Bioethical Topics Research Articles

Future Lives and Deaths with Purpose: Perspectives on Capacity, Character, and Intent

Abstract The articles in this issue of the Journal of Medicine and Philosophy explore emerging technologies, medical innovations, and shifting moral norms, expanding present discussions around topics in bioethics both old and new. Some question whether novel definitions of death and harm change the moral permissibility of killing, particularly at the hands of a physician. Others question how increased or decreased abilities affect responsibility and achievement. Another illustrates how rhetorical appeals to character have been used to justify otherwise morally illicit actions within the clinic. Together, these articles shed new light on topics in the field of bioethics.

The concept of intersectionality in bioethics: a systematic review

BackgroundIntersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a “traveling concept”, which also made its way into bioethical research.MethodsWe conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included.ResultsThe qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies.ConclusionsThis systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions.

Implementing a formal curriculum on surgical ethics and palliative care for otolaryngology residents

ObjectiveResidents are faced with ethical issues every day but most residency curriculums do not routinely include formal ethics skills training. In order to address this, a comprehensive curriculum on ethics and surgical palliative care was implemented for otolaryngology residents. MethodsAn 8-h ethics didactics curriculum was designed in collaboration with our institution's Institute of Ethics. Varied strategies were used to cover basic principles and practical skills. Anonymous assessments were completed by learners at 3 points during the curriculum on a 5-point scale. ResultsNine residents were surveyed. Prior to the curriculum, a large majority of residents (85 %) expressed little to no familiarity with basic ethical principles. There was statistically significant improvement in understanding of and familiarity with bioethics topics, including the four principles of bioethics (Δ = 2.4, p = 0.004). There was also statistically significant improvement in comfort with the implementation of ethical decision making and palliative care skills, including with difficult conversations with patients (Δ = 1.3, p = 0.03). Participation in sessions was excellent with positive qualitative feedback. ConclusionAn interactive curriculum in ethics and palliative care can be engaging and practical for busy surgical residents, with measurable improvement in comfort with challenging cases and ethical, patient-centered care.

Islamic perspectives on preconception, prenatal, and perinatal counseling.

With advances in prenatal imaging, genetic testing, and medical treatment of premature neonates, new bioethical challenges have arisen. Many Muslims turn to their faith and religious leaders to help navigate these novel challenges. This article briefly discusses the factors that are involved in religious leaders issuing a fatwa, or religious opinion. Using clinical scenarios, this article reviews the current discourse amongst Islamic scholars and laws in Muslim-majority countries regarding challenging bioethical topics surrounding preconception counseling, antenatal testing and termination of pregnancy, as well as Islamic scholars' attempts to determine a minimum gestational age of viability using primary religious texts, the Quran and hadith. Challenges and shortcomings in the Islamic perspective on these issues are also addressed to highlight areas in which further research should be pursued. A deeper understanding of Islamic religious perspectives on these topics can help clinicians in providing care that is informed by patients' cultural and religious values.

Supporting Solidarity

Supporting Solidarity

Essential bioethics topics in anti-doping strategies in sports

Bioethics has a huge theoretical and applied potential for preventing and solving various problems regarding the life and health of individuals. Sport is an important area of social life that is excessively dominated by various trends, including unfavorable ones, which harm the health of athletes. The article reflects sources of bioethics that interpret sports activities influenced by doping. Analytical, hermeneutic methods and bioethical methodological tools were applied. A rather sensitive topic, frequently discussed at different levels, is the use of doping substances in sports. This negative phenomenon is evolving, becoming more and more diverse and difficult to combat. The application of bioethics benchmarks creates favorable conditions in the annihilation of doping in sport.

Legal and Bioethical Educational Module in Saudi Board of Emergency Medicine: A Qualitative Need Assessment".

Medical malpractice is a leading cause of morbidity and mortality worldwide, negatively affecting healthcare systems, communities, and providers. Although physicians value legal knowledge, their understanding of medical law is limited. Integrating medical law and ethics into medical school curriculums can develop a practitioner's decision-making skills, critical thinking abilities, and ethical judgment. The Saudi Board of Emergency Medicine (SBEM) is a residency training program governed by the Saudi Commission for Health Specialties (SCFHS), which aims to improve healthcare quality and patient safety in Saudi Arabia. This study explored stakeholders' perceptions regarding implementing a legal and bioethical education module in the SBEM curriculum. Nineteen participants (seven program directors and 12 trainees) from the different training centers around the kingdom (from Riyadh, Jeddah, and eastern province) have been included in the study. Thirty minutes to one-hour face-to-face and virtual (zoom-based) structured interviews have been done. Each interview was audio-recorded and transcribed verbatim. Then, data have been analyzed using a grounded theory constant comparative approach to develop categories, central themes, and a descriptive model. Four themes have emerged from the data, including planning and executing the current bioethical and legal educational activities in the SBEM, the current teaching methods and guiding resources for the bioethical and legal subjects, the assessment methods used to evaluate the trainees' comprehension of bioethical and legal topics and the opinions regarding integrating bioethical and legal education module with the current curriculum of the SBEM. The study found that the current educational initiatives for legal and bioethical topics in SBEM are insufficient. There are no clear learning objectives, study guides, or combined practices for trainees to develop safe approaches when faced with ethical and legal challenges. A comprehensive protocol with required competencies and dedicated educators may help trainees understand Islamic ethics and jurisprudence principles for delivering culturally sensitive and patient-centered care. Further studies and needs assessments are recommended.

The birth of the "digital turn" in bioethics?

The so-called "empirical turn" in bioethics gave rise to extensive theoretical and methodological debates and has significantly shaped the research landscape from two decades ago until the present day. Attentive observers of the evolution of the bioethical research field now notice a new trend towards the inclusion of data science methods for the treatment of ethical research questions. This new research domain of "digital bioethics" encompasses both studies replacing (or complementing) socio-empirical research on bioethical topics ("empirical digital bioethics") and argumentative approaches towards normative questions in the healthcare domain ("argumentative digital bioethics"). This article draws on insights taken from the debate on the "empirical turn" for sounding out perspectives for the newly developing field of "digital bioethics." We particularly discuss the disciplinary boundaries, chances and challenges, and potentially undesirable developments of the research field. The article closes with concrete suggestions on which debates need to be initiated and which measures need to be taken so that the path forward of "digital bioethics" will be a scientific success.

Response-The Road Less Travelled: Why did Miles Little Turn to Qualitative Research and Where Did This Lead?

Miles Little is an Australian surgeon, poet, and philosopher whose published work spans diverse topics in surgery, medicine, philosophy, and bioethics. In 1974 he co-authored a survey that included an analysis of interviews conducted with amputees. This was his first foray into qualitative research. Twenty years later he established a research centre at the University of Sydney that initiated a programme of qualitative research in cancer medicine. For twenty years after that, the centre acted as a hub for research that applied qualitative methods from the social sciences to study the experiences of people who endure illness and onerous treatments and to reveal their evaluations of what medicine does to and for them. This essay explains why Little turned to qualitative research instead of pursuing two other research paradigms that were better established in the 1990s, namely, evidence-based medicine and quality-of-life research. It also notes a development in qualitative research methods that Little’s legacy helps to explain, one which can augment the symbolic power of socially marginalized individuals and groups. With reference to a current controversy in surgery, I argue that Little’s survey of amputees models a laudable response to criticism, and in this respect, it is still relevant today.

An exploration of how gender, political affiliation, or religious identity is associated with comfort and perceptions of controversial topics in bioethics.

Bioethics is an important aspect of understanding the relationship between science and society, but studies have not yet examined undergraduate student experiences and comfort in bioethics courses. In this study, we investigated undergraduate bioethics students' support of and comfort when learning three controversial bioethics topics: gene editing, abortion, and physician-assisted suicide (PAS). Furthermore, student identity has been shown to influence how students perceive and learn about controversial topics at the intersection of science and society. So, we explored how students' religious affiliation, gender, or political affiliation was associated with their support of and comfort when learning about gene editing, abortion, and PAS. We found that most students entered bioethics with moderated viewpoints on controversial topics but that there were differences in students' tendency to support each topic based on their gender, religion, and political affiliation. We also saw differences in student comfort levels based on identity: women reported lower comfort than men when learning about gene editing, religious students were less comfortable than nonreligious students when learning about abortion and PAS, and nonliberal students were less comfortable than liberal students when learning about abortion. Students cited that the controversy surrounding these topics and a personal hesitancy to discuss them caused discomfort. These findings indicate that identity impacts comfort and support in a way similar to that previously shown in the public. Thus, it may be important for instructors to consider student identity when teaching bioethics topics to maximize student comfort, ultimately encouraging thoughtful consideration and engagement with these topics.

Dignity of Human Life in Bioethics

Dignity of human life is widely uses in bioethics. There are many controversial topics in bioethics which uses human dignity as the basis of their argument. UNESCO’s Universal Declaration of Bioethics and Human Rights placed human dignity, human rights and fundamental freedom as the basic principle of bioethics. Human dignity become a solid and strong foundation for bioethical principles, in which, human being is placed at the center of the development of science and technology and not marginalized.

A Look Back at Bioethics: William L. Meadow, 1948-2019.

A Look Back at Bioethics: William L. Meadow, 1948-2019.

STUDENTS’ VIEWS ON THE ROLE OF ETHICS EDUCATION FOR THEIR FUTURE MEDICAL PRACTICE

INTRODUCTION: Worldwide, in different ways, ethical dilemmas arise in medicine and life sciences. It is critical for medical professionals to respond with confidence when ethical challenges are addressed in their clinical practice. Medical ethics and bioethics education is recognized as an essential course of the medical curriculum. The course aims to provide students with knowledge and competencies on dealing with moral problems.
 OBJECTIVES: In this article, we aim to explore students’ views about the importance and role of medical ethics education for their future practice. Their suggestions on specific medical ethics and bioethics topics were also considered, as well as previous knowledge on ethics before they enrolled in university.
 METHODS: A paper questionnaire was developed and distributed among first-year foreign medical students from the Faculty of Medicine in the Medical University-Sofia in Bulgaria. All students participated in the study anonymously and voluntarily. The study was conducted during January and February 2020.
 RESULTS: Completed questionnaires were received from 366 medical students. Data collected demonstrates that only 19% of the students were taught ethics before enrolling in university and covered topics on philosophy and ethics, civil and human rights. The majority (92%) of the responders believe that the study of medical ethics and bioethics helps medical professionals to improve their skills in identifying ethical problems in their everyday practice. Interesting were the suggestions for topics in medical ethics and bioethics that needed further study during lectures and seminars and included principles of medical ethics and bioethics, ethical behavior in medicine and health care, ethical dimensions of new technologies in health care, ethical dimensions of clinical decisions and patients’ quality of life, ethics and health management.
 CONCLUSIONS: Medical ethics education is significant for future physicians, helping them to improve their skills in identifying ethical issues, and base their decisions on fundamental ethical principals in their everyday practice. Attention should be given to topics related to principles of medical ethics, models of patient-physician relationships, new technologies in health care, ethics and health policy.

TV medical dramas: health sciences students\u2019 viewing habits and potential for teaching issues related to bioethics and professionalism

BackgroundMedical dramas have been popular since their inception, especially among medical students. We hypothesized that the recent increase in the availability of TV medical series through online streaming platforms has probably changed health science students’ viewing habits as well as the representation of bioethical conflicts and health professionals.MethodsWe invited undergraduate students of medicine, nursing, and human biology to complete a self-administered questionnaire about their viewing habits and perceptions of the depictions of bioethical issues and professionalism in TV medical series.ResultsOf the 355 respondents, 98.6 % had watched TV in the last year, 93.5 % watched TV series, and 49.6 % watched medical dramas more than once a week. The most-viewed medical dramas were The Good Doctor, House MD, and Grey’s Anatomy. The most-remembered bioethical topics were medical errors, inappropriate professional behaviors, and death. Most students considered that ideals of professionalism were depicted positively and professionals were portrayed as intelligent, professionally qualified, and competent.ConclusionsMedical dramas are very popular with health science students and are potentially useful as teaching tools for discussing issues related to bioethics and professionalism.

A Research of Medical Ethics and Bioethics Topics and Keywords in Major Databases in Two Period Time: 1918-1919 Spanish Flu Pandemic and 2020 Novel Coronavirus Pandemic – Main Values and Social Needs

"The World Health Organization (WHO) on March 11, 2020, has declared the novel coronavirus (COVID-19) outbreak a global pandemic. But in the last 130 years mankind overpassed 5 major pandemic times. We noticed that bioethics has been born at the twilight of the Tuskagee experiment in 1972-1979 the period, needed for the federal research and Belmont report issue. Therefore, Spanish flu pandemic did not benefit from bioethics insights but medical ethics and Hippocrates Oath however influenced doctor’s professional ethics. We compare 1918-1919 topics of medical ethics for Spanish flu with 2020 for Coronavirus. We found out that PubMed (nih.gov) recognize some 8 issues for “medical ethics” and “Spanish flu” v. 792 for “medical ethics” and “coronavirus”, this is 100 times more. Most frequent key words are researched. Also, there are researched major moral values and bioethical principles that are at stack in pandemic time in order to improve our reactivity and adaptability to such global health problems. The question is that in Spanish flu pandemic when bioethics was not yet an important approach for diversity of values as it is now in 2020 coronavirus pandemic, society and medical system during the First World War was less prepared for ethical solutions of treatment and prevention of a pandemics disease than today. Responsibility, equity and justice must prevail for the treatment and for prevention. Ethics of scarce resources allocation brings the most complicate questions and require for a holistic approach and equity. "

Taking stock of the availability and functions of National Ethics Committees worldwide

BackgroundNational Ethics Committees (NECs) offer important oversight and guidance functions and facilitate public debate on bioethical issues. In an increasingly globalized world where technological advances, multi-national research collaborations, and pandemics are creating ethical dilemmas that transcend national borders, coordination and the joining of efforts among NECs are key. The purpose of this study is to take stock of the current NEC landscape, their varying roles and missions, and the range of bioethical topics on which they deliberated since their inception.MethodsData on the availability, functions, and ethical deliberations (publications) of NECs globally were gathered through a systematic search of NEC websites and through contacts known to the authors. The search was conducted in English, French, and Spanish. The data abstraction was done in Excel and included the NEC’s country, region, functions, and deliberations on bioethical issues. Deliberation topics were classified into thematic categories through an iterative process of regrouping to arrive at the main set of themes.Results124 NECs in 100 countries were identified. 44% of the NECs are in Europe and 47% are in high-income countries. Out of the 1108 retrieved publications, 40% were on bioethics in the context of research, followed by the clinic (28%) and public health issues (22%). The top five topics of these publications were: research ethics (124; 9%), genetics and genomics (62; 6%), organ transplantation (58; 5%), assisted reproductive technology (49; 4%), and end of life (36; 3%).ConclusionOur study makes an important contribution to understanding the current interests and functions of NECs and the range of their bioethics deliberations. By making the data publicly available through this publication, it allows users to conduct tailored analyses and queries based on their interests, and to seek and strengthen collaboration and exchange. It also makes the case for the fruitfulness of developing and maintaining a global repository of current and new deliberations to more effectively advance this field for the greater good of humanity, research, and public health.

Systematic reviews of empirical literature on bioethical topics: Results from a meta-review.

BackgroundIn bioethics, especially nursing ethics, systematic reviews are increasingly popular. The overall aim of a systematic review is to provide an overview of the published discussions on a specific topic. While a meta-review on systematic reviews on normative bioethical literature has already been performed, there is no equivalent for systematic reviews of empirical literature on ethical topics.ObjectiveThis meta-review aims to present the general trends and characteristics of systematic reviews of empirical bioethical literature and to evaluate their reporting quality.Research designLiterature search was performed on PubMed and Google Scholar. Qualitative content analysis and quantitative approaches were used to evaluate the systematic reviews. Characteristics of systematic reviews were extracted and quantitatively analyzed. The reporting quality was measured using an adapted PRISMA checklist.FindingsSeventy-six reviews were selected for analysis. Most reviews came from the field of nursing (next to bioethics and medicine). Selected systematic reviews investigated issues related to clinical ethics (50%), followed by research ethics (36%) and public health ethics or organizational ethics (14%). In all, 72% of the systematic reviews included authors’ ethical reflections on the findings and 59% provided ethical recommendations. Despite the heterogeneous reporting of the reviews, reviews using PRISMA tended to score better regarding reporting quality.DiscussionThe heterogeneity currently observed is due both to the interdisciplinary nature of nursing ethics and bioethics, and to the emerging nature of systematic review methods in these fields. These results confirm the findings of our previous review of systematic reviews on normative literature, thereby highlighting a recurring methodological gap in systematic reviews of bioethical literature. This also indicates the need to develop more robust methodological standards.ConclusionThrough its extensive overview of the characteristics of systematic reviews of empirical literature on ethical topics, this meta-review is expected to inform further discussions on minimal standards and reporting guidelines.

Bioetička edukacija na teološkim fakultetima Univerziteta u Sarajevu

U okviru Univerziteta u Sarajevu egzistiraju dva teološka fakulteta, Fakultet islamskih nauka i Katolički bogoslovni fakultet. Obje visokoobrazovne institucije dugo vremena nisu bile u sastavu navedenog sveučilišta, budući da su obitavale isključivo pod okriljem religijskih institucija. Na navedenim fakultetima izučavaju se, pored teoloških, i svjetovni moduli, te je primjetno da se polju bioetike daje posebno mjesto kao jednome od neophodnih suvremenih segmenata odgojno-obrazovnog procesa. Analogno rečenome, u tekstu je načinjena razdioba studijskih programa, tj. istaknuto je gradiranje znanstvenih i stručnih ciklusa u obrazovnome procesu, kako na Fakultetu islamskih nauka, gdje se nastava izvodi na dodiplomskom, diplomskom te doktorskom studiju, tako i na Katoličkom bogoslovnom fakultetu, gdje je ustaljen integrirani studij teologije, pored kojega je već nekoliko godina još zastupljen diplomski studij Međureligijski studij i izgradnja mira, koji se provodi u suradnji s Fakultetom islamskih nauka i Pravoslavnim bogoslovskim fakultetom Sv. Vasilija Ostroškog iz Foče. Pravoslavni bogoslovski fakultet je zapravo sastavnica Univerziteta u Istočnome Sarajevu, stoga nije uzet u razmatranje u ovome radu. Autori rada razmatranju bioetičkih problema pristupali su iz pozicije praktičke filozofije, tj. njene grane etike, koristeći pri tome interdisciplinarni i pluriperspektivni pristup. Na osnovi silabusa načinjena je analiza bioetičkih problema primarno iz filozofskog (etičkog) motrišta, analizirani su predmetni udžbenici i literatura. Naravno, vodilo se računa o radovima nastavnika s ovih institucija, koji su pisani iz polja bioetike. Bez obzira na različito religijsko fundiranje bioetičkih problema na ova dva fakulteta,u smislu različitih epistemičkih polazišta islama i kršćanstva, u zaključcima rada ukazano je na točke zajedničkog ,,bioetičkog“ interesa, ali i razilaženja među njima.

Bioethics in Physiotherapy and Nursing Schools’ Programs

Abstract The interest in ethical and bioethical topics in society is always present. However, the question arises as to how are ethical and bioethical problems of broad spectrum presented to the public, starting from issues related to health, medicine, technology, genetics, to issues about economy and politics. If ethical-bioethical issues will be addressed in different fields of social life without systematic methodological preparation, we could easily be trapped in ethics and bioethics speeches, which would be presented in a way that suits somebody at a certain point. When talking about educational institutions like College or Polytechnic with medical and health-related study programs, it would certainly be useful to make an analysis about the ethical-bioethical topics and subjects they are offering to students. Recently, there is a high interest of high school graduates in enrolling to professional study programs like Physiotherapy and Nursing. Bioethics is an obligatory subject within the framework of those study programs. However, lecturers of different profiles are chair professors of Bioethics at the aforementioned institutions, starting from physicians, through philosophers, theologians, sociologists, and lawyers. Of course, that is possible because a scientist can deal with various scientific challenges through his career, but it would certainly be important to at least equate syllabi, as well as plans and programs of Bioethics in Physiotherapy and Nursing study program. It is important to note that in Physiotherapy programs, besides subjects from the field of biomedicine, a significant part of the program is based on the science of movement and especially therapeutic exercises, which point out the need to include the field of kinesiology into the Bioethics plan and program.

Bioethics Education in the Medical Programme among Malaysian Medical Schools: Where Are We Now?

Introduction:A global trend in medical education is the inclusion of bioethics teaching in medical programme. The objective of this article is to describe the current state of bioethics education in the medical programme among Malaysian medical schools.Method:A national survey was conducted among Malaysian medical schools between January and March 2019. One representative from each medical school was invited to respond to the survey. Respondents were faculty members involved in teaching and assessment of bioethics in their medical schools, or/and in developing and coordinating bioethics curriculum. Descriptive statistics were reported.Findings:Out of 30 medical schools, 11 completed and returned the survey (overall response rate = 36.7%). Of these 11 schools, 6/10 (60%) were from public institutions while 5/20 (25%) were from private institutions. All except 1 school implemented a formal bioethics curriculum. A wide range of bioethics topics are currently taught in the medical programme. The majority involved in teaching bioethics were health care professionals (mainly clinicians), followed by lawyers. Lecture and attendance, respectively, are the most common teaching and assessment method. Major barriers to the implementation of bioethics education included limited qualified teaching staff (6/11 = 54.5%), no established curriculum to follow (5/11 = 45.5%), limited financial resources to hire qualified staff (4/11 = 36.4%), and no consensus among faculty members (4/11 = 36.4%).Conclusion:Bioethics education in Malaysia is relatively new and mostly limited by a shortage of scholars in bioethics. National support and institutional collaboration in providing bioethics training is the key to enhance the quality of bioethics education.