Bioethical Framework Research Articles

A Personalist Approach to the Just Allocation of Resources in the Midst of a Pandemic

This paper examines the ethical implications of healthcare resource allocation during the first wave of COVID-19 in Italy, from 21 February to 31 May 2020, with a focus on the utilitarian principles that prioritized age-based resource allocation. By comparing this approach to an ontological personalist bioethics framework, the study aims to offer a more equitable strategy for healthcare allocation applicable to any pandemic. Data from governmental reports, healthcare policies, and ethical guidelines were analyzed, revealing that Italy’s utilitarian method led to significant ethical concerns, particularly regarding age discrimination. In contrast, the ontological personalist approach emphasizes the dignity and intrinsic worth of each individual, irrespective of age or health condition. The findings demonstrate that this personalist framework fosters a more balanced and fair allocation of resources, respecting human dignity and offering a universally applicable alternative to age-based prioritization. Ultimately, the study suggests that integrating ontological personalist principles into healthcare policies could enhance ethical decision-making in future pandemics, ensuring that resource allocation practices align more closely with human rights and individual dignity.

A queer feminist posthuman framework for bioethics: on vulnerability, antimicrobial resistance, and justice.

In this paper, I discuss the bioethical principle of justice and the bioethical key concept of vulnerability, in a queer feminist posthuman framework. I situate these contemplations, philosophical by nature, in the context of antimicrobial resistance (AMR), one the most vicious moral problems of our time. Further, I discuss how gender and sexual variance, vulnerability and justice manifest in AMR. I conclude by considering my queer feminist posthuman framework for vulnerability and justice in relation to the notion of antibiotic vulnerabilities, suggesting a lacuna for further AMR research.

Religious Approaches to Bioethical Reasoning: Bridging Values and Ethics

Religious traditions exert a profound influence on bioethical reasoning, shaping how different communities approach complex ethical issues like end-of-life care, genetic manipulation, and medical interventions. This study investigates the diverse methodologies employed by various religions, focusing on how scriptural interpretation and ethical principles inform their bioethical frameworks. By conducting a comparative analysis across major world religions, the research highlights both the distinct and shared approaches these traditions take toward navigating bioethical dilemmas. Case studies and contemporary examples are examined to illustrate how religious moral reasoning influences decision-making in areas such as ventilator use, feeding tubes, and genetic interventions. The study shows that although religious traditions offer a strong basis for ethical reasoning, their values frequently clash with secular perspectives, making consensus difficult in multicultural societies. Resolving these conflicts is vital for cultivating ethical harmony and encouraging cross-cultural dialogue.

Re/Thinking Bioethics: Reproduction and Non-Reproduction in an Intersectional Bioethics’ Perspective

The article begins by reconstructing the main feminist bioethics perspective as a “new discourse” within the official bioethical discussion. It illustrates how the moral discussion and juridification have contributed to remove reproduction and non-reproduction from the personal and intimate context, reinventing them as a “states business”. This process framed these issues in terms of “duties”, “rights”, “family planning”, “demography”, and “population policy”. In this manner, law and morality have helped to reinforce a specific construct of fertility, motherhood, and family. By comparing two interrelated forms of Cross Border Reproductive Care (CBRC), concerning abortion and surrogacy, the article analyses how bioethical and legal frameworks – through their polarized and dichotomic discussion between law and morality – confirm and strengthen gender injustice in reproductive life. That comparison of cross-border travels highlights that surrogacy and abortion restrictions stem from a shared social and legal paradigm that relies on traditional gender roles and reveals how the stratification of reproduction is based on multiple discrimination along the lines of gender, race, and class. Finally, the article introduces an intersectional bioethics point of view on reproductive health to re-read the phenomena of non-reproductive and reproductive tourism and to propose a critique of the main global Northern feminist bioethical discourses and ethical-philosophical paradigms.

How Can Newborn Toxicology Testing Be More Equitable? An Interactive Ethics Workshop.

Practice variation in newborn toxicology testing during the birth hospitalization exists across institutions and legal jurisdictions. While testing can provide benefits, indiscriminate testing has been shown to perpetuate health care inequities. In the backdrop of an opioid epidemic and a charged medicolegal landscape, this workshop guides participants to reexamine newborn toxicology testing through a shared ethical lens. We conducted a live, 90-minute workshop in English at an international pediatric conference. Physicians, residents, and fellows participated in large- and small-group breakout sessions to learn relevant clinical and bioethical frameworks, share their own local context and expertise, and explore ethical applications through case-based discussions. We administered two anonymous online follow-up surveys to assess self-perceived impact on participant knowledge, behavior, and clinical practice. Seven facilitators and 45 individuals participated in the workshop. Eighteen participants completed survey 1 immediately following workshop conclusion, and six participants completed survey 2 after 3 months had elapsed. Immediately following the workshop, 94% of respondents reported that they had been introduced to a new idea, and 82% were considering practice change. A low response rate to survey 2 limited interpretation, but some respondents reported self-perceived change following workshop attendance. This workshop facilitated conversation between physician participants on a complex pediatric health care inequity issue using an ethical framework.

Doing ethics with microbes: toward a queer feminist posthuman framework for bioethics.

The Centre for the Social Study of Microbes (CSSM) at University of Helsinki, Finland is a Wellcome-funded hub for creating new approaches to human-microbial relations. Most urgently, the complex relations between microbes, antimicrobial resistance (in its human-health centered definition, understood as infection and disease now uncurable by antibiotics, threatening human life and wellbeing), animals, environments and climate emergency require new theoretical and methodological approaches. These include a variety of research interest from global fermentation practices and cultures to microbial bioremediation techniques, from aquatic microbes to urban gardens. A key orientation of CSSM is also combining ethnography with artistic and performative practice such as felting, painting, installation, sculpture and audiovisual means, to gain a deeper, more sensory and embodied perspective of our shared lives with microbes. As their agency exists outside textuality, new experimental methodology is needed to engage with it. Thinking with microbes invites many ethical issues that often remain unaddressed in medical and scientific approach. As one of such contributions, we suggest a new framework for bioethics. In a conceptual analysis, a queer feminist posthuman framework aims for radical reorientation of human exceptionalism for more-than-human justice while keeping existing social justice issues between groups of people, such as vulnerabilities cascading around gender and sexual variance, in the same framework. Both a theoretical and practical initiative, seeking to forge solidarity between justice movements, this framework could ground policies relevant to a broader bioethical and philosophical research community, and social scientists studying microbes. This open letter discusses this work at the CSSM.

Navigating the Nexus of Bioethics and Geopolitics: Implications for Global Health Security and Scientific Collaboration.

Bioethics plays a pivotal role in guiding ethical decision-making within the realm of medical research and healthcare. However, the influence of geopolitics on bioethical considerations, particularly regarding bioweapons research, remains an underexplored area. This study delves into the uncharted territory of how international political interests can intersect with bioethical principles, potentially shaping collaborative efforts and global health policies related to bioweapons research. Through a hypothetical scenario involving a hypothetical pathogen, a collaborative effort between unspecified countries, we examine the implications of such cooperation on global health governance, with a specific focus on bioweapons research. Ethical dilemmas surrounding responsible research, potential risks and benefits, equitable distribution of findings, and biosafety measures are explored. This analysis underscores the importance of transparent and responsible practices in bioweapons research amidst geopolitical tensions. By striking a balance between national interests and international solidarity, we advocate for robust bioethical frameworks to navigate such collaborations for the collective well-being of humanity and to mitigate potential risks associated with bioweapons research.

Ethics in Patients' Health Literacy: a scoping review and a critical discussion.

A growing body of literature has acknowledged that a high number of populations with low Health Literacy (HL) is related to poor health outcomes, inequities in healthcare and high economic costs. Those findings have formulated the research questions of this review: (i) what ethical issues arise within the context of patients' HL and (ii) What is the relationship between HL and quality of life? This review followed the guidelines of Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) and it was conducted in five databases: PubMed, CINAHL, MEDLINE, Scopus and Science Direct between June 2022 and December 2023. Out of the 3164 titles retrieved, 285 abstracts were eligible to proceed. Following a thorough examination of the full text of 61 papers, 45 sources were identified that met the inclusion criteria. The data analysis process was guided by the research questions, employing a thematic approach. Four themes were identified: the use of language and patient understanding, human rights, the principlism approach (justice, beneficence, non-maleficence and autonomy) and quality of life. The first theme mainly focused on the relation of HL with the notion of consent forms and national action plans. Human rights in relation to HL were discussed as a minor issue. The bioethical framework by Beauchamp and Childress (Principles of Biomedical Ethics, 6th edn. Oxford University Press, New York, NY, 2009), was addressed by several studies, with a particular focus on justice and the loss of autonomy. Quality of life indicated a positive correlation with HL by most of the authors, while few studies revealed a moderate correlation.

Relevance and Premises of Values-Based Practice for Decision Making in Brain Health.

Brain health is a complex concept, shaped by a plethora of determinants related to physical health, healthy environments, safety and security, learning and social connection, as well as access to quality healthcare services. Decision-making in this complex field is characterized by diverse values, potentially conflicting interests, and asymmetrically influential stakeholders. Values-based practice (VBP) is a toolkit for balancing values in a democratic and inclusive way, so that every stakeholder feels a sense of ownership over the decision made. In VBP, the emphasis is on good process rather than on pre-determined 'correct' outcomes. Based on two case vignettes, we highlight the relevance of the ten principles of VBP for balancing different values to the satisfaction of those directly concerned, in a given decision-making process. In addition, we argue that the successful implementation of VBP in the complex area of brain health, as well as in other fields, is premised on higher order values (meta-values), beyond mutual respect and the legal, regulatory, and bioethical framework. These include mutual regard, reciprocity, autonomy, and an egalitarian attitude towards VBP procedures and involved stakeholders.

From super-wicked problems to more-than-human justice: new bioethical frameworks for antimicrobial resistance and climate emergency.

In this article, building on our multidisciplinary expertise on philosophy, anthropology, and social study of microbes, we discuss and analyze new approaches to justice that have emerged in thinking with more-than-human contexts: microbes, animals, environments and ecosystems. We situate our analysis in theory of and practical engagements with antimicrobial resistance and climate emergency that both can be considered super-wicked problems. In offering solutions to such problems, we discuss a more-than-human justice orientation, seeking to displace human exceptionalism while still engaging with human social justice issues. We offer anthropological narratives to highlight how more-than-human actors already play an important role in environmental and climate politics. These narratives further justify the need for new ethical frameworks, out of which we, for further development outside the scope of this article, suggest a queer feminist posthumanist one.

Artificial Gametes and Human Reproduction in the 21st Century: An Ethical Analysis.

Artificial gametes, derived from stem cells, have the potential to enable in vitro fertilization of embryos. Currently, artificial gametes are only being generated in laboratory animals; however, considerable efforts are underway to develop artificial gametes using human cell sources. These artificial gametes are being proposed as a means to address infertility through assisted reproductive technologies. Nonetheless, the availability of artificial gametes obtained from adult organisms can potentially expand the possibilities of reproduction. Various groups, such as same-sex couples, post-menopausal women, and deceased donors, could potentially utilize artificial gametes to conceive genetically related offspring. The advent of artificial gametes raises significant bioethical questions. Should all these reproductive scenarios be accepted? How can we delineate the range of future reproductive choices? A normative bioethical framework may be necessary to establish a consensus regarding the use of human artificial gametes. This review aims to present the current state of research on the biological roadmap for generating artificial gametes, while also summarizing proposed approaches to establish a normative framework that delineates ethically acceptable paths for reproduction.

290 Are you trust-worthy: Trust-building activities in Translational Sciences

OBJECTIVES/GOALS: Many researchers aim to build trust with communities and participants. Trust building is meant to achieve greater representation across aspects of research whether in participation, or more comprehensively as partners from design to dissemination. We provide practical guidance for trust building activities and the ethical issues that can arise. METHODS/STUDY POPULATION: While trust itself is inherently seen as an ethical good, often little attention is paid to the ethical aspects of trust building exercises themselves and the fact that trust can vary in type. Using a bioethical analysis of trustworthiness, we discuss how to approach trust in different relationships and settings. Explicit communication about the supports/constraints and potential outcomes of new trusted relationships is required for ethical practice. Where relationships are built without appropriate transparency and follow through, or with misunderstandings about potential shared values, priorities, or desired outcomes, significant harms can occur in the short- and long term. Using a bioethical framework and practical examples we provide guidance on how to engage in ethical trust building activities. RESULTS/ANTICIPATED RESULTS: While many people are good at the trust building work they do, this work is often not shared as best practices and is ascribed to individual skill. This is slowly changing and an evidence-base is being developed that can support those new to these activities. Ethical guidance to support trust building practices, especially for those new to these activities, is currently lacking. By providing both a conceptual and normative bioethical analysis grounded in practice, we provide the foundations for new activities and the necessary support for work that explores and determines best practices. This analysis provides an understanding of trust including a taxonomy and a discussion of how different types of trust can be built and can support research activities, as well as problems that can arise. DISCUSSION/SIGNIFICANCE: Trust building activities with communities and participants are crucial to much of translational science and research, but ethical guidance on how to engage in these activities well is lacking. We provide bioethical guidance and offer practical recommendations.

Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals.

The field of bioethics examines the moral and ethical dilemmas that arise in the biological sciences, healthcare, and medical practices. There has been a rise in medical negligence cases, complaints against healthcare workers, and public dissatisfaction with healthcare professionals, according to reports from the Indian Medical Council and other healthcare associations. We intend to assess the level of knowledge, attitude, and practice of bioethics among the registered healthcare professionals (HCPs) of Maharashtra, India. A State-level online survey was conducted among the registered HCPs (n = 2143) casing all five regions of the Maharashtra state using a pre-tested self-administered questionnaire. The responses were expressed as mean, and proportions with their standard deviation and 95% CI respectively. Binary logistic regression and a multivariate logistic model were used to determine factors associated with knowledge, attitude, and practice of bioethics. Of the 2143 registered HCPs in Maharashtra included in this study, most of them (65.2%) had adequate knowledge of bioethics. Adequate knowledge was associated with lower age, profession (nurses and dentists), employment in the private sector, HCPS at Marathwada and Pune, and higher educational attainment. About 3 in 5 HCPs (59.4%) had a favorable attitude towards the ethical practice of bioethics, and was associated with profession, place of work, region of practice, and work experience. The distribution of unethical bioethics practices among 10 items was proportionally high, and only 34.4% reported good/fair practice. The common unethical practices in the state were allowing patients to be examined by interns, and not informing them about professional misconduct to the regulatory bodies. Most HCPs had adequate knowledge of bioethics, which is encouraging and would favor the laying foundation for forming a good bioethics framework. Only 3/5 HCPs demonstrated a favorable attitude, and the observed unethical practice is alarmingly common. A serious consideration to evaluate the compliance level of bioethics practice periodically and measures to educate, sensitize, and train bioethics among HCPs in Maharashtra is warranted.

Dilemmas in Decision Making: An In-depth Exploration of Abortion, End-of-lifecare, and Euthanasia in Medical Ethics

This comprehensive study delves into the multifaceted ethical considerations surrounding abortion, end-of-lifecare, euthanasia in the field of medical ethics. Through an in-depth exploration, it has been dissected the nuanced interplay between patient autonomy and healthcare provider's moral obligations. additionally, we analyze the impact of legal and cultural factors on ethical perspective, offering a thorough examination of global variations. By addressing the broader societal implications and ethical responsibilities of healthcare professionals, this research contributes a holistic perspective to the ongoing discourse. framed within established bioethical frameworks, the study not only uncovers the complexities of decision-making but also underscores the need for a compassionate and patient-centred approach in navigating these ethically challenging scenarios.

Communication Gaps in Georgian Palliative Medicine: Ethical and Legal Review

Introduction: Difficulties in communication, decision-making, and end-of-life management have emerged in the implementation of palliative care in recent decades. The imperfection of ethical issues was also highlighted. This fact is confirmed once again by a study conducted by the oncology department of the Batumi High-technology Hospital, which aimed to study the adequate perception of existing oral pathologies by patients under palliative care and their impact on the quality of life.
 Aim: We aimed to discuss the mentioned problem within the framework of bioethics and Georgian legislation.
 Methods: Despite the few amount of literary sources, we tried to discuss the mentioned issue based on Georgian legislation and also existing literature.
 Conclusion: Thus, as we mention in medical activities there are cases when the real diagnosis is not told to the patient for ,,his favor'', also there are cases when an inappropriate diagnosis is made, which can lead the patient to a fatal condition. In this case, the patient can civilly protect his rights.
 The best option is to provide the patient with information in the correct form so that it does not mean the end of the world and does not cause depression in him. The patient should be able to pass the last stage of life peacefully and with dignity.

Plastic Bits

In Countersexual Manifesto, Paul Preciado claims that we are on the verge of a historic planetary mutation. ‘We will soon stop printing the book’, Preciado tells us, ‘and start printing the flesh, thus entering the new era of digital biowriting.’ The radical juncture of which Preciado speaks is the potential rewriting of sex alongside recent advances in 3D bioprinting, a process of combining cells, nutrients, proteins and biopolymer gels to fabricate biomedical parts which imitate natural tissues or organs of the human body. The commercialization of 3D bioprinting might liberate the productive forces of desire and equip countersexual revolutionaries with the tools to invent new bodies without persecution. Yet bioethical frameworks continue to exclude access to bioprinting technologies for the production of sex organs, citing moral concerns. This article returns to Preciado’s rallying call for access to 3D bioprinting, to examine the importance of sexual plasticity as it appears today and to consider whether sex is always already interfaced with plastic technologies in quotidian life, for better or worse.

Bioethical issues in the family health strategy: Considerations for nursing care management.

To understand the bioethical issues involved in the care management of nurses working in the Family Health Strategy. A qualitative study was conducted through five focus groups with 36 nurses selected in the sample. Thematic content analysis was performed based on the bioethical framework, and the synthesis was presented in a conceptual map. Bioethical issues were identified in the nursing care practice, related to both specific bioethical themes and the peculiarities of the work. Additionally, challenges and facilitators that interfere with addressing these issues were identified. Understanding the bioethical issues involved in the care management of nurses was possible with the theoretical support of different bioethical perspectives. The identified issues relate to persistent and current themes in the field of bioethics. However, some aspects intrinsic to daily practice are still imperceptible to professionals, contributing to the difficulty of discussing bioethics in this care model.

Values-Based Medicine Is an Ethical Concept for Implementing the Ethical Principles in Daily Practice.

Values-based medicine (VsBM) is an ethical concept, and bioethical framework has been developed to ensure that medical ethics and values are implemented, pervasive, and powerful parameters influencing decisions about health, clinical practice, teaching, medical industry, career development, malpractice, and research. Neurosurgeons tend to adopt ethics according to their own values and to what they see and learn from teachers. Neurosurgeons, in general, are aware about ethical codes and the patient's rights. However, the philosophy, concept, and principles of medical ethics are rarely included in the training programs or in training courses. The impact of implementing, observing the medical ethics and the patients' value and culture on the course, and outcome of patients' management should not underestimate. The main principles of medical ethics are autonomy, beneficence, nonmaleficence, justice, dignity, and honesty, which should be strictly observed in every step of medical practice, research, teaching, and publication. Evidence-based medicine has been popularized in the last 40-50years in order to raise up the standard of medical practice. Medical ethics and values have been associated with the medical practice for thousands of years since patients felt a need for treatment. There is no conflict between evidence-based medicine and values-based medicine, as a medical practice should always be performed within a frame of ethics and respect for patients' values. Observing the principles of values-based medicine became very relevant as multicultural societies are dominant in some countries and hospitals in different corners of the world.

Invisibility in global health: A case for disturbing bioethical frameworks.

In recent years, the global health community has increasingly reported the problem of 'invisibility': aspects of health and wellbeing, particularly amongst the world's most marginalized and impoverished people, that are systematically overlooked and ignored by people and institutions in relative positions of power. It is unclear how to realistically manage global health invisibility within bioethics and other social science disciplines and move forward. In this letter, we reflect on several case studies of invisibility experienced by people in Brazil, Malaysia, West Africa and other transnational contexts. Highlighting the complex nature of invisibility and its interconnectedness with social, political and economic issues and trends, we argue that while local and targeted interventions might provide relief and comfort locally, they will not be able to solve the underlying causes of invisibility. Building from the shared lessons of case study presentations at an Oxford-Johns Hopkins Global Infectious Disease Ethics Collaborative (GLIDE), we argue that in dealing with an intersectional issue such as invisibility, twenty-first century global health bioethics could pursue a more 'disturbing' framework, challenging the narrow comforting solutions which take as a given the sociomaterial inequalities of the status quo. We highlight that comforting and disturbing bioethical frameworks should not be considered as opposing sides, but as two approaches working in tandem in order to achieve the internationally set global health milestones of providing better health and wellbeing for everyone. Insights from sociology, anthropology, postcolonial studies, history, feminist studies and other styles of critical reasoning have long been disturbing to grand narratives of people and their conditions. To rediscover the ethos of the WHO Alma Ata Declaration-a vision of "health for all by the year 2000"-these thinking tools will be necessary aids in developing cooperation and support beyond the narrow market logic that dominates the landscape of contemporary global health.

A social and ethical game-changer? An empirical ethics study of CRISPR in the salmon farming industry

The genome editing technology CRISPR is described as a technological game-changer because of its flexibility and precision, and as an ethical game-changer due to its ability to engineer traits in living organisms without crossing species, avoiding a significant objection to genetically modified organisms (GMOs). In salmon farming, applications of CRISPR in breeding hold the promise of handling environmental and fish welfare challenges yet require social acceptance. Adopting an empirical bioethics framework, this stakeholder interview study shows that respecting species borders is important, but not decisive, for acceptance among Norwegian stakeholders. The main objections are based on moral reflections about technology use and outcomes. These reflections combine principles and pragmatic deliberations of moral costs and benefits, suggesting that CRISPR applications with environmentally and ethically significant benefits can be socially acceptable. This indicates that the game-changing potential of CRISPR relies on the characteristics of the editing and the context in which the application takes place.