Cases In Bioethics Research Articles

Between science, science-fiction and COVID19 as a way to interpret the ontological realm of COVID19. Humanity in the post-COVID19 and re-application of knowledge.

The current article is an attempt by the authors to present a bioethical case, or rather a search being undertaken to develop tools to interpret the novel ontological realm which has been created, and continues to be transformed in real time, by the COVID19 pandemic and its aftermath. The ontological realm is new, but the physical features of the world and the human in it are partially constants and identical to the previous realm parameters, the pre-COVID19 space-time. The question of existence in the new ontological realm is…how can the continuum of Homo sapiens and its existence be sustained in this new realm? The tools being developed use of previous information and knowledge of the members of Homo sapiens as a starting point and source of metaphors as tools to facilitate existence in the new realm. In this way, existing knowledge, which is held by individual members of Homo sapiens, and which exists and continues being created in the continuum of Homo sapiens, can be the foundation for the creation of new knowledge about the post-COVID19 realm and the individual and collective comprehension of humans of it and in it. Conceptual metaphors, the creation of compound metaphor and the prospective dialectic are suggested by authors as a possible epistemic implementation mechanisms in this context. The adaptation of humanity, its imagination and some professions are used to demonstrate the case for the ‘new science of human existence’ in the post-COVID19 world.

Voluntary interruption of psychotic pregnancy: Use of antipsychotic drugs in a bioethical case

IntroductionDecisions about use and safety of antipsychotic drugs during pregnancy it’s been a controversial issue in psychiatric practice because of the difficult finding the good choice, ethically and medically.ObjectivesTo provide an example of a real case to shed light about the psychopharmacological and ethical management of the situation helping a psychotic patient to make a voluntary decision.MethodsExpose a clinical case of a patient in a psychiatric institution for several psychotic symptoms who we discover she’s pregnant during her hospitalization and treatment process. She is a 36 years old single woman who shows disorganized maniac psychotic behavior including disinhibition, promiscuity, persecutory and symbolic delusional ideas, self-surrender and insomnia. She’s admitted against her will in a University Hospital, being transferred to a Psychiatric Hospital with risperidone (2mg/24h) and clonazepam 2mg (2mg/24h). She had a positive pregnant test. Receiving the patient, we made an updated bibliographical review about use of antipsychotic during pregnancy, consult with the patient’s family and hospital legal advice’s service and coordinate with Gynecology’s service. The patient was ambivalent about the decision conditioned by her symptoms.ResultsWe decide to optimize drugs to olanzapine (until 30mg/24h) during the first week not using mood stabilizers because of malformations risk, with a great amelioration of symptoms, experiencing a back to reality with a coherent speech and eutimia, deciding a voluntary interruption of pregnancy.ConclusionsPsychosis in pregnancy can be a bioethical challenge wich must be management according to science (practice clinical guidelines point olanzapine as a choice to be considered) and woman’s will.

Bioethical Cases within Clinical Trials During COVID-19; Vision towards a New Design Focused on the Patient ́S Safety and Needs

María Fernanda Alpizar, Jesus Manuel De Aldecoa and Melchor Alpizar-Salazar* Author Affiliations Specialized Centre for Diabetes, Obesity and Prevention of Cardiovascular Diseases, CEDOPEC, S.C. Mexico Received: February 26, 2021 | Published: March 09, 2021 Corresponding author: Melchor Alpizar-Salazar, MD, PhD, FACE Specialized Centre for Diabetes, Obesity and Prevention of Cardiovascular Diseases, CEDOPEC, S.C. Mexico DOI: 10.26717/BJSTR.2021.34.005556

An Organ for My Child: Public Appeals for Limited Resources.

The case of Jamie Fiske and subsequent public appeals for particular children by President Ronald Reagan represent classic cases in pediatric bioethics in which parents or others publicly appealed for a donor organ for a particular child. These raise questions about the appropriate boundaries for public appeals for a limited resource for a particular child and how the press and medical community should respond to such appeals. Public appeals by parents to advocate for their child to receive a limited resource above others promote rationing by morally irrelevant factors and shift the public focus from the national shortage of organs for transplant to the needs of a particular child. Yet these appeals are understandable and will likely continue. Recognizing this, we consider appropriate responses by the media, transplant community, hospitals, and individual clinicians.

Toward the Polyphonic Case.

Can one publish a bioethics case ethically? I suspect that most in bioethics would feel comfortable publishing a case if the subject-the patient-gave explicit permission, the amount of biographical information revealed was under the control of the subject, and the subject fully understood the benefits and risks of publishing the case. Some might add that the subject should have a chance to approve the final representation. I think that the ethics of publishing cases needs to be rethought. And this rethinking needs to be focused not on the way publishing a case might harm a patient (that is, nonmaleficence) but, rather, on how a case presentation does not convey the patient's own voice in the narrative (that is, respect for autonomy). Bioethics needs a new model of case presentation: the polyphonic case, which demands that the subject be a part of the case's construction.

Ethical aporia of organ donation development

Aim.The Aim of the article is to investigate the ethical and epistemological problems that have arisen in recent years in connection with the emergence of incidents that have caused the problematization of traditional approaches to the definition and ascertainment of death (in particular, cases that reflect the history of Jahi McMath and Anahita Meshkin) and the spread in the West such practices, as «controlled donation» and «donation after euthanasia».Materials and methods.The article uses the method of socio-ethical analysis and the bioethical case study methodology.Results.The analysis of the development of ethical support for the practice of organ donation is presented.Conclusion.The conclusion is made about the pronounced liberalization of the ethics of organ donation, characterized by the dictates of local moral contingency, linguistic manipulations with the categories of «gift», «harm», «autonomy» and the threat of trends in technological instrumentality in the system of development of transplantology and organ donation with the initial minimum of ethical grounds.

Teoretyczny i praktyczny problem pamięci w kontekście osobowej tożsamości pacjenta cierpiącego na chorobę Alzheimera – bioetyczne stanowisko Davida DeGrazii

The presented article illustrates David DeGrazia’s bioethical standpoint regarding the theoretical and the practical problem of memory in the context of the personal identity of a patient suffering from Alzheimer's disease. The first part of the article is a presentation of the theoretical problem of memory in the context of numerical and narrative identity being the center of the metaphysical theory of the human person. The second part of the article presents a practical memory problem in the bioethical case of a patient diagnosed with early stages of Alzheimer’s disease. The American bioethicist and philosopher David DeGrazia proposes that the theoretical solutions regarding the identity of the human person find their practical application in bioethics in resolving moral dilemmas in the health care. The final part of the article focuses on criticizing the possibilities of practical applications of theoretical solutions on the subject of the human person in the bioethical position of David DeGrazia.

Equipping African medical students with ethical decision-making skills: A case-based method from Burundi

In addition to medical ethical issues faced in every context globally, many African contexts have the challenge of additional ethical scenarios particular to African culture, resource limitation, and more varied levels of professional expertise. In an effort to equip medical trainees with the knowledge and skills to confront these situations well and from a particularly Christian vantage point, we developed a bioethics module for African medical students in Burundi that began with a didactic ethics lecture and spent most of the time on student-led, facilitated case discussions. The cases were designed to highlight problems specifically created by the particularities of our rural, African, under-resourced context. Five rounds of implementing this module have shown a positive and interactive reception, with students critically thinking about the problems, engaging in personal application, and being willing to disagree with each other. Evaluation after each module has resulted in some cases being discarded and others modified. Facilitation of case discussions has been especially aided by structuring cases that specifically force the making of a difficult ethical decision, soliciting an articulation of any disagreements existing within the presenting group, and exploring permutations of each case in order to see if that changes opinions and to clarify the underlying ethical principles at play. In our setting, the creation of bioethical case scenarios that are specifically applicable to the context of our African learners has been helpful in making a module with useful content capable of growing the ethical decision-making capacity of the participants.

Mathetiks - a transdisciplinary education paradigm (the case of bioethics)

The novelty of the article is related to the use of the resources of the philosophy of transdisciplinarity to justify the relevance and heuristic importance of the concept of "Mathetiks", introduced by the Czech pedagogue-humanist Jan Amos Comenius (Komensky) to refer to practices of self-education.
 The aim of the article is to use resources of the philosophy of transdisciplinarity to justify the relevance and heuristic importance of the concept of "Mathetiks", introduced by the Czech pedagogue-humanist J. A. Kоmensky three centuries ago to distinguish and establish coordination in the unified educational process of pedagogical practices of teaching and self-learning of students. The modern interpretation of the ideas of mathetiks (on the example of the problems of bioethical education) is carried out with the implementation of the concepts of the philosophy of science Th. Kuhn and R. Merton in the context of post-nonclassical studies. The notion of "paradigmatic syndrome", which arises as a result of philosophical reflection on the peculiarities of the formation of the post-classical matrix of the development of modern scientific knowledge, is introduced. One of its defining factors is the conceptualization and institutionalization of processes to ensure continuity of knowledge (education) and constant innovative changes taking place in society. The most adequate form of philosophical and methodological reflection in this situation, according to the author, is the philosophy of transdisciplinarity as an integrating mechanism not only of the disciplinary knowledge, but also of education and innovation, the necessary components of the social system aimed at self-renewal. The philosophy of transdisciplinarity and the philosophy of education have in many ways similar paradigm structures, oriented target cause of the actor on self – education -mathetiks. The target specifies the reason for the project-based nature of the paradigmatic constructs in education and bioethics. First of all, this is the clarification of the problem field, training and teaching to act in it according to the existing rules and the creative nature of project activities. Orientation to the value priorities of the community expressed both in symbolic generalizations and implicit forms (M. Polanyi) of personal knowledge and practice.

Kwestie bioetyczne w encyklice „Laudato si’” papieża Franciszka

Artykuł podejmuje refleksję nad wątkami bioetycznymi zawartymi w ostatniej encyklice papieża. W punkcie pierwszym analizuje modele filozoficzne we współczesnej bioetyce, szczególnie rozpowszechnione w ostatnich latach, takie jak: scjentyzm, utylitaryzm, model absolutnej autonomii i personalizm. W punkcie tym ukazano również ocenę tych sposobów filozofowania dokonaną przez papieża Franciszka i jego wniosek, że jedynie model personalistyczny jest adekwatny do właściwego rozwiązania kwestii ekologicznej i bioetycznej.W punkcie drugim opisane są trzy modele ekologiczne: model antropocentryczny, biocentryczny i partnerski. Ukazana jest także refleksja Franciszka w tej kwestii: relacja człowieka do przyrody powinna mieć charakter partnerski i uwzględniać fakt odpowiedzialności człowieka przed Bogiem za działania wobec przyrody. Człowiek powinien być nie władcą tego świata, lecz sługą mającym na celu dobro stworzeń i winien szanować nadane przez Boga prawa.W trzeciej części omówiono kazusy bioetyczne poruszone w encyklice Laudato si’. Dotyczą one początków życia człowieka (status embrionu ludzkiego, aborcja), przemocy wobec dzieci, godności osoby cierpiącej i starszej oraz bioetyki ekologicznej (zadawanie cierpień zwierzętom i żywność GMO).

A sociological analysis of ethical expertise: The case of bioethics

AbstractThis paper examines the question of ethical expertise and does so in the context of bioethics or, more accurately, applied ethics and the ethical governance of the life sciences. This analysis builds on a perspective set out in a previous paper and develops it further such that it relates to democratic processes. I argue that the academic practice of applied ethics exhibits a particular logic, way of thinking or eidos. Drawing on work in the history of science I present the logic of this practice as underpinned by a particular set of values or ethos. This can be contrasted with what Bernstein calls the democratic ethos as well as that of everyday moral agents. Using the framework of expertise developed by Collins and Evan’s—which differentiates between ubiquitous, contributory, and interactional expertise—I suggest that (bio)ethicists should modulate their expertise depending on the particular nature of the fora—academic, public, and policy-making—they are speaking in.

Commentary: Revised recommendation from CMDh on use of valproate in women is ethically incomplete and neglects the interests of women.

Commentary: Revised recommendation from CMDh on use of valproate in women is ethically incomplete and neglects the interests of women.

Human dignity as foundation of an ethics in psychiatry

Psychiatry is distinguished from other fields of medical expertise and bears a particular kind of responsibility, namely the treatment of persons incapable of informed consent per se. The History of psychiatry shows that much too often inhuman abuse was happening in psychiatric facilities. An ethics of psychiatry therefore requires a reliable and stable foundation for values that allow justifying normative claims embracing both characteristics. Such a basic foundation already exists in form of the pluralistic and international recognition of human dignity. We argue that human dignity does and has to go beyond "respect for autonomy" and by that it can function as highest authority on questions concerning value judgments on critical cases in psychiatric bioethics.

Alicia Ouellette: Bioethics and disability: toward a disability-conscious bioethics

Alicia Ouellette’s Bioethics and Disability: Toward a Disability-Conscious Bioethics is the result of her ‘‘ten-year journey toward disability consciousness’’ (p. 5). By saying so, Ouellette suggests a bioethics ‘‘mindful of and knowledgeable about the fact of disability in bioethical cases’’ (p. 316). Thus, a common struggle should be overcome: bioethics versus the disability rights community. The book begins with an introduction to (and a brief history of) Bioethics on the one side and the disability rights community on the other. Ouellette then explains that she is firmly convinced that, despite the differences and points of friction between the two groups, the disability perspective should be included in debates concerning bioethical issues. In other words, it is possible for bioethicists and disability experts to work together. Ouellette describes herself as a ‘‘firm believer in the case-study method for nuanced understanding of legal doctrine and policy’’ (p. 6), and for that reason, she uses case studies throughout the book to address issues that may arise in different stages during the life cycle. Each of these chapters is structured in four parts: one (or more) exemplary case studies followed by discussions—one from a bioethics point of view, and another from the disability community point of view, and a conclusion called ‘‘observations.’’ Firstly, it is worthwhile to underline the ability of the author to choose particular cases (from the famous Terry Schiavo to less known ones) while being aware of the possible biases this may introduce and so avoiding getting trapped. Secondly, it is important to focus on the ‘‘Observations’’ section, which are at the core of Ouellette’s work—

Who Makes the Decisions, Especially When it Concerns Minors?

Bioethical questions within the law, especially those concerning life-saving treatment, often require quick decisions. But litigation is notoriously slow and cumbersome. Such disputes are often moot by the time they reach an appellate court—one that can issue a decision of precedential value—because a decision by the court can have no practical legal effect on the controversy. While courts normally dismiss moot cases, there are some important exceptions. Famously, the U.S. Supreme Court in Roe v. Wade proceeded to decide the constitutionality of restrictions on abortion, even though the plaintiff’s baby had already been born (Roe v. Wade, 410 U.S. 113 (1973)). After all, “the normal 266-day human gestation period is so short that the pregnancy will come to term before the usual appellate process is complete. If that termination makes a case moot, pregnancy litigation seldom will survive much beyond the trial stage, and appellate review will be effectively denied” [125]. Roe is not unique in this respect. Traditionally, appellate courts have adjudicated moot bioethics cases in two main situations: (1) when the issues are of public importance and (2) when the issues are capable of repetition yet evading review. But, increasingly, appellate courts are abdicating their responsibility to decide moot cases satisfying these exceptions. In re Sheila W., 2013 WI 63; 348 Wis.2d 674, 835 N.W.2d 148, a July 2013 decision from the Wisconsin Supreme Court, is of interest because it illustrates a growing trend of appellate courts declining to address difficult and controversial bioethics issues. Sheila W. (Sheila) was a 15-year-old resident of Dane County, Wisconsin. In February 2012 she was diagnosed with aplastic anemia, a life-threatening illness in which a person’s immune system attacks her bone marrow, preventing the body from producing new blood cells. Sheila’s physicians gave her antibody treatments. After three days, however, Sheila’s red blood cell, white blood cell, and platelet counts remained very low. Her physicians determined that she needed blood transfusions. Without them, Sheila was at risk of infection, spontaneous hemorrhage, and cardiac arrest. In short, Sheila’s physicians concluded that, without blood transfusions, she would die. But Sheila and her family are Jehovah’s Witnesses who believe that God prohibits blood transfusions. Accordingly, Sheila’s parents refused to consent to blood transfusions. Moreover, Sheila’s parents thought that Sheila was mature enough to make her own decision. They told Sheila that they would support her decision whether to accept or refuse transfusions. Like her parents, Sheila also refused to consent to the transfusions. She told her attending physician that she “would rather die... than survive [with] the stigma Bioethical Inquiry (2013) 10:441–444 DOI 10.1007/s11673-013-9486-z

HOSPITAL CHAPLAIN AS RELIGIOUS INTERPRETER IN BIOETHICAL DILEMMAS

Using a recent example of a highly publicized case in Canada in which a family’s demands for life-sustaining treatment based on religious beliefs were pitted against a physician’s re-fusal to provide “inappropriate” care, this article critiques the suggestion that chaplains function as “religious interpreters” in bioethics cases that seek to determine the medical validity of religious beliefs. It argues that the chaplain as interpreter of religious beliefs and values requires a full vision of the chaplain’s unique and complex role in healthcare that (1) regards the patient not the chaplain as the “expert,” (2) utilizes a variety of key images of pastoral care, and (3) engages a process of dialogical hermeneutics. It concludes that in its broadest understanding and fullest appreciation beyond judgemental interpretation of facts alone pastoral care provides a helpful re-source to healthcare teams and an influential model in the art of ethics consultation that embraces uncertainty to build trust among stakeholders.

Textual Practices in Crafting Bioethics Cases

Bioethics case reports generally treat aspects of moral fathomability, characterised and addressed in different ways. This paper reads the case as a textual model of scenarios and draws attention to its structure, narrative shape, linguistic register, and the effects of tone and temporality on reader expectation and responsiveness. Such textual elements of case composition reflect authorial purpose and influence the interpretation, including moral and ethical interpretation, of bioethics cases.

Fostering critical thinking, reasoning, and argumentation skills through bioethics education.

Developing a position on a socio-scientific issue and defending it using a well-reasoned justification involves complex cognitive skills that are challenging to both teach and assess. Our work centers on instructional strategies for fostering critical thinking skills in high school students using bioethical case studies, decision-making frameworks, and structured analysis tools to scaffold student argumentation. In this study, we examined the effects of our teacher professional development and curricular materials on the ability of high school students to analyze a bioethical case study and develop a strong position. We focused on student ability to identify an ethical question, consider stakeholders and their values, incorporate relevant scientific facts and content, address ethical principles, and consider the strengths and weaknesses of alternate solutions. 431 students and 12 teachers participated in a research study using teacher cohorts for comparison purposes. The first cohort received professional development and used the curriculum with their students; the second did not receive professional development until after their participation in the study and did not use the curriculum. In order to assess the acquisition of higher-order justification skills, students were asked to analyze a case study and develop a well-reasoned written position. We evaluated statements using a scoring rubric and found highly significant differences (p<0.001) between students exposed to the curriculum strategies and those who were not. Students also showed highly significant gains (p<0.001) in self-reported interest in science content, ability to analyze socio-scientific issues, awareness of ethical issues, ability to listen to and discuss viewpoints different from their own, and understanding of the relationship between science and society. Our results demonstrate that incorporating ethical dilemmas into the classroom is one strategy for increasing student motivation and engagement with science content, while promoting reasoning and justification skills that help prepare an informed citizenry.

Istota argumentacji teologicznej w bioetyce

W artykule autor podejmuje kwesti związku między bioetyką i teologią. Pokazuje, jak prawdy teologiczne i dogmatyczne mogą stanowić podstawę refleksji i orzeczeń w sprawach bioetycznych. Ukazane zostłay kwestię problemów bioetycznych w Biblii, przedstawiając niektóre fragmenty Starego i Nowego Testamentu, gdzie można znaleźć nawiązania do ludzkiego życia i śmierci (np Wj 21: 12-32; Job 10: 8- 12, Psalmy, Listy Pawła). Autor postuluje konieczność właściwej egzegezy tekstów biblijnych i ich dokładnej analizy z językowego punktu widzenia. Następnie pokazuje wkład Ojców Kościoła w kwestii rozwiązywania niektórych problemów bioetycznych, podkreślając znakomite refleksy Tertuliana w tej sprawie w swoich traktatach "Apologetic" oraz "O duszy". Następny odnosi się do dogmatycznych prawd, w szczególności takich jak: wiecznego aktu stworzenia Syna przez Ojca i wcielenia Syna Bożego.

The Methods of Applied Philosophy and the Tools of the Policy Sciences

In this paper I argue that applied philosophers hoping to de- velop a stronger role in public formation can begin by aligning their methods with the tools employed in the I proceed first by characterizing the standard view of policymaking and education as instrumentally oriented toward the employment of specific tools. I then investigate pressures internal to philosophy that nudge work in applied philosophy toward the periphery of debates. I capture the dynam- ics of these pressures by framing them as the dilemma and the problem problem. Seeking a remedy, I turn to the interdisciplinarity of a unique approach to policymaking generally known as the policy sciences. Finally, I investigate the case of bioethics, an instance where philosophy has made decent headway with policymakers. From this I draw parallels to public policy. I suggest that because the sciences are essentially an alchemist's brew of academic fields, and because philosophy covers many of the foundational questions associated with these fields, it is only natural that applied philosophers should begin collaborations with other applied academics by adopting the strategies that have so successfully applied in other theoretical fields.