The world is currently responding to the climate crisis and the nature crisis as if they were separate challenges. This is a dangerous mistake. The 28th Conference of the Parties (COP) on climate change is about to be held in Dubai while the 16th COP on biodiversity is due to be held in Turkey in 2024. The research communities that provide the evidence for the two COPs are unfortunately largely separate, but they were brought together for a workshop in 2020 when they concluded that: ‘Only by considering climate and biodiversity as parts of the same...]]>
We then outline two independent but compatible justifications for doctors’ strikes, one that appeals to doctors’ interests in fair pay and working conditions and one that appeals to doctors’ duty to protect public health. We also suggest that doctors’ strikes can be supererogatory when they aim to correct a government failing in its own duty to protect public health. Finally, we assess the 2023 UK doctors’ strikes. We conclude that they are justified and there is a case for considering them supererogatory.
]]>It is unclear what the duty of practising sustainable healthcare means at the level of doctor–patient interaction. Parsa-Parsi et al flag the potential conflict in the ICoME’s provisions if ‘the actions of physicians are influenced by environmental considerations to the detriment of patients’ (p. 2), noting that the ICoME does not provide a handhold to improve understanding of such tensions. The code ‘does not...]]>
At the peak of the COVID-19 pandemic, many countries in Europe and America implemented remote-by-default healthcare policies. At that time, the policy aimed to ensure that patients enjoyed continued access to care while protecting healthcare professionals’ health and well-being. After the COVID-19 pandemic, this policy remained in place. Regardless of the nature...]]>
The privileged relationship between the physician and their larger community has, since at least the 1980s, been described as a social contract. Writing in The...]]>
Important principles, notably respect for patients’ autonomy, have arisen from case law and subsequently been adopted into medical ethics. As pointed out by Beauchamp and Childress, it is only ‘since the mid-1970s (that) the primary justification advanced for requirements of informed consent has been to protect autonomous choice’ (pg.118).
Sarela raises a fundamental and, as stated in the commentary, unresolved debate: ‘should ethics shape law or is it the converse’?
In this paper, we consider whether inappropriately adaptive preferences—preferences that are based on and that may perpetuate social injustice—should be categorised as autonomous in a way that gives them normative authority. Some philosophers have argued that inappropriately adaptive preferences do not have normative authority, because they are only a reflection of a person’s social context and not of their true self. Under this view, medical professionals who refuse to carry out actions which are based on inappropriately adaptive preferences are not in fact violating their patient’s autonomy. However, we argue that it is very difficult to articulate a systematic and principled distinction between normal autonomous preferences and inappropriately adaptive preferences, especially if this distinction needs to be useful for clinicians in real-life situations. This makes it difficult to argue that inappropriately adaptive preferences are straightforwardly non-autonomous.
Given this problem, we argue that there are significant theoretical issues with contemporary understandings of autonomy in bioethics. We discuss what this might mean for the practice of medicine and for medical ethics education.
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