Emma Tumilty

In ‘Patients, doctors and risk attitudes,’ Makins argues for ‘straightforwardly’ (Makins1 p1) extending antipaternalistic views about medical decision-making to include deferential considerations of risk attitudes that a patient might endorse. Reflecting on Makins’ important contribution to higher order attitudes in decision theory, we seek to clarify the practical applicability of his argument to specific clinical settings, namely in mental health. We argue that considering low and higher order risk preferences are not only practically difficult, but also potentially ethically fraught and especially so in the provision of mental healthcare. Deferring to risk attitudes potentially mutes a more robust curiosity of patients’ preferences and desires that can promote both autonomy and beneficence but are explicitly relationally grounded. We argue that a relational understanding of autonomy is a much more robust way of thinking about the value of risk attitudes among other patient preferences, attitudes and goals. Makins rightly expounds on the challenges faced by healthcare professionals who are often required to make determinative recommendations for their patients. Providers must explain uncertain benefits in relation to uncertain risks, therefore, exploring the risk attitudes of patients, appears, prima facie, a rational, patient-centred and autonomy-promoting choice. It invariably invites discussion of Perske’s 1972 dignity of …

Debates regarding clinical ethicists’ scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists’ roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space. Such expanded capacities offer more robust, positive contributions to institutional culture, stakeholders’ relationships, and patient-centered care.

This book surveys the distinctions that underlie the unbound potential and existential risks of life expansion and radical modifications posed by a transhuman world. Humanness is in flux as human bodies are being hacked and altered in their quest for super wellness, super intelligence and super longevity. Now is the time to discuss how best to think about dealing with bodies that have been hacked to exceed natural physical limits or more technically, species typical functioning. Enter the advent of transhumanism to take uncertainty by the horns. According to transhumanists, death is unnecessary and medical conventions undermine the possibility to radically evolve. To biohackers, there is no need to wait to explore the risks that conventional medicine dares not. This book is of interest to anyone interested in tapping into this growing movement of modifying the human body as it is right now.

In order to create sustainable health systems, many countries are introducing ways to prioritize health services underpinned by a process of health technology assessment. While this approach requires technical judgments of clinical effectiveness and cost-effectiveness, these are embedded in a wider set of social (societal) value judgments, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritization and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritization process.

This paper demonstrates the limited efficacy procedural ethics has for qualitative research. Ethics committee's instructions have a short shelf life given the research question qualitative researchers create is volatile; that is, likely to change due to the inductive, emergent, informant-led nature of qualitative research. Design-This article draws on extensive literature to examine the void between the original research design and the messy reality experienced in the field. We focus on how researchers can practice ethically by recognizing the need for agile and responsive ethics praxis in their work. Findings-This practice describes the researcher, recognizing the initial support from an ethics committee and its limitations, but as the research gets underway assuming full responsibility for ethical considerations that emerge in the field. Practical implications-Researchers' responsibilities entail recognising the dual …

The COVID-19 pandemic has changed the world. The depth and breadth of changes are still unfolding. What is the place of feminist bioethics in this new world? It's important to point out that COVID-19 is only one of a few major catastrophes we are facing as humans. The ongoing and worsening effects of climate change, along with the paltry efforts of politicians to address it, are an urgent concern. Humanitarian crises caused by climate change, by COVID-19, or crises unrelated to either but surely worsened by both, are also...

Finding Your Ethical Research Self introduces novice researchers to the need for ethical reflection in practice and gives them the confidence to use their knowledge and skill when, later as researchers, they are confronted by big ethical moments in the field. The 12 chapters build on each other, but not in a linear way. Core ethical concepts like consent and confidentiality once established in the early chapters are later challenged. The new focus becomes how to address qualitative research ethics when confidentiality and consent take on a limited form. This approach helps students understand that the application of concepts always requires thoughtful adaptation in different contexts and the book provides guidance on how to do this. Classroom/workbook exercises develop alternative solutions to create process consent, internal confidentiality, and engage reference groups, as examples. The first eight chapters allow students to develop their ethical research self before thinking through how they might address formal ethics review. Formal ethics review is deliberately not introduced until Chapter 9. Chapter 10 offers practical help to elements of review, before Chapter 11 emphasises the key message by providing examples of researchers' dilemmas in the field using vignettes and discussion. By providing these examples, students become aware that these can arise, explore how they might arise, and recognise how they might deal with them in the moment when they are unavoidable. With numerous examples of ethical dilemmas and issues and questions and exercises to encourage self-reflection, this reflexive, learn-by-doing model of research ethics will be highly useful to the novice researcher, undergraduate, and postgraduate research student.

COVID-19 has meant that the past year has been difficult for everybody and terrifying and heartbreaking for many. We here at IJFAB found ourselves, for the first time, separated by physical distances and pandemic-era planning that precluded those necessary in-person meetings and less formal interactions during conferences and other social occasions that connect so much of the feminist bioethics community. The editorial team has been variously in lockdown, shielding because of health vulnerabilities, or ill, in our different cities and continents. Alongside so many of our readers, contributors, and reviewers, Zoom became the space where we tried to continue to bring you what we consider...

In this chapter we outline the need to develop ethical frameworks to guide research on the role of animal-orientated health, therapeutic, and service interventions. We discuss findings from our research on uses of animals in therapeutic settings and benefits of human–canine interactions for human health. These stories from the field reveal that current ethics review processes do not recognise the animal as an equal partner in the potential reciprocal benefits and risks of therapeutic human–animal relationships. We explore how these review processes frame research on the relationships between humans and non-human animals and use the ethical review system of Aotearoa/New Zealand as an example. We propose an ethical framework that goes beyond animal welfare legislation and recognises a range of non-human animal capacities.