Physician outreach during a pandemic: shared or collective responsibility?

In 'Ethics of sharing medical knowledge with the community: is the physician responsible for medical outreach during a pandemic?' Strous and Karni note that the revised physician's pledge in the World Medical Association Declaration of Geneva obligates individual physicians to share medical knowledge, which they interpret to mean a requirement to share knowledge publicly and through outreach. In the context of the COVID-19 pandemic, Strous and Karni defend a form of medical paternalism insofar as the individual physician must reach out to communities who may not want, or know to seek out, medical advice, for reasons of public health and health equity. Strous and Karni offer a novel defence of why physicians ought to intervene even in insular communities, and they offer suggestions for how this could be done in culturally sensitive ways. Yet their view rests on an unfounded interpretation of the Geneva Declaration language. More problematically, their paper confuses shared and collective responsibility, misattributing the scope of individual physician obligations in potentially harmful ways. In response, this reply delineates between shared and collective responsibility, and suggests that to defend the obligation of medical outreach Strous and Karni propose, it is better conceptualised as a collective responsibility of the medical profession, rather than a shared responsibility of individual physicians. This interpretation rejects paternalism on the part of individual providers in favour of a more sensitive and collaborative practice of knowledge sharing between physicians and communities, and in the service of collective responsibility.

Age-not sex or gender-makes the case of Ellie Anderson Complex.

In 'The Complex Case of Ellie Anderson', Joona Rasanen and Anna Smajdor raise several ethical questions about the case. One question asks, but does not answer, whether Ellie faced discrimination for being transgender when her mother was not allowed access to Ellie's sperm following her death. In raising the question, the authors imply anti-trans bias may have influenced this determination. However, this inference is not supported by current ethical and legal guidance for posthumous use of gametes, with which Ellie's case is consistent. We consider the authors' responses to their other ethical queries, and how their suggestions for what options might have been available to Ellie and her family are instructive for addressing attempts in the USA and UK to restrict minors' access to gender-affirming medical treatment, including puberty-blocking therapy.

Bioethics and Civic Education in a Post-Roe America.

This essay explores how bioethics as a field, rather than as a collection of individual efforts by bioethicists working within it, can inform deliberation on matters of bioethical import that, for better or worse, are in the hands of civic processes. It is motivated by the repeal of a constitutional protection of abortion access in the Supreme Court Dobbs v. Jackson Women's Health Organization decision, which effectively returned abortion regulations to states rather than setting a baseline federal protection of abortion access up to fetal viability. Given the outsized role of local legislators in shaping health-care policy through legislation, about abortion as well as other health topics, the author proposes foundational bioethical education for legislators and considers two potential models for such education: one that operates on a clinical ethics consultation model, and one that mirrors bioethical coursework taught in traditional academic settings but modified for a legislator audience. Although both models present notable challenges requiring further conceptualization and problem-solving, overcoming these hurdles would enable bioethics to provide a service to civic learning and placemaking that would complement advocacy or lobbying efforts by individual bioethicists.

Trauma Informed Ethics Consultation.

We argue for the addition of trauma informed awareness, training, and skill in clinical ethics consultation by proposing a novel framework for Trauma Informed Ethics Consultation (TIEC). This approach expands on the American Society for Bioethics and Humanities (ASBH) framework for, and key insights from feminist approaches to, ethics consultation, and the literature on trauma informed care (TIC). TIEC keeps ethics consultation in line with the provision of TIC in other clinical settings. Most crucially, TIEC (like TIC) is systematically sensitive to culture, history, difference, power, social exclusion, oppression, and marginalization. By engaging a neonatal intensive care ethics consult example, we define our TIEC approach and illustrate its application. Through TIEC we argue it is the role of ethics consultants to not only hold open moral spaces, but to furnish them in morally habitable ways for all stakeholders involved in the ethics consultation process, including patients, surrogates, and practitioners.

Narrative and Medicine: Premises, Practices, Pragmatism.

Narrative is now a commonly used term in medical education, ethics, and practice. Yet the concept of narrative defies singular definition, and definitional and functional pluralism about narrative in health care remains underappreciated. Diverse conceptualizations of narrative are generically grouped under umbrella terms like "medical humanities" or "narrative medicine." Such broad grouping risks undermining attention to relevant differences in use, meaning, or theory of narrative, overestimating the scope of certain criticisms of narrative practice or use, while overlooking more insidious concerns. This essay moves toward a conceptual clarification of narrative in medicine through a process of naming and sorting. Narrative conceptualizations are grouped into narrative premises which include descriptive and normative claims about narrative, and narrative practices, which put narrative into action as process, method, or tool. A philosophical pragmatist approach to narrative in medicine reworks narrative anxieties about fact and fiction, truth or falsehood, in terms of the justifiability of belief, the inclusion or exclusion of experience, and the rationality of practices that are never perfect and always up for revision.

A Problem of Self-Ownership for Reproductive Justice.

This paper raises three concerns regarding self-ownership rhetoric to describe autonomy within healthcare in general and reproductive justice in specific. First, private property and the notion of "ownership" embedded in "self-ownership," rely on and replicate historical injustices related to the initial acquisition of property. Second, not all individuals are recognized as selves with equal access to self-ownership. Third, self-ownership only justifies negative liberties. To fully protect healthcare access and reproductive care in specific, we must also be able to make claims on others to respect, protect, and fulfill our positive rights. As much as nondomination remains an urgent demand for reproductive rights, it does not go far enough to ensure reproductive justice.