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‘Moral bioenhancement’ refers to the use of pharmaceuticals and other direct brain interventions to enhance ‘moral’ traits such as ‘empathy,’ and alter any ‘morally problematic’ dispositions, such as ‘aggression.’ This is believed to result in improved moral responses. In a recent paper, Tom Douglas considers whethermedical interventions of this sort could be “provided as part of the criminal justice system’s response to the commission of crime, and for the purposes of facilitating rehabilitation : 101–122, 2014).” He suggests that (...) they could “at least in some cases, permissibly be provided without valid consent : 101–122, 2014)” as a form of rehabilitative punishment. He argues for this conclusion by ‘parity of reasoning,’ starting from the currently accepted practice of non-consensual incarceration. His argument appears to be dependent on the successful defence of the following two claims: that non-consensual incarceration is a morally justifiable practice, and that there is no meaningful distinction between the forcible imposition of this practice, and the forcible imposition ofmedical interventions on prisoners. From both claims, he deduces : if non-consensual incarceration is morally justifiable, so is the non-consensual imposition ofmedical correctives, in some cases. In this paper, I begin by suggesting that the basic argument behind the Parity Claim results in a reductio ad absurdum, whereby any practice that is sufficiently similar to incarceration in the ways Douglas presents, would also be considered permissible. This appears to be an unpalatable conclusion, casting doubt on the soundness of a key premise. Douglas appears to offer no means of deciding which practices are sufficiently similar to incarceration in terms of harm and threat to agency, and of the practices that I will present, which do seem to be, it does not seem that he could rule them out in any principled way. Next I turn to dispute claim relating to the purported justifiability of incarceration on rehabilitative grounds. If successful, this attack causes a break in reasoning from the justifiability of incarceration, to the justifiability ofmedical interventions.Medical interventions would then require an alternative, independent justification, through outlining the ways in which they are conducive to a particular aim of punishment, without relying on the justifiability of incarceration. This argument has not been provided, and I suggest that attempts to do so may run into difficulty. I untangle and make explicit the various assumptions made in Douglas’ contention thatmedical interventions “might be thought conducive to rehabilitation in some offenders,” locating my critique in the wider debate on the causes of crime. Finally, I seek to challenge the normative weight of the Parity Claim, arguing that to show that two practices are comparable in some sense is not sufficient to show that both are equally as permissible. Other social purposes must be considered, leading me to suggest that the forcible impositionmedical correctives falls beyond the appropriate remit of the criminal justice system. (shrink)

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Would compulsory treatment or vaccination for Covid-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic. We argue that, if the permissive English approach to external constraints for Covid-19 has been justified, then there is a case for a similarly permissive approach (...) to compulsorymedical interventions. (shrink)

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There have been growing calls within Australia and beyond to defermedical interventions for children born with variations in their sex characteristics. These calls are increasingly grounded in the claim that such interventions when performed on infants and young children are a violation of their human rights. This paper examines the basis for this claim. It also examines the differences between the principles-based approach tomedical ethics which has tended to dominant decisions regarding the treatment of children born (...) with variations in their sex characteristics, relative to the adoption of a rights-based approach. It identifies the points of complementarity between these two discourses but suggests that a rights-based approach offers some unique and differing insights into several issues concerning children born with variations in their sex characteristics. (shrink)

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Criminal offenders are sometimes required, by the institutions of criminal justice, to undergomedical interventions intended to promote rehabilitation. Ethical debate regarding this practice has largely proceeded on the assumption thatmedical interventions may only permissibly be administered to criminal offenders with their consent. In this article I challenge this assumption by suggesting that committing a crime might render one morally liable to certain forms ofmedicalintervention. I then consider whether it is possible to respond (...) persuasively to this challenge by invoking the right to bodily integrity. I argue that it is not. (shrink)

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To be effective, amedicalintervention must improve one's health by targeting a disease. The concept of disease, though, is controversial. Among the leading accounts of disease-naturalism, normativism, hybridism, and eliminativism-I defend a version of hybridism. A hybrid account of disease holds that for a state to be a disease that state must both (i) have a constitutive causal basis and (ii) cause harm. The dual requirement of hybridism entails that amedicalintervention, to be deemed (...) effective, must target either the constitutive causal basis of a disease or the harms caused by the disease (or ideally both). This provides a theoretical underpinning to the two principle aims ofmedical treatment: care and cure. (shrink)

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Traditionally, mechanistic reasoning has been assigned a negligible role in standard EBM literature, although some recent authors have argued for an upgrade. Even so, the mechanistic reasoning that has received attention has almost exclusively been positive—both in an epistemic sense of claiming that there is a mechanistic chain and in a health-related sense of there being claimed benefits for the patient. Negative mechanistic reasoning has been neglected, both in the epistemic and in the health-related sense. I distinguish three main types (...) of negative mechanistic reasoning and subsume them under a new definition of mechanistic reasoning in the context of assessingmedical interventions. This definition is wider than a previous suggestion in the literature. Each negative type corresponds to a range of evidential strengths, and it is argued that there are differences with respect to typical evidential strengths. The variety of negative mechanistic reasoning should be acknowledged in EBM, and it presents a serious challenge to proponents of so-calledmedical hierarchies of evidence. (shrink)

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The classification ofmedical interventions as either invasive or non-invasive is commonly regarded to be morally important. On the most commonly endorsed account of invasiveness, amedicalintervention is invasive if and only if it involves either breaking the skin (‘incision’) or inserting an object into the body (‘insertion’). Building on recent discussions of the concept of invasiveness, we show that this standard account fails to capture three aspects of existing usage of the concept of invasiveness in (...) relation tomedical interventions—namely, (1) usage implying that invasiveness comes in degrees, (2) that the invasiveness of anintervention can depend on the characteristics of the salient alternative interventions, and (3) thatmedical interventions can be invasive in non-physical ways. We then offer the beginnings of a revised account that, we argue, is able to capture a wider range of existing usage. Central to our account is a distinction between two properties: basic invasiveness and threshold invasiveness. We end by assessing what the standard account gets right, and what more needs to be done to complete our schematic account. (shrink)

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A central tenet ofmedical ethics holds that it is permissible to perform amedicalintervention on a competent individual only if that individual has given informed consent to theintervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering amedicalintervention is outweighed. For example, if an individual’s refusal to undergo amedicalintervention would lead to the transmission of (...) a dangerous infectious disease to other members of the community, one might claim that it would be morally permissible to administer theintervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensualmedical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

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This study examines the ends ofmedicalintervention and argues that mainstream contemporary medicine assumes that appropriate ends may be discovered (i.e., naturalism), rather than created or decided upon (i.e., conventionalism). The essay then applies these considerations to the problem of the demarcation of the normal from the pathological. I argue that the common formulations of this dispute commit a fallacy, as they characterize the "normal" as a state of the organism and not as an ongoing process within (...) it. Such a process may be characterized as self-creation and self-repair. Such considerations support the conclusion that normality may be regarded as a regulative idea, rather than as an end-state, and as part of the ends ofmedicalintervention, depending upon choice and context. (shrink)

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Allocation of very scarcemedical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, (...) and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles. (shrink)

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The Supreme Court’s decision in the Dobb’s case has given rise to confusion in themedical community, mostly concerning the specific definition of an abortion and what procedures are acceptable. Catholic bioethics has a long history of examining the ethical issues surrounding procedures used in vital conflict situations and other instances where direct or indirect abortion may be the preferred treatment. This article lays out the important points and ethical dimensions surrounding some of the most common pregnancy related interventions (...) and provides guidance to physicians seeking to treat both patients in a manner that acknowledges their value as human beings. (shrink)

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This paper discusses a series of important methodological issues in developing targeted health-related quality of life measures in studies of the effects ofmedical interventions. Such measures cannot be developed unless the evaluator understands the life domains thatmedical interventions affect. Qualitative discovery methods are needed to obtain this understanding. Once domains are targeted for measurement, careful and systematic laboratory pilot work should be used to select initial scale items. Psychometric evaluation of response patterns in subsequent field tests (...) is needed to assess the measures. Less concern should be directed to internal consistency reliability of scales in the psychometric evaluation and more to the ability of short scales to reproduce total scale variance and to provide precise measurement within the range of the outcome where effects are expected. The paper closes with a discussion of modern methods of item response scaling that can be used to address these issues. (shrink)

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We often hear stories of people in terrible and seemingly intractable situations that are preyed upon by individuals offering empty promises of help. Frequently these cases are condemned as "exploiting the hope" of another. These accusations are made in a range of contexts, including human smuggling, the beauty industry, and unprovenmedical interventions. This concept is meant to do heavy lifting in public discourse, identifying a specific form of unethical conduct. However, it is poorly understood what is intended to (...) be wrong by exploiting hope, the range of activities that can accurately be captured under this concept, and what should be done about it. Thus, it is an ethical concept that is ripe for extended analysis and discussion. (shrink)

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Medical interventions that cure or preventmedical conditions are central to medicine; and thus, understanding them is central to our understanding of medicine. My purpose in this paper is to explore the conceptual foundations of medicine by providing a singular analysis of the concept of a ‘preventive or curativemedicalintervention’. Borrowing a general account of prevention from Phil Dowe, I provide an analysis of prevention, cure, risk reduction, and a preventive or curativeintervention, before (...) turning to preventive and curativemedical interventions. The resulting counterfactual-mechanistic account holds that preventive and curativemedical interventions reduce the probability of amedical condition in an actual population compared to their counterfactual omission, commonly by disrupting an etiological or constitutive mechanism for the condition. (shrink)

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Many health care systems include programs that allow patients in exceptional circumstances to accessmedical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, (...) including the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. (shrink)

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Medical interventions such as methadone treatment for drug addicts or “chemical castration” for sex offenders have been used in several jurisdictions alongside or as an alternative to traditional punishments, such as incarceration. As our understanding of the biological basis for human behaviour develops, our criminal justice system may make increasing use of suchmedical techniques and may become less reliant on incarceration. Academic debate on this topic has largely focused on whether offenders can validly consent tomedical (...) interventions, given the coercive environment of the criminal justice system. Both sides in this debate share the assumption that administeringmedical interventions to offenders without their valid consent would be unethical. Recently, Thomas Douglas has mounted a formidable challenge to this “consent requirement”. Essentially, his argument rests on a comparison between prison andmedical interventions. Douglas asks: if the state is entitled to impose a prison sentence on a criminal without the criminal’s consent, why is consent required for the imposition of amedicalintervention? The most obvious way of defending the consent requirement against Douglas’s challenge appeals to the fact that incarceration merely interferes with the right to free movement, butmedical interventions interfere with the right to bodily integrity. This argument rests on what Douglas calls the “robustness claim”—the claim that the right to bodily integrity is more robust than the right to freedom of movement. In other words, the right to freedom of movement loses its protective force in a wider range of circumstances than the right to bodily integrity. Douglas’s article seeks to undermine the robustness claim, by arguing that neither case-based intuitions, nor theoretical considerations support this claim. In this article, I will attempt to raise some doubts about Douglas’s challenge to the consent requirement and the robustness claim. (shrink)

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The notion of causal evidence in medicine has been the subject of wide philosophical debate in recent years. The notion of evidence has been discussed mostly in connection with Evidence Based Medicine and, more in general, with the assessment of causal nexus inmedical, and especially research contexts. “Manipulative evidence” is one of the notions of causal evidence that has stimulated much debate. It has been defined in slightly different ways, attributed different relevance, and recently placed at the core (...) of Gillies’ “action-related theory of causality”, a view specifically meant to address causation in medicine. While in general sympathetic to Gillies’ account, and totally convinced of the relevance of manipulative evidence and different sorts of interventions in the biomedical sciences, we believe that some further qualifications are needed to allow the notion of manipulative evidence to better express features ofmedical practice. In particular, we provide some qualification of the role of “interventional evidence” proposed by Gillies, suggesting a distinction between “interventional evidence” and “evidence for interventions”. A case study from research on rare diseases is analyzed in depth and a multifaceted notion of manipulative evidence put forward that allows better understanding of what manipulations inmedical contexts amount to and what their targets are. (shrink)

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Hastings Center Report, Volume 52, Issue 2, Page 32-40, March‐April 2022.

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The ever increasing ability ofmedical technology to reshape the human body in fundamental ways—from organ and tissue transplants to reconstructive surgery and prosthetics—is something now largely taken for granted. But for a philosopher, such interventions raise fundamental and fascinating questions about our sense of individual identity and its relationship to the physical body. Drawing on and engaging with philosophers from across the centuries, Jenny Slatman here develops a novel argument: that our own body always entails a strange dimension, (...) a strangeness that enables us to incorporate radical physical changes. (shrink)

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Increasing ethical attention and debate is focusing on whether individuals who take part in clinical trials should be given access to post-trial care. However, the main focus of this debate has been upon drug trials undertaken in low-income settings. To broaden this debate, we report findings from interviews with individuals (n = 24) who participated in a clinical trial of a closed-loop system, which is amedical device under development for people with type 1 diabetes that automatically adjusts blood (...) glucose to help keep it within clinically recommended ranges. Individuals were recruited from UK sites and interviewed following trial close-out, at which point the closed-loop had been withdrawn. While individuals were stoical and accepting of the requirement to return the closed-loop, they also conveyed varying degrees of distress. Many described having relaxed diabetes management practices while using the closed-loop and having become deskilled as a consequence, which made reverting back to pre-trial regimens challenging. Participants also described unanticipated consequences arising from using a closed-loop. As well as deskilling, these included experiencing psychological and emotional benefits that could not be sustained after the closed-loop had been withdrawn and participants reevaluating their pre- and post-trial life in light of having used a closed-loop and now perceiving this life much more negatively. Participants also voiced frustrations about experiencing better blood glucose control using a closed-loop and then having to revert to using what they now saw as antiquated and imprecise self-management tools. We use these findings to argue that ethical debates about post-trial provisioning need to be broadened to consider potential psychological and emotional harms, and not just clinical harms, that may result from withdrawal of investigated treatments. We also suggest that individuals may benefit from information about potential nonclinical harms to help make informed decisions about trial participation. (shrink)

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The most important distinction in value theory is the subjective-objective distinction which determines the epistemological status of value judgments aboutmedicalintervention. Ethical decisions inmedicalintervention presuppose one of three structures of justification — namely, an inductive approach, a deductive approach which can be either consequentialist or non-consequentialist, and a uniquely ethical approach. Inductivism and deductivism have been discussed extensively in the literature and are only briefly described here. The uniquely ethical approach which presupposes value (...) objectivism is analyzed in detail. This method involves a purely ethical inference which moves from facts to values directly with an emphasis on reason which involves a non-logical justification (as opposed to illogical). It involves the use of natural practical arguments which have an imperative conclusion but no imperative premise and exhibit a value-requiredness between two states of affairs. (shrink)

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In recent years, I have developed an endurance running art-practice as part of a larger inquiry into the performative nature of human physical activity. In the Absence of Running is series of artworks made using images frommedical arthroscopic interventions following the diagnosis of medial meniscus tears to the cartilage and osteoarthritis in both my knees. Faced with not being able to run or to make artworks using running in the long-term, I turned to the tools ofmedical (...)intervention. If a camera was going inside my knee for the purpose of surgery, I would use it for the purpose of art. The resulting videos and photographs led to a contemplation on the image and viewing practices not previously anticipated, not least on the now endemic uses of advanced imaging technologies as integral parts of surgical operations. Their reassembly as a stop-frame animation and artist’s book in physical and electronic form enabled a process of slowing down and re-engagement with the image and physicality of the book itself and processes and with practices of viewing. This was important in reasserting the sense of human agency in our relationship to images in a world where this appears to be increasingly absent. (shrink)

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Nathaniel Hawthorne’s The Birthmark offers a sharp lens through which to examine power, purity, and personal identity. Scientist and spiritual idealist, Aylmer, is obsessed with “correcting” the only flaw he perceives in his wife Georgina, the imprint of a small red hand on her pale cheek. For Alymer, this one “imperfection” reaches deep into Georgina’s heart, a sign of sin, decay, and mortality. It is the natural that must be overcome with science. Drawing on Hawthorne’s tragic fiction, this paper questions (...) the influence of stigma, power dynamics, and mind-body dualism in constructing disability identity within the framework ofmedical and spiritual practices of care. Whether in the role of a spiritual leader, chaplain, ormedical professional, people providing care must first address ableism and perceptions of normalcy in relation to their own identity and calling before offering professional advice to disabled people seeking guidance or support. It is only as professional fields adopt a posture marked by courageous humility that healing practices will promote the flourishing of all people, including those with disabilities. (shrink)

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One of the major objectives in a democratic state is ensuring health security of the citizens including combating epidemic diseases. The subject matter of this article is the presentation and analysis of legal regulations regarding preventive vaccination in Poland, in particular the aspect of imposing a legal obligation and restricting parents’ right to express consent formedicalintervention. The reflections made herein are aimed at finding an answer to the question whether the adopted legal solutions are admissible in (...) a democratic state with regard to ensuring health security. The purpose of the analysis is also to assess whether the abovementioned legal regulations have been formulated in a clear way and do not raise interpretation doubts and, consequently, whether they are comprehensible to the parents obliged to comply with them. As it follows from analysis of the legal provisions, parents must not refuse to subject a child to obligatory preventive vaccination and their consent is not required by law, both as regards themedical qualifying examination to exclude contraindications to performing vaccination and the vaccination itself. It is a legal obligation, from which exemption is only possible on grounds of certainmedical conditions that would render vaccination inadvisable. The legal provisions that concern obligatory preventive vaccination in Poland, including in particular those referring to its enforceability, have not been formulated in a way that is sufficiently comprehensible to parents who are under the obligation of complying with them, irrespective of the fact that the language of the provisions of law should be clear and raise no interpretative doubts. In a democratic state the protection of public health against epidemic hazards justifies the implementation of legal solutions that restrict an individual’s freedom of self-determination, thus limiting the right of patients or their statutory representatives to grant or refuse consent for amedicalintervention in the form of preventive vaccination – the purpose of this legal solution being to prioritize the safeguarding of state health security. It is vitally important to engage in a social dialogue with the purpose of convincing the public of the need for vaccination, its significance and its implementation for the better good. (shrink)

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BackgroundSwedish healthcare providers are supposed to be value-neutral when making clinical decisions. Recent conducted studies among Swedish physicians have indicated that the proportion of those whose personal values influence decision-making vary depending on the framing and the nature of the issue.ObjectiveTo examine whether the proportions of value-influenced and value-neutral participants vary depending on the extent to which theintervention is considered controversial.MethodsTo discriminate between value-neutral and value-influenced healthcare providers, we have used the same methods in six vignette based studies (...) including 10 more or less controversial interventions. To be controversial was understood as being anintervention where conscientious objections in healthcare have been proposed or anintervention that is against law and regulations.ResultsEnd of life decisions and female reproduction issues are associated with conscientious objection and more or less against regu... (shrink)

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This chapter examines how social- scientific research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientific researchers might find an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by first distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarcemedical interventions, including an approach—the complete lives (...) system—which I have previously defended, and a brief recap of social-scientific research on the allocation of scarcemedical resources. Following these overviews, I examine different ways in which public preferences could matter to the ethics of allocation. Last, I suggest some ways in which social scientists could learn from ethics as they conduct research into public preferences regarding the allocation of scarcemedical resources. (shrink)

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Applying bioethical principles can be difficult in resource-poor environments, particularly for Western doctors unfamiliar with these limitations. The challenges become even greater when clinicians must make rapid critical decisions. As the following case in Zambia illustrates, the Rapid Ethical Decisionmaking Model, long used in emergency medicine, is a useful tool in such circumstances.

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Using the case of Ebola Virus Disease as an example, this paper shows why patients at high risk for death have a defensible moral claim to access unregisteredmedical interventions, without having to enrol in randomized placebo controlled trials.A number of jurisdictions permit and facilitate such access under emergency circumstances. One controversial question is whether patients should only be permitted access to UMI after trials investigating the interventions are fully recruited. It is argued that regulatory regimes should not prioritise (...) trial recruitment over patient access, even if this results in drug research and development delays.We describe how the moral duty to rescue impacts on others' duties to oblige patients seeking emergency access to unregisteredmedical interventions. The view that eligible patients are owed the provision of access to UMI regardless of their willingness to enrol in a randomised controlled trial is defended. (shrink)

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We are grateful to the commentators for their close reading of our article 1 and for their challenging and interesting responses to it. We do not have space to respond to all of the objections that they raise, so in this reply, we address only a selection of them. Some commentaries question the usefulness of developing an account of the sort we provide, 2 or of revising the Standard Account (SA) in doing so. 3–5 Our schema is intended to provide (...) a framework for developing a full account of invasiveness that captures existing uses of the term. On the assumption that the term is used somewhat reliably and consistently–and we are inclined to agree with some of our commentators 3 4 that people are not terribly confused or mistaken in how they employ the term–an account that captures these... (shrink)

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Snyder’s book ‘Exploiting hope’ is as relevant as ever. His book is about the hope of desperate individuals seeking treatments that cannot be found in conventional medicine. The book engages with hope in the setting of phase I cancer trials, stem cell interventions, right-to-try laws and crowd funding, offering a new language to explain our discomfort with some of these quests. At the same time the book seems particularly relevant given current events. While despair and quests for novel interventions touched (...) only a few patients with specific conditions up to a year ago, they are now familiar to us all. Early on in the COVID-19 pandemic all of us probably experienced hope for interventions that could save us... (shrink)

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This volume focuses on issues involving the inviolability of the human body and the decision to end life. The contributors explore the difficulties in framing a public policy that legalizes aid in dying, and return to the more general question of what is the most fair and effective relationship between privatemedical authority and public policy.

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The dominance of themedical-model in American psychiatry over the last 30 years has resulted in the subsequent decline of the “talking cure”. In this paper, we identify a number of problems associated with medicalized psychiatry, focusing primarily on how it conceptualizes the self as a de-contextualized set of symptoms. Drawing on the tradition of hermeneutic phenomenology, we argue that medicalized psychiatry invariably overlooks the fact that our identities, and the meanings and values that matter to us, are created (...) and constituted by our dialogical relations with others. While acknowledging the importance ofmedical and pharmaceutical interventions, we suggest that it is only by means of the dialogical interplay of the talking cure that the client can both recognize unhealthy and self-defeating ways of being and be opened up to the possibility of new meanings and self-interpretations. (shrink)

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Children's consent to treatment remains a contentious topic, with confusing legal precepts and advice. This paper proposes that informed consent in children should be regarded as shared between children and their families, the balance being determined by implicit, developmentally based negotiations between child and parent--a "family rule" for consent. Consistent, operationalized procedures for ethically obtaining consent can be derived from its application to both routine and contentious situations. Therefore, use of the "family Rule" concept can consistently define negligent procedure in (...) obtaining consent from children, and could be used as a unifying framework in the development of new professional guidelines. A "guideline"-based approach to children's consent to treatment may offer greater individuality than a "rights"-based approach, though careful training and oversight will be needed for it to be effective. (shrink)

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According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate theirmedical c...

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De Marco and colleagues claim that the standard account of invasiveness as commonly encountered ‘…does not capture all uses of the term in relation tomedical interventions1 ’. This is open to challenge. Their first example is ‘non-invasive prenatal testing’. Because it involves puncturing the skin to obtain blood, De Marco et al take this as an example of how an incision or insertion is not sufficient to make anintervention invasive; here is a procedure that involves an (...) incision, but it is regarded as non-invasive. However, this ignores the context, and the term should really be understood in reference to the fetus. It is hard to believe healthcare professionals regard taking blood to measure, for example, ferritin levels as invasive but taking blood to look for fragments of fetal DNA as not. If anyone uses the term thinking it is not invasive to the mother, the solution would be to call it invasive, not redefine what is invasive. De Marco and colleagues’ second example is describing electroconvulsive therapy (ECT) as invasive. However, this is not borne out by their referenced papers. The first cited source is about non-invasive brain stimulation2 and only contains a single sentence about ECT. This sentence may suggest that their view is that ECT …. (shrink)

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This article discussed Jeremy Snyder’s book “Exploiting Hope. How the Promise of NewMedical Interventions Sustains Us—and Makes Us Vulnerable”, 2021, Oxford University Press.

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Volume 25, Issue 3, March 2025, Page 30-33.

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