Navigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives.

The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often-discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia.

Distinctive But Not Exceptional: The Risks of Psychedelic Ethical Exceptionalism.

When used clinically, psychedelics may appear unusual or even unique when compared to more familiar or long-standing medical interventions, prompting some to suggest that the ethical issues raised may likewise be exceptional. If that is correct, then perhaps psychedelics should be treated differently from other medical substances: for example, by being subjected to different ethical or evidentiary standards. Alternatively, it may be that psychedelics have more in common with various existing medical interventions than first meets the eye.

Scaffolding informed consent.

The principle of respecting patient autonomy underpins the concept and practice of informed consent. Yet current approaches to consent often ignore the ways in which the exercise of autonomy is deeply epistemically dependent.In this paper, we draw on philosophical descriptions of autonomy 'scaffolding' and apply them to informed consent in medicine.

Heritable polygenic editing: the next frontier in genomic medicine?

Polygenic genome editing in human embryos and germ cells is predicted to become feasible in the next three decades. Several recent books and academic papers have outlined the ethical concerns raised by germline genome editing and the opportunities that it may present. To date, no attempts have been made to predict the consequences of altering specific variants associated with polygenic diseases.

Conscientious objection: a global health perspective.

Conscientious objection is a critical topic that has been sparsely discussed from a global health perspective, despite its special relevance to our inherently diverse field. In this Analysis paper, we argue that blanket prohibitions of a specific type of non-discriminatory conscientious objection are unjustified in the global health context. We begin both by introducing a nuanced account of conscience that is grounded in moral psychology and by providing an overview of discriminatory and non-discriminatory forms of objection.

Clinical, Ethical, and Legal Considerations Raised by Self-Reported Genital Mutilation Following Voluntary Cosmetic Labiaplasty.

An increasing number of women are undergoing female genital cosmetic surgery (FGCS). Labiaplasty, the most commonly performed FGCS, consists of a surgical procedure to decrease the inner labia size so that no or less tissue protrudes beyond the outer labia. Anatomically, it is similar to female genital mutilation/cutting (FGM/C) Type 2a.

Professional obligations and the demandingness of acting against one's conscience.

Conscience is typically invoked in healthcare to defend a right to conscientious objection, that is, the refusal by healthcare professionals to perform certain activities in the name of personal moral or religious views. On this approach, freedom of conscience should be respected when the individual is operating in a professional capacity. Others would argue, however, that a conscientious professional is one who can set aside one's own moral or religious views when they conflict with professional obligations.

Uterus transplants and Mexico's rule of law.

Uterus transplantation is a new fertility treatment for some women who lack a functioning uterus. The number of countries where these transplants are performed has steadily increased, and in Mexico, there is a growing interest in this procedure among patients, researchers, and clinicians. In this paper we look at Mexico and its legal system in order to determine what is the legal status of uterus transplants, and whether there is a right to them according to Mexican legislation.

Polygenic risk scores and embryonic screening: considerations for regulation.

Polygenic risk scores (PRSs) have recently been used to inform reproductive decision-making in the context of embryonic screening. While this is yet to be widespread, it is contested and raises several challenges. This article provides an overview of some of the ethical considerations that arise with using PRSs for embryo screening and offers a series of regulatory considerations for jurisdictions that may wish to permit this in the future.

Manipulation cases in free will and moral responsibility, part 2: Manipulator-focused responses.

In this paper-Part 2 of 3-we discuss one of the two main types of soft-line responses to manipulation cases, which we refer to as manipulator-focused views. Manipulator-focused views hold, roughly, that the reason that Victim lacks responsibility (or lacks full responsibility) is because of the way the action is related to the Manipulator. First, we introduce these views generally, and then we survey some detailed versions of such views.

How to Make Psychedelic-Assisted Therapy Safer.

Classic serotonergic psychedelics are experiencing a clinical revival, which has also revived ethical debates about psychedelic-assisted therapy. A particular issue here is how to prepare and protect patients from the vulnerability that the psychedelic state creates. This article first examines how this vulnerability manifests itself, revealing that it results from an impairment of autonomy: psychedelics diminish decision-making capacity, reduce controllability, and limit resistance to external influences.

Ethics round table: choice and autonomy in obstetrics.

Decisions about how and where they deliver their baby are extremely important to pregnant women. There are very strong ethical norms that women's autonomy should be respected, and that plans around birth should be personalised. However, there appear to be profound challenges in practice to respecting women's choices in pregnancy and labour.

Manipulation Cases in Free Will and Moral Responsibility, Part 1: Cases and Arguments.

A common style of argument in the literature on free will and moral responsibility is the Manipulation Argument. These tend to begin with a case of an agent in a deterministic universe who is manipulated, say, via brain surgery, into performing some action. Intuitively, this agent is not responsible for that action.

Credit and blame for AI-generated content: Effects of personalization in four countries.

Generative artificial intelligence (AI) raises ethical questions concerning moral and legal responsibility-specifically, the attributions of credit and blame for AI-generated content. For example, if a human invests minimal skill or effort to produce a beneficial output with an AI tool, can the human still take credit? How does the answer change if the AI has been personalized (i.e.

Recognising uncertainty: an integrated framework for palliative care in perinatal medicine.

In perinatal medicine, the number of babies with life-limiting or life-threatening conditions is increasing and the benefits of providing palliative care with a holistic, interdisciplinary approach are well documented. It can be particularly challenging, however, to integrate palliative care into routine care where there exists uncertainty about a baby's diagnosis or potential outcome.This framework, developed collaboratively by the British Association of Perinatal Medicine (BAPM) and the Association of Paediatric Palliative Medicine (APPM), offers supportive guidance for all healthcare professionals working in perinatal medicine across antenatal and neonatal services.

Morality on the road: Should machine drivers be more utilitarian than human drivers?

Machines powered by artificial intelligence have the potential to replace or collaborate with human decision-makers in moral settings. In these roles, machines would face moral tradeoffs, such as automated vehicles (AVs) distributing inevitable risks among road users. Do people believe that machines should make moral decisions differently from humans? If so, why? To address these questions, we conducted six studies (N = 6805) to examine how people, as observers, believe human drivers and AVs should act in similar moral dilemmas and how they judge their moral decisions.

Misaligned hope and conviction in health care.

It is often said that it is important for patients to possess hope that their treatment will be successful. We agree, but a widely appealed to type of hope-hope based on conviction (religious or otherwise), renders this assertion problematic. If conviction-based hope influences patient decisions to undergo medical procedures, then questions are raised about the scope of patient autonomy.

Wish to die trying to live: unwise or incapacitous? The case of University Hospitals Birmingham NHS Foundation Trust versus 'ST'.

The recent legal dispute about medical treatment for a 19-year-old patient, Sudiksha Thirumalesh, (known initially by the Court of Protection as 'ST') in A NHS Trust versus ST & Ors (2023) raised several challenging ethical issues. While Sudiksha's case bears similarities to other high-profile cases in England and Wales, there are key differences. Crucially, Sudiksha herself was part of the disagreement.

Pandemic preparedness: why humanities and social sciences matter.

Whilst many lessons were learned from the COVID-19 pandemic, ongoing reflection is needed to develop and maintain preparedness for future outbreaks. Within the field of infectious disease and public health there remain silos and hierarchies in interdisciplinary work, with the risk that humanities and social sciences remain on the epistemological peripheries. However, these disciplines offer insights, expertise and tools that contribute to understanding responses to disease and uptake of interventions for prevention and treatment.