Paul Cummins

The need for high-quality, accessible training in responsible conduct of research (RCR) globally is evident in the annual increase in paper retractions for scientific misconduct. This paper describes an RCR course that we developed as part of a master’s in bioethics degree (MScB) program available to a culturally and linguistically diverse group of scientists, clinicians, and other research stakeholders from low- and middle-income countries (LMICs). The course has been delivered fully online simultaneously in English and Spanish using instructional materials informed by the perspectives of two culturally diverse co‑teaching faculty members. In addition to aiming to educate learners and inspire them to conduct research responsibly and motivate others to do so, thets pedagogical and technical design of the course is intentionally structured to strengthen fellows’ critical thinking, deepen their understanding of regional and international research ethics guidance, and promote collaboration between Spanish‑ and English‑speaking participants. The RCR course has earned Quality Matters certification, reflecting its commitment to high‑quality online pedagogy, whilst containing cost. In this paper, we outline the course’s structure and core design elements to offer a model that can be adapted for other RCR programs across diverse countries and cultural contexts.

In response to anthropogenic climate change, bioethics scholars have advocated a return to its roots in Van Rensselaer Potter's vision of bioethics as a discipline integrating the humanities and the sciences to support ecology. These scholars have noted that the discipline of bioethics diverged from this vision, and today its focus is on human health. This paper's ultimate argument is that these scholars do not appreciate the radicalness of their proposal and its potential to disrupt the discipline. This paper's argument unfolds in four steps. In the first step, the paper describes the environmental impact of U.S. health care and claims that contemporary bioethics is unlikely to prioritize environmental protection over patients because of its humanistic character. To emphasize this character, this part of the paper identifies two forms of health care treatment that bioethics would not deny to patients despite their environmental costs. The second step of the paper is to review the scientific fact of man-made climate change and its inauguration of a new geological epoch, the Anthropocene. Then, the third step of this paper reflects on this fact's impact on the category of humanist understanding. The central idea in the third part of this paper is that the Anthropocene undermines the traditional dichotomy between man and nature, which is conceptually necessary for humanist philosophy. If the human is not a distinct category, then attributing preeminent value to humans is invalid, undermining the system of thought centered on humans. The final step in this paper argues that the consequence of reckoning with contemporary ecology is that it generates a demand for a new system of value–and Anthropocene ethics – that deprioritizes human good, and which would provide rebuttals to criticisms that such a system of values is misanthropic. An Anthropocene ethics may justify prioritizing environmental protection over patients’ health needs.

Chaplains frequently serve on ethics committees, as ethics consultants, and as Institutional Review Board (IRB) members in hospitals. However, little is known about how Clinical Pastoral Education (CPE) residents are trained in ethics and whether this training is appropriate or adequate for chaplains' subsequent work in health care settings. We created a survey to canvas 222 CPE residency programs in the United States accredited by the ACPE: The Standard for Spiritual Care (ACPE) to inquire about the prevalence of ethics curricula within residency programs, the educational structure of ethics curricula, and challenges associated with teaching ethics within CPE. We received a total of 84 responses for a 38% response rate. Of these, three-quarters of the programs had a required ethics curriculum, another 10% were in the process of developing one, and 18% had none. There was a great deal of variability in the ethics curricula among the different programs. Developing guidelines for a standardized ethics curriculum could help healthcare chaplains provide more effective service on ethics committees, as ethics consultants, and as IRB members.

Financial reimbursements after receiving the coronavirus disease 2019 (COVID-19) vaccine have been criticized in the literature. This strategy has been described as payment to receive the vaccines, undue inducement, and unethical. We are aware that healthcare workers who work in primary healthcare, prevention, and public health may encounter similar reasons from people who refuse vaccination against COVID-19. For this reason, we are compelled to clarify these claims and provide arguments for all healthcare workers who might be challenged by such reasoning. In this critical review, we discuss why the claims against financial incentives that have been presented in the literature are erroneous.

Providing education is a common justification for the professional value of clinical ethicists (CEs). We argue for a cautious approach in claiming educational benefits from CEs' activities. CEs' contributions to consultation, policy development, and research are recognized, but their role as educators is less well-defined. We describe various modes - formal, semi-formal, and informal - of education CEs may provide to healthcare institutions. Formal education in a defined curriculum primarily takes place in academic medical centers. This is the most structured and measurable form of education CEs may provide because standardized assessments for this form of instruction exist. Semi-formal education, usually taking the form of ad hoc lectures and debriefings, may occur at any healthcare institution but not within a set curriculum. Semi-formal education is flexible but there are not established robust mechanisms for assessing its educational impact. Finally, CEs provide informal education implicitly and spontaneously during their clinical ethics consultations. While this is secondary to the clinical ethics consultations, adult learning theory suggests that the informal education occurring in them has a great potential. In the absence of systematic evaluations of impact, however, claims of educational benefit will be unsubstantiated. We also observe that CEs and their institutions must judiciously balance CEs' educational responsibilities with their primary consulting role to ensure they function effectively as clinical ethics consultants. We conclude that the field should include pedagogical development in clinical ethics training and develop assessment tools for semi-formal and informal ethics education to buttress claims that CEs provide educational benefit.

Objective To examine opinions about incentives for vaccination against COVID-19. Methods A qualitative study was conducted in spring 2022. The study population consisted of pairs of university students and their parents throughout Serbia. The qualitative content analysis was applied. Results A total of 18 participants (9 student-parent pairs) were included. The following themes were identified: 1) Attitudes about financial incentives for vaccination, 2) Non-financial incentives for vaccination, and 3) Suggestions to enhance vaccination coverage. Theme 1 comprised several subthemes: General response to money, Dissatisfaction with financial incentives, Satisfaction with financial incentives and Amount of money to change people’s opinion. Most parents and some students expressed a clear dissatisfaction and disapproval of the concept of financial incentives for compliance with vaccination. Financial offers would not make our participants change their position on whether to receive the vaccine, as no major differences in attitude towards vaccinations between the vaccinated and the non-vaccinated study participants was observed. Non-financial incentives were more acceptable compared to financial ones, but they were also seen as beneficial for some and not others. Conclusions Financial incentive programs’ potential for inefficiency and public mistrust make other methods to boost vaccine uptake better public health choices for now.

Ten years have passed since the last regional assessment of the state of Fogarty International Center-funded research ethics education and challenges facing research ethics in Latin America and the Caribbean basin. Program directors and faculty from four international research ethics education programs met in Spring 2024 to discuss their progress, challenges, and future priorities. The themes that emerged from these discussions were the structural difficulties faced by regional ethicists, the use of pedagogical innovations to mitigate different barriers faced by fellows, and the need to anticipate future challenges for the region including climate change.

As a response to the well-documented projects for how anthropogenic climate change (ACC) will negatively impact human health, health and bioethics scholars have argued for the urgency of mitigating ecological damage healthcare systems cause. Mitigation is not the only focus because ACC is already affecting health. Under current plans to reduce emissions, the sixth Intergovernmental Panel on Climate Change (IPCC) predicts warming to exceed safe levels. Climate health scholars have begun to advocate for climate change adaptation (CCA) as it is essential to anticipate and prepare for how extreme ACC will affect health. CCA strategies that emphasize continuity of operation in the face of extreme weather events dominate. These plan project the future climate to be much like the present one, just worse, and assume an unwarranted future of climate stability. Recent scientific evidence indicate ACC is accelerating faster than climate models predicted. We may be moving from an era of climate stability to an era of instability. The dominance of CCA in preparing for ACC will, at best, preserve the status quo for population health at the expense of envisioning initiatives to help all people live healthier lives in a radically changed world. To prepare for an unstable climate future, healthcare should adopt a stance of climate change resilience that prioritizes public health initiatives to secure healthier lives among a broader population segment.

That Jehovah’s Witnesses may refuse lifesaving blood transfusions is a morally accepted feature of contemporary medical practice. The principle of respect for autonomy supports this, and there is seldom reason to interfere with this choice because it rarely harms another individual. Advances in surgical technique have made it possible for transplant surgeons to perform bloodless organ transplant, enabling Jehovah’s Witnesses to benefit from this treatment. When the transplant organ is a directed donation from a family member or friend, no ethical dilemma arises. However, when a Jehovah’s Witness cannot identify a living donor and wishes to be listed for organ transplant, the transplant team may face an ethical dilemma. On the one hand, it wishes to provide care to the patient that is compatible with her or his preferences. On the other hand, the team may wonder if it is fair to other patients who need an organ and will accept blood transfusion to include the Jehovah’s Witness patient on a waiting list for a donated organ. If the Jehovah’s Witness patient is listed and receives an organ, then a patient who also needs an organ, and who is willing to accept all care to optimize the success of the transplant, may be denied an organ.To frame the ethical dilemma outlined above we present an anonymized case of a Jehovah’s Witness woman in urgent need of a kidney, who was referred to one of the authors’ institution’s transplant center. We review the evolution of the Jehovah’s Witness position on blood transfusion and the medical community’s efforts to provide care that accommodates this religious commitment. If Witnesses are to be denied transplant in the name of justice, there must be an ethically sound reason. We identify two rationales in the literature: (1) this allocation is unacceptable because it will cost lives; (2) resources should be allocated to patients who comply with the standard of care. We argue that neither apply to this dilemma. We also emphasize the importance of examining the data on outcomes of transplant with and without transfusion. Our interpretation of the published data on transplant without transfusion is that the outcomes are similar. We conclude that, in the absence of data that resources are risked, it is not ethical to refuse to include a Jehovah’s Witness patient on a waiting list for an organ. Finally, we reflect on the heterogeneity in transplant institutes’ polices for accepting Jehovah’s Witness patients.

The aim of this paper is to analyze an Intensive Care Unit case that required ethics consultation at a University Hospital in Northern Italy. After the case was resolved, a retrospective ethical analysis was performed by four clinical ethicists who work in different healthcare contexts. Each ethicist used a different method to analyze the case; the four general approaches provide insight into how these ethicists conduct ethics consultations at their respective hospitals. Concluding remarks examine the similarities and differences among the various approaches and offer a reflection concerning the possibility of a shared resolution to the case. The authors’ efforts to come to a tentative consensus may serve as an example for professionals working in medical contexts that reflect an increasing pluralism of values. This article aims to respond to some of these concerns by illustrating how different methods in clinical ethics would be used when considering a real case. The goal is not to establish the best model on a theoretical level, but to learn from actual practice in order to see if there are common elements in the different methods, and to validate their pertinence to clinical ethics consultation.

From February 2020, the COVID-19 pandemic led to closures of educational institutions to reduce the spread of infectious disease. This forced the U.S. education system into a massive experiment with online education. Despite conducting online bioethics education for nearly twenty years, our bioethics program, a joint endeavor of Clarkson University and Icahn School of Medicine at Mount Sinai, was not immune to this disruption because our curriculum features intensive, one-week onsite courses. Even in the face of historic disruptions, it is vital to ensure minimal interruptions to teaching and assessing students to provide effective education. This paper reviews the steps we took to successfully convert the onsite components of our curriculum to a synchronous online format, and it focuses on how we preserved instruction and assessment of practical skills that comprise these courses’ core. It also explains how we fostered interactive classroom environments.

This article attempts to motivate a reorientation of ethical analysis of conscientious objection by physicians. First, it presents an illustrative case from a hospital emergency department for context. Then, it criticizes the standard pro- and anti-CO arguments. It proposes that the fault in standard approaches is to focus on the ethics of the physician’s behavior, and a better way forward on this issue is to ask how the party against whom the physician exercises the CO ought to respond. It connects this question with recent trends in physician employment models, which suggest that CO may become a potential source of conflict in the future. The article then develops a relational account of CO that extends James Childress’ insights about the nature of CO in “Appeals to Conscience”. This relational account characterizes CO as a two-place relation between conscientious objector and expectant party, in which the conscientious objector makes a request of the expectant party, which has implications that will be welcome and unwelcome for both the pro- and anti-CO camps. Finally, the paper applies this relational account of CO to the case when the physician is an employee. This application demonstrates that it is highly context dependent whether or not an employer should accede to the CO requests of physician–employees.