Alexa Nord-Bronzyk

The dominance of ableist assumptions in precision medicine has recently been challenged, notably by Mintz, Stramondo, and Tabor (2024). Yet a similarly radical critique exists in Daoist traditions, particularly in the philosophy of Zhuangzi. While Mintz, Stramondo, and Tabor call for greater disability inclusion in genetics and genomics, they do not fully engage with how cultural and philosophical worldviews shape responses to genetic intervention. Drawing on our research on preimplantation genetic testing for monogenic disorders (PGT-M), we argue that concepts like ziran (自然naturalness) and wuwei (無為non-action) can deepen our understanding of disability inclusion, particularly in Asian contexts. The comparatively restrictive approval of PGT-M in Asia reflects cultural discomfort with disrupting what is seen as nature’s course. Zhuangzi’s allegories—especially those illustrating “the usefulness of the useless”—challenge dominant hierarchies of ability and provide clinicians with tools to engage more sensitively with patients who may see genetic testing as ethically troubling. This paper integrates Daoist insights to propose a globally inclusive bioethics, one that affirms non-intervention as a legitimate stance and broadens how we conceive of naturalness, disability, and autonomy. By doing so, we aim to enrich debates around precision medicine and support ethically pluralistic genomic care.

Contemporary Western bioethics, informed by liberalism and utilitarianism, has developed alongside a proactive, interventionist model of medicine marked by the assumption that every illness has a cure and that pain is unnecessary. In contrast, medical practice in much of Asia reflects different philosophical roots. One of these, Daoism, embraces a very different attitude towards medical intervention. Within Daoist philosophy, the unique understanding of naturalness or spontaneity ( ziran, 自然) helps illuminate some anti-interventionist trends within medical practice in parts of Asia historically influenced by this tradition. We illustrate this through the relatively low uptake of epidural use among expectant mothers in Japan. Although Daoism originated in China, Daoist concepts influenced the formation of Zen Buddhism through the historical transmission of Chinese philosophy and medicine, particularly during the Tang and Song periods. Although often subtle, this influence has shaped modern cultural attitudes discussed below. Philosophical Daoism is usually discussed in relation to two main texts, the Laozi and the Zhuangzi. ‘Dao’ (道) is understood as the metaphysical source of all things and the guiding principle of nature. A closely related concept is ‘ziran’ (自然), often translated as spontaneity, naturalness or being ‘self-so’. If Dao is the guiding principle, ziran is the way it is expressed in the natural world. Importantly, ziran exists at multiple levels: an overarching ‘ziran’ of nature and a personal ‘ziran’ of each individual. In Daoist philosophy, there is a strong belief in the inherent goodness of nature and going with the flow of nature is often held up as an ethical ideal. Along with this, the concept of health is often understood less as the elimination of disease and more as …

Controlled Human Infection Models (CHIMs) are a type of clinical trial involving deliberately exposing human volunteers to an infectious agent. Compared to studies of natural infection, CHIMs offers distinctive benefits, from the ability to study presymptomatic infection to a direct assessment of the efficacy of vaccines and therapeutics in a shorter time and involving fewer participants. Although the CHIMs do not fundamentally differ from other early‐phase clinical trials, they raise a unique set of ethical considerations. Modern CHIMs have been limited to studies which pose very low risk of participants experiencing serious adverse events, and CHIMs which lie on the upper end of risk remain controversial. Setting risk thresholds for more hazardous trials has become a topic of debate leading to various attempts to develop a model to ethically evaluate these risks. While there are now well‐accepted practices around established pathogens, future pandemics may involve more extreme threats to public health and CHIMs may have an important emergency rescue function, with some groups willing to undertake significant risks. We must ask, what risk of death and serious morbidity should future CHIMs permit in the face of such challenges? This paper proposes a taxonomy laying out three possible approaches for thinking about risk thresholds in CHIM: (1) consistency; (2) engaging community perspectives; and (3) no risk threshold. We explore the strengths and weaknesses of each approach and offer a resource for those in the research community to inform their evaluation of the ethical permissibility of current and future CHIM.

In this paper, we set out to examine the implications of a Daoist philosophical perspective within the clinical encounter. Specifically, we will explore how the unique and sometimes radical views of the Ancient Daoist philosopher Zhuangzi (and the concepts of ziran 自然 “nature” or “spontaneity”, the fasting of the “heart-mind” cheng xin 成心, and wuwei 無為 “non-action”) can invite us to reframe and reconceptualize some of the common assumptions that currently govern the doctor-patient relationship, as well as prompt us to reflect anew upon the proper goals and scope of medical practice itself. We take the view that ethics need not be limited to a set of rules. Ethics can be thought of as a set of skills and abilities that include perspective taking, tolerance and openness to experiences. This allows us to explore and critically engage with Zhuangzi’s unique philosophy and appreciate its contribution to the bioethics literature, in particular with its applications in caring for patients with disability and chronic illness. Our analysis leads us to coin the term “reciprocal-emerging” to express the dynamic and transformational of nature of the doctor-patient relationship through a Zhuangzian lens.

© 2015 Elsevier Inc.We demonstrate using conditional mutagenesis that Pbx1, with and without Pbx2+/- sensitization, regulates regional identity and laminar patterning of the developing mouse neocortex in cortical progenitors and in newly generated neurons. Pbx1/2 mutants have three salient molecular phenotypes of cortical regional and laminar organization: hypoplasia of the frontal cortex, ventral expansion of the dorsomedial cortex, and ventral expansion of Reelin expression in the cortical plate of the frontal cortex, concomitant with an inversion of cortical layering in the rostral cortex. Molecular analyses, including PBX ChIP-seq, provide evidence that PBX promotes frontal cortex identity by repressing genes that promote dorsocaudal fate.

Risk prediction in emergency medicine (EM) holds unique challenges due to issues surrounding urgency, blurry research-practise distinctions, and the high-pressure environment in emergency departments (ED). Artificial intelligence (AI) risk prediction tools have been developed with the aim of streamlining triaging processes and mitigating perennial issues affecting EDs globally, such as overcrowding and delays. The implementation of these tools is complicated by the potential risks associated with over-triage and under-triage, untraceable false positives, as well as the potential for the biases of healthcare professionals toward technology leading to the incorrect usage of such tools. This paper explores risk surrounding these issues in an analysis of a case study involving a machine learning triage tool called the Score for Emergency Risk Prediction (SERP) in Singapore. This tool is used for estimating mortality risk in presentation at the ED. After two successful retrospective studies demonstrating SERP’s strong predictive accuracy, researchers decided that the pre-implementation randomised controlled trial (RCT) would not be feasible due to how the tool interacts with clinical judgement, complicating the blinded arm of the trial. This led them to consider other methods of testing SERP’s real-world capabilities, such as ongoing-evaluation type studies. We discuss the outcomes of a risk–benefit analysis to argue that the proposed implementation strategy is ethically appropriate and aligns with improvement-focused and systemic approaches to implementation, especially the learning health systems framework (LHS) to ensure safety, efficacy, and ongoing learning.