to frustrating interactions with patients and breakdown of the doctor-patient relationship. Ménière’s disease is a particular type of vertigo disorder which will serve as the foundation for this study which will examine the severe vertigo attacks and chronic disequilibrium these patients experience through the lens of Heidegger’s highly technical phenomenological analysis of angst and death. Ménière’s disease is an inner ear disorder that causes violent vertigo attacks and hearing loss followed by severe disequilibrium. During the attacks patients are incapacitated by the vertigo, and after the attack subsides, the disequilibrium makes life’s normal pursuits meaningless. These patients understand the role of entities in their lives, but entities do not matter to them. Heidegger introduces the concept of for-the-sake-of-which to describe how entities in the world are interrelated with Dasein’s purpose of disclosing a world. He provides a sense of for-the-sake-of-which where everyday entities are used to fulfill Dasein’s activities which is an existentiell mode of for-the-sake-of-which. His famous example is the hammer in the workshop. He also gives a sense of for-the-sake-of-which where the totality of entities in the world are related to Dasein’s ultimate goal of being a discloser of its world. This is Dasein’s ultimate for-the-sake-of-which, which is an existential mode. In this paper I show that for-the-sakes-of-which can be thought of as having an existentiell and existential sense, and the existentiell for-the-sakes-of-which can be inauthentic or authentic. I will show how Heidegger’s analysis of Dasein can be applied to concrete human existence, using the inner ear disorder, Ménière’s Disease as an example. I am suggesting that the disequilibrium from Ménière’s disease is a naturalized account of Heideggerian angst and is being-towards-death. I am also suggesting that the Ménière’s attack is an experience of existential death because all possibilities and solicitations are impossible. I show that some Ménière’s patients are able to take on authentic for-the-sake-of-which by becoming resolute and anticipating death. (shrink)

The right of patients to decline information about their health, prognosis, and available treatment options is a salient principle in both domestic law and international declarations and conventions. This right may be considered either unnegotiable or subject to certain terms and conditions. While respecting this right may seem straightforward, doing so in clinical practice can be challenging. This article uses a realistic hypothetical scenario to examine the epistemic, moral, and practical challenges that can arise, particularly with patients nearing the end (...) of life. These challenges include how and when to honor the right and its potential conflict with moral values such as self-determination, authenticity, and avoiding harm to oneself and others. The end of life exacerbates these issues because of the irretrievability of decisions and the successive reduction of possible courses of action, as well as potentially changing preferences. These potential conflicts of values deserve further attention and must be considered when deciding whether to honor a patient’s wish not to know. (shrink)

This conceptual review examines how autonomy became the dominant moral grammar of late modern Western societies and how its expansion reshapes subjectivity, institutions, public life, and healthcare practice. A genealogy traces autonomy from Enlightenment duty bound self legislation and civic self rule, through liberal non interference, to later forms shaped by expressive individualism, therapeutic culture, and recognition based claims. The paper argues that autonomy’s normative achievements remain decisive, yet its cultural absolutization can generate a fragile subject who is highly expressive (...) but insufficiently equipped for sustained responsibility. Five linked pathologies are analysed: autonomy as entitlement and boundary protection, transgression emptied by indeterminate norms, opinion transformed into performative positioning under hyperpluralism and platform surveillance, symbolic authority eroded across education and the professions, and duties devalued within a rights centred moral economy. In response, the paper proposes a reconstructive framework that redefines autonomy as ethical maturity, a formed capability sustained by responsibility, legitimate authority, deliberative practices of opinion, and duty. Particular attention is given to philosophy of medicine, where patient autonomy and professional autonomy illuminate the difference between supported agency and consumerist choice. Methodologically, the article combines genealogical reconstruction, phenomenological interpretation, and a purposive interdisciplinary synthesis of sociology, developmental psychology, philosophy of medicine, moral psychology, and media studies. Implications are sketched for education, healthcare, professional trust, and platform governance, with emphasis on proportional accountability and repair. (shrink)

Prevention can make a significant contribution to a longer and healthier life. However, individual behavioural prevention has an influence on lifestyle with regard to how one deals with time. After all, prevention is always about making decisions in the present to change anticipated conditions in the future in a beneficial way. It is associated with challenges and an increase in responsibility. Its results are uncertain. The essay asks how one can respond to these characteristics of individual behavioural prevention. One possible (...) response is to adopt an attitude of irony. (shrink)

The uptake of social science methods by bioethics significantly expanded its methodological spectrum, raising new theoretical, methodological, and practical questions. Recently, we are witnessing another trend, adding advanced data science methods to bioethics’ toolkit to aid, for example, in online data analysis, support scholarly writing, and inform clinical ethics. This article explores the emerging field of Digital Bioethics across its dimensions by analysing the tangled relationship between topics and methods, highlighting intersections between Digital Bioethics and Bioethics of the Digital, and (...) advocating for a methods-based definition of the field. The use of advanced data science methods within bioethics must be interpreted in the context of the use of Artificial Intelligence (AI) in health care. At the same time, it presents unique opportunities and challenges. Defining, and thus demarcating, Digital Bioethics can create support for the new field but also requires navigating trade-offs. To do so, we take four kindred academic fields as points of comparison (Digital Humanities, Experimental Philosophical Bioethics, computational medicine and digitised biology) to analyse what each of them teaches for critically assessing and further developing Digital Bioethics. The article discusses potential pitfalls and concludes with recommendations on how the field can fully develop its potential to promote bioethical research and argument. Furthermore, the article discusses how a critical reflection of the use of AI methods within bioethics itself will also contribute to the ethical oversight of increasingly AI-driven branches of healthcare. (shrink)

Cognitive biases are widely discussed in the medical literature as systematic deviations from rational judgment and as significant contributors to diagnostic error. However, the prevailing view of cognitive biases as inherently epistemically detrimental may be challenged by recent research highlighting their potential utility. In this paper, we argue that the impact of cognitive biases in medicine depends not only on their internal cognitive structure, but also on the ecological characteristics of the medical environments in which they operate. We develop a (...) conceptual framework that distinguishes between three types of cognitive biases: (1) those that are epistemically reliable (and practically useful) in so-called “safe cognitive environments”, where ecological informational structures reliably support the use of “fast and frugal” heuristics; (2) those that are practically useful in “pragmatically permeable contexts” such as emergency care or public health, where time pressure, uncertainty, or resource constraints justify decisions that are epistemically suboptimal but action-guiding; and (3) those that are neither epistemically nor pragmatically defensible, and thus constitute clear targets for mitigation. By offering this taxonomy, we aim to clarify when and why cognitive biases hinder or support medical reasoning and practical actions. Our analysis also emphasizes the need to reframe some traditional assumptions in medical epistemology and education. Rather than attempting to eliminate all cognitive biases, we advocate for a more nuanced, context-sensitive, and ecologically informed approach in medicine. We conclude by outlining the implications of this framework for improving diagnostic accuracy, professional training, and institutional practices in healthcare. (shrink)

Appeals to vulnerability are widespread in bioethics, yet they continue to face criticism. One line of critique concerns their normative force, with two major sceptical claims dominating the debate. The strong version holds that vulnerability alone carries little or no normative force. The moderate version grants some role but denies that it has the same normative force as concepts such as wrong or wronging. I revisit these claims in light of Catriona Mackenzie’s rejoinder, which shifts the focus from relational or (...) situational vulnerability to its ontological sense, framed as a morally salient feature of humanity. While Mackenzie’s account is novel, it faces challenges from the needs‑theory literature she draws on, where dependence appears a more direct basis for grounding obligations related to vital needs. I examine Mackenzie’s favoured argumentative strategy of intertwining dependence and ontological vulnerability, and I argue that even if one accepts intertwinement in functional co‑constitution sense, this would not by itself establish vulnerability as a foundational obligation‑grounding concept. I then consider possible avenues for vulnerability defenders. I argue that the option of identifying another transitive intra‑conceptual relation between dependence and vulnerability is not readily available. A second option is to claim that ontological vulnerability is foundational not through a transitive relation from dependence but because both are morally salient. I argue that the stronger sense of moral salience implies obligation‑grounding, making the argument circular; and that the weaker sense, understood as mere moral relevance, leaves the account open to the very sceptical challenge it aims to resist. (shrink)

Artificial intelligence is increasingly integrated into medical decision-making, often framed as a supportive tool that enhances accuracy while leaving final judgment to clinicians. This paper argues that such framing obscures a deeper structural shift: medical action may proceed without any judgment ever occurring. AI systems do not judge; they generate outputs through statistical transduction. Clinicians, under institutional and legal pressures, may relay these outputs without regenerating them as their own reasons. When neither AI nor clinician generates judgment, decisions are enacted (...) without a judging subject. While judgment without a judging subject may be sustainable elsewhere, medicine renders this absence unsustainable. Medical practice is characterized by irreversibility, case-specificity, meaning-demand, and relational accountability—features that presuppose judgment as a human act. Even clinically correct outcomes do not guarantee that patients will recognize a decision as right for them. When judgment disappears, informed consent persists only as a procedural ritual, simulating understanding without grounding it. To make this absence explicit, the paper introduces Metaqualia Theory (MTQ), distinguishing patient experience (Q), technical transduction (T), and judgment as meaning-generating endorsement (M). This leads to a prior ethical question: Is there an M here? This question precedes concerns about explainability and helps clarify the conditions under which consent and responsibility remain meaningful. The analysis suggests that when AI outputs are not regenerated as human judgment, their role in medical practice raises structural limits that cannot be addressed by transparency alone. (shrink)

Since Andrew Jameton introduced the term “moral distress” (MD) in 1984, the idea has gained enormous attention in the healthcare literature. We offer a critical, narrative review of the understandings of MD that have been proposed, with an eye towards their scope and corresponding ability to speak to the moral vulnerability inherent in human life. Jameton’s understanding of MD is narrow in the sense that it requires the presence of institutional constraints (e.g., hierarchies or hospital policies) that prevent a healthcare (...) professional from doing what they take to be morally right. Other theorists have suggested that internal constraints (e.g., lack of moral courage) can engender MD as well, and still others have suggested that neither kind of constraint is necessary, as MD can arise from moral conflicts and moral uncertainty in addition to constraints. We criticize understandings of MD that emphasize institutional and/or internal constraints, as they exclude cases in which MD does not arise from any flaw or shortcoming and so for which there is no fix. However, we also criticize understandings of MD that look beyond constraints in general, as they lose sight of MD’s distinguishing feature as a moral experience, namely the anguished or panicked sense that one is constrained from doing what one takes to be morally required. We suggest that the corrective involves acknowledging a third kind of constraint: human constraints, or constraints that arise from the human condition rather than any kind of flaw or shortcoming. (shrink)

Nielsen et al. (2025) recently presented a critique of the current scholarship on epistemic injustice in healthcare, emphasizing the absence of robust empirical evidence, the conceptual difficulty of establishing criteria for identification, and the risk of theoretical misapplication of Miranda Fricker’s original framework. While the call for nuance and careful theoretical articulation might be worthwhile, the framing of their critique risks reinforcing precisely the patterns of epistemic exclusion that the concept of epistemic injustice is meant to expose. The implication that (...) epistemic injustice must be operationalized and empirically validated in large-scale quantitative studies before it can be acknowledged as clinically and ethically significant may inadvertently replicate a longstanding hierarchy of knowledge in which certain forms of suffering become “real” only once translated into quantifiable data. In this response, we aim to advance the scholarly debate by questioning the argumentative basis of Nielsen et al.’s claim that fundamental scientific, conceptual, and theoretical flaws undermine the field of epistemic injustice in healthcare. We propose instead approaching epistemic injustice with social objectivity and methodological pluralism; the concept should not be dismissed for lacking quantification or standardization, but rather recognized for its complexity and significance in improving equity, care, and clinical encounters. (shrink)

Colgrove and Rodger argue that the case advanced by Smajdor and Räsänen for classifying pregnancy as a disease can be defeated by an existence proof—that is, by identifying at least one plausible theory of disease that excludes pregnancy while avoiding objections raised by Smajdor and Räsänen. Their candidate is a dysfunction account, according to which a disease requires the failure of some internal mechanism to perform its biological function. Pregnancy, they claim, involves no such failure. Even if one accepts the (...) legitimacy of this dialectical strategy, the proposed exclusion is not as simple as advertised. In particular, the exclusion is obtained by narrowing the target phenomenon and by treating the concept of ‘proper function’ as if it had a determinate, value-free extension—one that it in fact does not possess. Since the apparent dialectical effect of an imperfect rebuttal can be to strengthen rather than weaken the target of criticism, I find it worth responding to both pieces in a single, joined-up analysis, which I aim to present here. (shrink)

This article 1 is retracted by the journal. What happened after publication The journal _Bioethics_ published a critique 2 about the quality of the work and the accuracy of the references, including concerns that several references did not exist. A linked editorial suggested that these references are consistent with, or raise concerns about, undeclared generative AI use. 3 During the investigation the author told the journal that they wrote the text, however, they used generative AI to understand referenced sources. The (...) author did not adequately verify these references prior to submission. Reasons for retraction The article is retracted due to concerns about reliability - the references cited to support its arguments do not exist. These references were included in the article due to undeclared AI use with inadequate oversight by the author, which the journal considers to be a form of misrepresentation.... (shrink)

Background Pulse diagnosis is a culturally embedded form of medical knowledge in Chinese medicine, combining tactile experience, diagnostic judgement, and conceptual classification. When such knowledge is represented in international terminology standards, translation is not only a linguistic matter but also a process of conceptual standardisation. This study examines how English renderings of Chinese pulse diagnosis terminology are revised across two World Health Organization (WHO) terminology standards. Methods The study compared 49 Chinese pulse diagnosis terms shared by the 2007 _International Standard (...) Terminologies on Traditional Medicine in the Western Pacific Region_ and the 2022 _WHO International Standard Terminologies on Traditional Chinese Medicine_. Each shared Chinese term was aligned across the two standards, and its English rendering or renderings were recorded. Cross-version changes were classified into three revision types: retention, expansion, and replacement. Frequencies and percentages were calculated descriptively and no inferential statistical tests were used. Results Seventeen terms were retained without lexical change, accounting for 34.7% of the sample. Eight terms, or 16.3%, were expanded through the addition of one or more English variants. Twenty-four terms, or 49.0%, were replaced by new renderings or new sets of renderings. These patterns show that the later standard does not simply eliminate variation. Instead, it preserves some established forms, adds variants for selected concepts, and reorganises others around new English expressions. The revisions are especially significant for pulse diagnosis because the terms encode tactile qualities, embodied diagnostic procedures, culturally specific imagery, and broader patterns of Chinese medical reasoning. Conclusions Cross-version variation in WHO pulse diagnosis terminology should not be read only as inconsistency. It provides textual evidence of how culturally embedded medical knowledge is stabilised, revised, and made usable in international communication. The findings suggest that terminology standards should make the status of variants more explicit, including preferred renderings, accepted variants, displaced forms, and brief revision rationales. (shrink)

The COVID-19 pandemic exposed science’s adaptive strengths and epistemic limits. In fact, in the pandemic, mRNA vaccines are attributed to have saved millions of lives. The maxim “correlation does not imply causation” is an essential safeguard against premature causal inference. However, its use may become epistemically restrictive when the absence of established causality is treated as sufficient reason not to investigate (severe) vaccine adverse events. This article examines the conditions under which a valid cautionary principle may have contributed to premature (...) epistemic closure. Thomas Kuhn’s theory of scientific paradigms is used as one interpretative lens rather than as an empirical explanation of institutional behaviour. We argue that the correlation–causation distinction can shift from a heuristic of caution to an instrument of epistemic conservatism, reinforcing prevailing frameworks and discouraging exploration of anomalies. A published autopsy case report involving multifocal necrotizing encephalitis and myocarditis after BNT162b2 vaccination is examined as an illustrative and hypothesis-generating case, not as representative evidence of systematic institutional conduct. A qualitative approach using Bradford Hill’s criteria provides partial, inconclusive evidence of a causal relationship while also exposing the methodological limits of the tool employed. The results of the analysis showed that one of the nine criteria demonstrated support of causality, seven were partially supported, and one did not support causality. The analysis suggests, but does not prove, a causal relationship between the BNT162b2 vaccine and multifocal necrotizing encephalitis. The absence of the nucleocapsid protein does not provide definitive evidence to demonstrate a vaccine origin. Analytical methods are described which can distinguish between the wild-type SARS-CoV-2 spike protein and the recombinant spike protein expressed following mRNA vaccination. The absence of evidence does not mean evidence of absence and we must keep an open mind to this when reviewing such evidence on causality. (shrink)

People’s supportive attitudes towards the publicly funded health system are crucial for ensuring the system’s sustainability through crises and maintaining its core functions of funding and providing health services for all. In the literature, this supportive attitude is considered a form of health sector solidarity. Existing explanations for health sector solidarity focus on individuals’ feedback to the health system—such as satisfaction and performance evaluation—but pay scant attention to the moral judgements underlying this solidaristic attitude. This study aims to investigate the (...) moral foundations of health sector solidarity in Taiwan. Using the Taiwan Society Political and Moral Values Survey 2025 data, the study examines the relationships between health sector solidarity and moral foundations. The findings indicate that, after controlling for respondents’ socio-demographic characteristics and health system-related attitudes, solidarity is positively associated with beliefs in mutual assistance, reciprocity, the human right to health, and self-interest, and negatively associated with meritocracy. National sentiment is not significantly associated with health sector solidarity. By including the moral foundations, this study provides a more comprehensive examination of the factors influencing health sector solidarity in Taiwan and informs future health reform agendas. (shrink)

This article responds to Paul B. Preciado’s call for the ‘depatriarchalization, deheterosexualization and decolonization’ (2021, 76) of psychoanalysis by developing a method of epistemological insubordination for reading the psychoanalytic archive. Historic texts, still taught in contemporary trainings, mobilise powerful affective responses in trainees yet remain largely unexamined as transferential objects within training institutions. Situating psychoanalytic writing as a Derridean archive, I perform a queer phenomenological historiographic reading of Helene Deutsch’s writings on female homosexuality for “straight lines,” “straightening devices,” and “queer (...) angles”, tracing shifts in psychoanalytic attitudes between 1930s Vienna and 1940s Boston. I then extend this method by working with my own fabulative responses to these difficult texts, developing a technique of failed fabulation that mobilises the rigid, mythosymbolic structures of the ego through playfully fucking with the psychoanalytic ancestors. Finally, I consider how these methods might support pedagogy in psychoanalytic training courses, while attending to the unevenly distributed risks of this approach. The article contributes to debates within queer medical humanities about how clinical education can reckon with its colonial, cis-heteronormative legacies. (shrink)

Clinical reasoning is often described through partially independent frameworks, including causal explanation, probabilistic inference, ethical deliberation, and narrative understanding. What remains insufficiently clarified is how these dimensions are structurally integrated in the care of a particular patient. Drawing on Paul Ricoeur, this paper argues that clinical reasoning is best understood as a hermeneutic and practical movement structured by three interrelated arcs: an epistemological arc (from naive understanding, through explanation, to informed understanding), an ethical arc (from teleology, through deontology, to practical (...) wisdom), and an anthropological arc (from suffering, through cultural works, to renewed acting). Within the epistemological arc, explanation unfolds through four modes of intelligibility—causal, probabilistic, teleological, and narrative—and is coordinated by the clinical skill of scale shifting. The paper’s central claim is that teleology mediates between diagnosis and ethics: first as a mode of intelligibility that discloses what is at stake in the patient’s life, and then as a normative orientation guiding deliberation about action. Narrative, in turn, does not replace causal, probabilistic, or ethical reasoning, but configures these heterogeneous elements into a meaningful whole and renders them appropriable within the patient’s lived world. Finally, this paper presents a fictional clinical case to show how clinical explanation may support patient self-understanding and renewed agency. (shrink)

Informed consent protects autonomy in clinical research, and it is often assumed that clearer Participant Information Sheets and Informed Consent Forms may also improve recruitment. This study examined whether the ethical and linguistic qualities of these documents are associated with accrual-related outcomes in industry-sponsored interventional trials. We conducted a retrospective analysis of ClinicalTrials.gov records with readable consent materials, operationalizing ethical clarity, linguistic comprehensibility, and cognitive burden using large language model-based extraction and quantitative text analysis. These measures were linked with trial (...) status, enrolment, and operational duration. Across multinomial, binary, and competing risk models, none of the consent quality indicators predicted termination for poor accrual. Structural factors, particularly start year and enrolment capacity, showed much stronger associations with continuation or discontinuation. The findings suggest that recruitment failure reflects organizational and infrastructural constraints rather than shortcomings in consent communication. Ethically robust communication remains essential, but efforts to improve accrual should target structural conditions that support feasible trial delivery. (shrink)

A surgeon performing a retroperitoneal procedure inadvertently begins dissecting the wrong kidney. The error is recognized intraoperatively, the correct structure is identified, and the procedure is completed successfully. The patient suffers no measurable clinical harm. The institution classifies the event as a near-miss, and no disclosure is initiated. This paper argues that the classification, while legally defensible, is morally inadequate. The absence of measurable clinical harm does not eliminate the ethical obligations a serious procedural error generates; it displaces them onto (...) forms of harm—relational, professional, and institutional—that the standard harm-based framework cannot capture. Drawing on Bernard Williams’s concept of moral residue and Nussbaum’s account of shame and concealment, the paper argues that patients have a right to know that a serious error occurred in their care even when it produced no measurable injury, and that the near-miss framework, while valuable as a learning instrument, mischaracterizes the ethical obligations such errors generate. A central section examines the etiology of the error—institutional failure, diagnostic insufficiency, and individual inattention—and defends an invariance thesis: what varies with etiology is the remediation owed and the party who owes it, not the patient’s claim to an honest account of what occurred in her own body. The invariance follows from the framework: an obligation fluctuating with the cause of an error would track culpability rather than the relational structure of the encounter. A framework of relational disclosure is proposed as an alternative grounded in the ethics of trust, recognition, and institutional integrity. (shrink)

Stem Cell-Based Embryo Models (SCBEMs) have been welcomed enthusiastically because they would allow the study of specific phases of human embryonic development without resorting to embryos produced in vitro. This enthusiasm is based on the idea that research on such models is morally less problematic than research on human embryos. However, this position has recently been challenged, as some authors argue that there are no good reasons to attribute a different moral status to SCBEMs compared to embryos, and the focus (...) on such models risks obscuring an appropriate evaluation of embryonic experimentation rather than representing a genuine moral advancement. In light of this disagreement, I discuss what I call the Argument for the Moral Advantage of SCBEMs and aim to defend it against recent criticisms. I first present the standard version of the argument and argue that it assumes embryos possess direct moral status based on their potential to become persons. Then, after discussing criticisms of the standard version, I explore revising the argument. I first consider relying on the embryos’ symbolic moral value; after dismissing this move, I introduce a revised version of the argument based on the pro tanto minimization of moral conflicts, rather than on embryos’ moral status or value. After defending the revised argument against several objections, I finally discuss regulatory issues concerning SCBEMs research. (shrink)

Cancer represents a significant and growing public health emergency in Nigeria, where high mortality rates, late-stage presentation, inadequate infrastructure, prohibitive costs and pervasive stigma combine to produce a multidimensional crisis. While epidemiological data and health system analysis illuminate the scale of the problem, they fail to capture the deeper ethical, structural and existential realities that shape the lived experience of cancer. This paper employs key philosophical concepts, including distributive justice, social justice, structural violence, biopolitics, epistemic injustice, care ethics, existentialism, Ubuntu (...) philosophy, vulnerability theory and the capabilities approach to analyze the complex realities of cancer in Nigeria. It is a critical reflection on the rationale for practices and policies that are often taken for granted, using the tools of formal philosophical inquiry, with a view to either grounding the practices in proper ethical understanding, or rethinking them along proper ethical lines. We argue that applying these philosophical frameworks reveal deep-seated inequities, challenges to patient agency, the corrosive effects of stigma rooted in epistemic failures, relational deficits in care, and the profound existential struggles patients and families face. By examining the interplay among scarce resources, cultural beliefs, systemic weaknesses, and fundamental questions of value and meaning, this paper argues that a philosophical perspective offers a roadmap for more humane, just, and culturally grounded reforms in cancer prevention, diagnosis, treatment, palliative care, and compassionate responses within the Nigerian context. (shrink)

Algorithmic systems are increasingly woven into healthcare, from triage applications to AI-enabled decision support tools. While such systems promise efficiency and diagnostic accuracy, they also perform a normative function: shaping whose knowledge is treated as credible, which symptoms matter, and how patient testimony is interpreted. This article introduces algorithmic gaslighting to name the patterned dynamic through which testimonial and hermeneutical injustices become recursively stabilized and internalized as patient self-doubt in algorithmically mediated clinical encounters. Building on feminist and disability bioethics accounts (...) of medical gaslighting—where clinicians dismiss or reinterpret patient reports, often in gendered or racialized ways—I extend the analysis to algorithmic contexts. Drawing on Miranda Fricker’s theory of epistemic injustice, I show how interlocking sociotechnical mechanisms—data violence, opacity, automated authority, and feedback loops—can displace patient credibility, constrain interpretive resources, and destabilize patient self-trust. These dynamics recalibrate epistemic agency, rendering patients as data objects rather than recognized knowers. To counter such harms, I propose a normative framework aimed at interrupting gaslighting dynamics in algorithmically mediated care, emphasizing rights to contestation, participatory design, critical audits, and shared responsibility. Recognizing algorithmic gaslighting helps safeguard trust, dialogue, and agency in the digital transformation of healthcare. (shrink)

In times of crisis or major change in medicine, humanities broadly speaking has often been seen as an answer to the question of how to keep the profession centered on human experience. We are currently in the midst of another major crisis in medicine with escalating levels of physician burnout and patient dissatisfaction. No one would disagree that we need to educate physicians who are empathetic. However, most of the emphasis on using humanities to help has centered on the idea (...) that students can be essentially inoculated against the socialization in medicine that, unchecked, will lead to a lack of empathy and connection to patients. This article reviews the limitations of isolating humanities interventions to the medical school years, as well as the narrow justification for history, humanities, and arts in medicine as tools for making better doctors. It then explores the ways in which history, humanities, and the arts can serve as a kind of tonic, a form of healing or antidote, to help the people who are practicing amidst the challenges of contemporary medicine. More boldly, this article makes the argument that history, humanities, and the arts can move beyond individuals to help us transform medicine itself. (shrink)

Likelihood ratios (LRs) are often used to quantify the evidential weight of clinical findings. In diagnostic accuracy studies, however, LRs are typically reported for individual findings, not for conjunctions of findings. Since LRs for conjunctions of findings are often unavailable, influential Evidence-Based Diagnosis texts suggest that individual LRs may be multiplied to obtain joint LRs, but only under the assumption of approximate conditional independence. This assumption can be _analytically_ convenient, but often implausible in clinical practice, where findings arise from shared (...) pathophysiological mechanisms. This article examines the plausibility of this assumption and how a hidden dependence structure among clinical findings can affect the LR of their conjunction. To make this possible, we define the _Coherence Factor_ ($$\Gamma$$) as the ratio between the association among findings under $$D$$ and the corresponding association under $$\neg D$$. It makes explicit the hidden dependence structure in the evaluation of joint LRs: it allows one to examine, in a formal way, the plausibility of the independence assumption, without replacing statistical approaches designed to account for it. In particular, this framework supports a more cautious interpretation of individual LRs by showing how using them _at face value_, whether individually or multiplicatively, presupposes a specific dependence structure, one rarely instantiated in clinical practice. The consequences of this analysis do not depend on whether physicians make calculations at the bedside, since it concerns how individual LRs should be interpreted in a Bayesian framework. (shrink)

Normothermic regional perfusion (NRP) can be used after the circulatory determination of death to prevent or minimize organ damage before the donor's organs are retrieved. It involves restarting circulation within the donor's body to reperfuse abdominal and thoracic organs while occluding the arteries that supply oxygenated blood to the brain to prevent brain recirculation and the possible restoration of brain function. Yet there are many who object to the use of NRP. These critics claim that donation with NRP, unlike standard (...) deceased donation, violates the dead donor rule. However, when we examine their arguments for this claim, we find that those or similar arguments apply with equal force to standard deceased donation. Critics of NRP have therefore insufficiently appreciated the implications of their criticisms for the other deceased donation practices that they defend. Either all deceased donation practices violate the dead donor rule, or none of them do. (shrink)

The 2021 Cures Act Final Rule mandated that patients have immediate and complete access to their health records. This policy change fundamentally altered the ethical significance of documentation, transforming the note from a useful clinical artifact to direct testimony from practitioners to clients. Drawing on conceptual and empirically informed resources from philosophy, psychiatry, and public health, we identify six ethical note obligations (ENOs) as a principled theoretical framework to support ethical documentation in a post-Cures Act context. Unfortunately, in nonideal circumstances, (...) these new obligations present an undue burden that is contrary to the aim of care, posing a dilemma between ethical note obligations and documentation burden. We reject note-taking contrary to care, which entails a call for strategies to reduce documentation burden to achieve the aims of the ENOs framework. To this end, we call for the ethical adoption of AI-assisted documentation to meaningfully alleviate documentation burden, thereby enabling ethical notes. (shrink)

Informed consent is fundamental to ethical research involving human participants; however, little is known about the public's understanding of research participants' rights in Myanmar. This multicenter cross‐sectional study examined patients' perceptions of medical research, attitudes toward information disclosure during the informed consent process, and recognition of participants' rights using a structured, self‐administered questionnaire completed by 284 adult patients from three hospitals. Most respondents viewed medical research positively but demonstrated varying levels of trust and understanding of ethical protections. Higher educational attainment (...) and household expenditure were associated with more favorable perceptions. Participants strongly supported transparent informed consent procedures and comprehensive information disclosure; however, awareness of complaint mechanisms and understanding of the rights to withdraw from research and confidentiality were limited. These findings identify priorities for strengthening ethics education, investigator communication, and institutional transparency to support meaningful informed consent and sustain public trust as health research continues to expand in Myanmar. (shrink)

Contributors to the debate on ethical rationing bring with them assumptions about the proper role of moral theories in practical discourse, which seem reasonable, realistic and pragmatic. These assumptions function to define the remit of bioethical discourse and to determine conceptions of proper methodology and causal reasoning in the area. However well intentioned, the desire to be realistic in this sense may lead us to judge the adequacy of a theory precisely with reference to its ability to deliver apparently determinate (...) answers to questions that strike most practitioners and patients as morally arbitrary. By providing ethical solutions that work given the world as it is, work in clinical ethics may serve to endorse or protect from scrutiny the very structures that need to change if real moral progress is to be possible. Such work can help to foster the illusion that fundamentally arbitrary decisions are ‘grounded’ in objective, impartial reasoning, bestowing academic credibility on policies and processes, making it subsequently harder for others to criticise those processes. As theorists, we need to reflect on our political role and how best to foster virtuous, critical practice, if we are to avoid making contributions to the debate that not only do no good, but may even be harmful. A recent debate in this journal illustrates these issues effectively. (shrink)