Clinical Ethics

The COVID-19 pandemic highlighted many issues that can occur due to lack of translation between the spheres of bioethics and clinical practice. In this paper, we examine how mothers and newborn infants were inappropriately separated during the initial stages of the pandemic due to inconsistent application of ethical principles in determining policy. One of the significant challenges that translational bioethics face is the complexity regarding its implementation into the health service environment. As outlined in the literature, it may be postulated that responsibility for translating bioethics from philosophical concepts into practice is the duty of those training in philosophical theory and reasoning. However, the use of bioethics in informing clinical practice is not just the case of needing a translator but rather requires an interpreter in the widest sense: professionals attuned to both bioethics and clinical practice, who can communicate with both groups effectively. A two-way dialogue needs to be more cohesively established to ensure clinical practice is guided by ethical principles and to focus academic debate towards the pragmatic issues that require ethical exploration. Utilising the translational bioethics model described by Bærøe and applying it to our perinatal COVID case study, we examine how an integrated translational bioethics approach could have prevented the harm and disruption to mother–infant dyads during the initial phase of the pandemic in 2020.

Iain Campbell

Georgette Eaton

Jennifer Peterson

The need for translational bioethics within perinatal healthcare and policy making: A COVID-19 case study

围产期医疗保健和政策制定中转化生物伦理学的必要性：一项COVID-19案例研究

Given the costs of litigation high-profile court cases about withdrawing life-sustaining medical treatment for seriously ill children in England &amp; Wales tend to be followed by discussion about how to avoid similar cases in future. Whilst two proposals, mediation and replacing the best interests standard with a harm threshold, have received broad attention, a proposal to replace the court by a specialist review committee has not been further investigated. This article analyses the effects of a putative replacement of the courts by a specialist review committee using the process enacted by the futility clauses in the Texas Advance Directives Act (TADA) as a model. Under TADA life-sustaining treatment may legally be withdrawn when a review committee deems it futile and no alternative healthcare provider can be identified. The investigation finds that installing a national review committee with the power to decide whether life-sustaining treatment is futile would have reduced the number of court cases about withdrawal thereof in England &amp; Wales to a handful over the last 3 decades. In addition to shorter procedures and costs savings, a national review committee modelled after TADA would have advantages for both clinicians and parents. Advantages for clinicians are more limited exposure to delivery of clinical care that may cause moral distress and less exposure to adverse press and social media content. Advantages for parents are that the process would establish them as ethical decision makers and offer the possibility of a transfer of the care of the child provided an alternative healthcare provider can be found. As such decisions taken by a specialist review committee may be more acceptable for parents than those of the courts.

Veronica ME Neefjes

Limiting court involvement in end-of-life treatment decisions for children in England &amp; Wales: Advantages and limitations of a specialist committee deciding on futility

限制英格兰和威尔士儿童临终治疗决策中的法院介入：专家委员会决定无效性的优势与局限

This article addresses how bodily integrity has been mobilised in the context of genital cutting of male infants and the extent to which the concept is taken into account in legal decision-making in the United Kingdom. While bioethicists have debated whether interventions on children's bodies are more appropriately determined on the basis of hypothetical consent or in the child's best interest, it is clear that in law the relevant test is whether interventions are in the child's best interest. As the issue of nonconsensual genital cutting of infants has become more contested, courts have been asked to adjudicate on the best interests of infants in situations where their caregivers disagree about procedures. Although this body of jurisprudence remains (surprisingly) small, in this article we argue that, while there are now discernible trends in such cases (e.g. deferring decision-making until the child has the requisite capacity to decide, engaging with certain human rights norms), too often judicial reasoning about a child's best interests remains largely empty of reasoned content, and in certain respects is regressing. Using the recent case of Re P to exemplify this logic, and drawing on our previous work advocating the value of embodied integrity, we argue that judges should adopt a more substantive framework of values in judging the child's corporeal and other interests in such cases. This would move best interests assessments beyond a mere formalistic exercise and lead to better reasoned legal judgements.

Marie Fox

Michael Thomson

Judging children's best interests: Centring bodily integrity

判断儿童的最佳利益：以身体完整性为中心

Several studies have established the prevalence of discrimination upon the basis of weight in healthcare; however, these studies lack the element of human experience that makes addressing the issue vital to both individual and public health. Narrative medicine is an interdisciplinary field that utilizes powerful narrative skills and creativity to address the needs of those who seek and deliver healthcare, promoting healing, and self-reflection for both patients and physicians. This paper seeks to re-evaluate key studies regarding the issue of weight discrimination in healthcare through the lens of narrative medicine. In doing so, it further integrates the aspect of human experience into the study of medical ethics in order to improve the lived experience of overweight individuals in medicine.

Anna E. Ulrey

Your patient is a person: A narrative medical approach to weight discrimination in medicine

您的患者是一个人：医学中体重歧视的叙事医学方法

Medical necessity (claiming that a medical intervention or care is – at minimum – reasonable, appropriate and acceptable) depends on empirical evidence and on the interpretation of that evidence. Evidence and its interpretation define the standard of care. This commentary argues that both the evidence base and its interpretation are currently weak gatekeepers. Empirical meta-research suggests that very few medical interventions have high quality evidence in support of their effectiveness and very few of them also have relatively thorough assessments of their potential harms. Therefore, evidence on the risk-benefit ratios carries almost always very large uncertainty. Arbitration about medical necessity is thus left to the interpretation process. Professional guidelines are notoriously unreliable and biased in this regard. Regulatory approval ends up being the key arbitrator, but over the years the regulatory process has been subverted. Regulatory approval currently does not mean that an intervention has a favourable risk-benefit ratio, but simply that it can be marketed, sold and made profit from. The process leads to a tragedy of commons where the final victim is society at large: medical necessity is invoked as an alibi for medicine to absorb societal resources.

John PA Ioannidis

Medical necessity under weak evidence and little or perverse regulatory gatekeeping

弱证据和少或反常监管门控下的医疗必要性

This paper presents a case for the decriminalisation of abortion in Britain in light of the increasing investigations into people experiencing pregnancy loss and prosecutions of those suspected of illegal abortion. This growing enforcement of the criminal abortion offences has coincided with the legal change to allow the home use of abortion pills through telemedicine, and comes in the context of global backlash against abortion rights. Framing abortion as a necessary healthcare service and human right, this paper demonstrates the harms caused by criminalisation and highlights how the law exacerbates socio-economic and other vulnerabilities. It is later illegal abortions that tend to be prosecuted, and while there are complex reasons as to why someone might require an abortion, the law prohibits abortion beyond 24 weeks except for narrow medical reasons, creating crisis situations for those that find themselves without legal access. Decriminalisation is necessary to move away from this culture of suspicion, hostility, and stigma that has been built around abortion.

Zoe L Tongue

The increasing investigations and prosecutions for illegal abortion in Britain: A case for decriminalisation

英国非法堕胎调查与起诉增多：去罪化之辩

Children are individuals, and they are owed rights as individuals. Here, I offer a defence of the child's right to bodily integrity against genital cutting and modification practices. The liberal commitment to the right to bodily integrity works with the harm principle as a liberty limiting commitment within a system that respects people's embodied moral personhood and their decisions about their lives and bodies. Like adults within a political system committed to the equal protection of individual rights, children must have equal rights that transcend the differences between them. But, they are different to adults in important ways, both philosophically and empirically. I offer an account of the child's right to bodily integrity that recognises them as particular embodied individuals, and prioritises their welfare interest in having their bodily integrity respected.

ISSN	1477-7509, 1758-101X
h-index	22

涉及主题	医学政治学心理学法学生物哲学经济工程类社会学工程伦理学精神科计算机科学护理部认识论经济增长病理内科学社会心理学数学医疗保健遗传学
出版信息	出版商: SAGE Publications Ltd，出版周期: ，期刊类型: journal，开源期刊: 否
基本数据	创刊年份: 2006，原创研究文献占比: 0.00%，自引率:N.A.， Gold OA占比: 0.00%

Clinical Ethics

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The need for translational bioethics within perinatal healthcare and policy making: A COVID-19 case study

Limiting court involvement in end-of-life treatment decisions for children in England & Wales: Advantages and limitations of a specialist committee deciding on futility

Judging children's best interests: Centring bodily integrity

Your patient is a person: A narrative medical approach to weight discrimination in medicine

Medical necessity under weak evidence and little or perverse regulatory gatekeeping

The need for translational bioethics within perinatal healthcare and policy making: A COVID-19 case study

Judging children's best interests: Centring bodily integrity

Limiting court involvement in end-of-life treatment decisions for children in England & Wales: Advantages and limitations of a specialist committee deciding on futility

The increasing investigations and prosecutions for illegal abortion in Britain: A case for decriminalisation

The child's welfare interest-based right to bodily integrity