Udo Schüklenk

Franklin Miller's thoughtful reply to our paper asks pointed questions about the role of the physician qua physician in physician-assisted death. Would making assisted dying available to treatment-resistant depressed people necessarily affect the professional integrity of healthcare professionals, as Dr Miller asserts? Dr Miller agrees with us on a number of crucial points: It is possible that some patients with treatment-resistant major depression are competent to make the decision to ask for assisted dying; it is possible that some such patients could make a rational choice if they requested such assistance. He also is generally supportive of physician-assisted death, at least for ‘terminally ill’ patients. He defines a terminally ill patient as someone who has a ‘predictable short life span and will die soon regardless of medical intervention’. We disagree with his conceptualisation of ‘terminal illness’ as requiring that death occurs within 6–12 months, given the existence of illnesses like Amyotrophic lateral sclerosis (ALS) or certain prostate cancers that are commonly considered to be terminal illnesses and that are taking their predictable course sometimes over years. If, all other things being equal, an illness is going to kill a patient at some point down the track, it surely should qualify for the label ‘terminal illness’. However, we will accept his definition for the sake of the argument. Dr Miller supports the availability of assisted dying for patients likely to die from that illness within 6 months from the day their request for assisted dying has been made. He broadly holds the kind of view we aimed to sway with our analysis. Apparently, we failed. Dr Miller thinks that physician-assisted death must be consistent with professional integrity, requiring that it is consistent with ‘the proper goals of medicine and the specific duties incumbent on clinicians in acting to realize …

This paper discusses a number of critical ethical problems that arise in interactions between queer patients and health care professionals attending them. Using real-world examples, we discuss the very practical problems queer patients often face in the clinic. Health care professionals face conflicts in societies that criminalise same sex relationships. We also analyse the question of what ought to be done to confront health care professionals who propagate falsehoods about homosexuality in the public domain. These health care professionals are more often than not motivated by strong religious convictions that conflict with mainstream medical opinion on homosexuality. We argue that they ought to be held accountable for their conduct by their professional statutory bodies, given that they abuse their professional standing to propagate sectarian views not representative of their profession. Lastly, we propose that medical schools have special responsibilities in training future health care professionals that will enable them to respond professionally to queer patients seeking health care

This article describes how a small but vocal group of biomedical scientists propagates the views that either HIV is not the cause of AIDS, or that it does not exist at all. When these views were rejected by mainstream science, this group took its views and arguments into the public domain, actively campaigning via newspapers, radio, and television to make its views known to the lay public. I describe some of the harmful consequences of the group's activities, and ask two distinct ethical questions: what moral obligations do scientists who hold such minority views have with regard to a scientifically untrained lay audience, and what moral obligations do mainstream newspapers and government politicians have when it comes to such views. The latter question will be asked because the 'dissidents' succeeded for a number of years in convincing the South African government of the soundness of their views. The consequences of their stance affected millions of HIV infected South Africans severely.

This article by one of the Editors of Bioethics, published in the 25th anniversary issue of the journal, describes some of the revolutionary changes academic publishing has undergone during the last decades. Many humanities journals went from typically small print-runs, counting by the hundreds, to on-line availability in thousands of university libraries worldwide. Article up-take by our subscribers can be measured efficiently. The implications of this and other changes to academic publishing are discussed. Important ethical challenges need to be addressed in areas such as the enforcement of plagiarism-related policies, the so-called ‘impact factor’ and its impact on academic integrity, and the question of whether on-line only publishing can currently guarantee the integrity of academic publishing histories

ABSTRACT Most pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that affect the poor. Benefit sharing as a strategy is conceptually problematic, even if one, as we do, agrees that impoverished indigenous communities should not be exploited and that they should be assisted in improving their living conditions. The accepted concept of intellectual property protection envisages clearly defined originators and owners of knowledge, whereas the concept of community membership is fluid and indigenous knowledge is, by its very nature, open, with the originator(s) lost in the mists of time. The delineation of ‘community’ presents serious conceptual and practical difficulties as few communities form discrete, easily discernable groups, and most have problematic leadership structures. Benefit sharing is no substitute for governments’ responsibility to uplift impoverished communities. Benefit sharing arrangements may be fraught with difficulties but considerations of respect and equity demand that prior informed consent and consultation around commercialisation of knowledge take place with the source community and their government.1.

This article analyses, from a bioethics journal editor's perspective, the threats to academic freedom and freedom of expression that academic bioethicists and academic bioethics journals are subjected to by political activists applying pressure from outside of the academy. I defend bioethicists’ academic freedom to reach and defend conclusions many find offensive and ‘wrong’. However, I also support the view that academics arguing controversial matters such as, for instance, the moral legitimacy of infanticide should take clear responsibility for the views they defend and should not try to hide behind analytical philosophers’ rationales such as wanting to test an argument for the sake of testing an argument. This article proposes that bioethics journals establish higher-quality requirements and more stringent mechanisms of peer review than usual for iconoclastic articles