498 e-Letters

  • Disease is not a metaphor we should use

    Smajdor and Räsänen's comparison of other human beings (those yet to be born) with pathogens or cancer has troubling historical antecedents. It reflects an undesirable coarsening of the debate around medical care in pregnancy, and does not reflect the lived experience of most women towards the children they bear.

    Hospitality provides a far better metaphor for pregnancy than disease. It focuses on our duty to support those who are unexpectedly or even reluctantly in the position of accommodating someone else in need.

  • The proportionality principle is the wrong ethical standard for vaccine mandates

    The article does not engage with the objections (published in this journal and also in response to the previous article by the same lead author) to the applicability of the ‘proportionality principle’ to ethical judgment when the considered intervention violates the right to life and discriminates on the basis of healthy, innate biological characteristics of the human race. In particular, the proportionality principle is irrelevant to coercive policies (mandates) if the associated procedure is known to kill a small percentage of people and therefore amounts to a mandated killing of a minority for the benefit of the majority. The right to life cannot be taken away in the interests of others, even if the majority would greatly benefit from the killing, without negating the very concept of human rights: if being born human is not a guarantee of the right to life, then there is no right to life. On this view, vaccination mandates can no longer be considered healthcare but democide.



  • Need to consider other benefits of COVID-19 vaccine boosters in university students

    We read with interest this risk-benefit and ethical analysis of the utility of SARS-CoV-2 vaccine boosters in university students. We have some major concerns about the choice of hospitalization as the primary measure of benefit. From the onset of the pandemic, healthcare providers, scientists, and public health experts in higher education have been learning from shared experiences, research, and evolving medical knowledge about the best way to safely populate college campuses with students, faculty, and staff. Hospitalizations averted is not the only marker of morbidity that is relevant to the college student population and given the rarity of severe disease requiring hospitalization in young, generally very healthy adults, hospitalization is not a good choice for a marker of COVID-19 related morbidity. We have also strived to minimize the risk of missed classes, severe illness, and need for prolonged medical leaves of absence given the potential adverse academic consequences of illness for students. Colleges and universities have been trying to balance infectious disease mitigation efforts with the need for in-person learning, social interactions, and the increased mental health challenges caused by some of these efforts that furthered the experience of isolation.

    Much has changed since early 2020 and most schools have continued to evolve their protocols and policies to reflect new information and relevant data. We are dedicated to learning and contributing to th...

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  • Mandating Uncertainty

    "The will of the people shall be the basis of the authority of government".Article 21 of the United Nations' 1948 Universal Declaration of Human Rights
    The most recent feature article by Bardosh et al opposes policies requiring vaccination with SARS Cov-2 mRNA vaccines in order to matriculate at universities in the United States (1). While the exposition put forward is thorough and cogent, the article raises a much larger question dealing with forced vaccination to prevent illness in our population. Vaccination has been enormously successful in dealing with a host of human diseases (2-4). One cannot overstate the huge benefits to humanity accruing from prevention of viral diseases including smallpox, rabies, yellow fever, measles, mumps, rubella, varicella and, of course, paralytic polio. Recently developed vaccines protect against hepatitis A and B. Human papilloma virus vaccine may succeed in reducing the cancer burden in women and also in men. Typhoid, tetanus, diphtheria, pertussis, hemophilus, meningococcus, and pneumococcus vaccines have been highly successful in dealing with these bacterial pathogens (5).
    All states require children to be vaccinated against certain communicable diseases as a condition for school attendance
    That is understandable since school brings together a large number of individuals in very close proximity. Certainly colleges with the inevitable crowded living conditions in dormitories promote a 24 hour expo...

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  • Feedback & request for correction

    I read with interest the article titled “Ethics of college vaccine mandates, using reasonable comparisons” by Lam LL and Nichols T1, published on Mar 30, 2023, in the Journal of Medical Ethics.

    I would like to comment on statements that the above authors made that COVID-19 vaccine-caused myocarditis cases are “generally mild” and “over 90% of the hospitalized vaccine-caused myocarditis cases fully recovered within days”, and that “approximately 10% of the hospitalised cases … may have some long-term consequences”.

    Among individuals with COVID-19 vaccine-associated myocarditis, the majority develop cardiac MRI abnormalities including fibrosis, which persist on follow-up, as shown below2-4. The authors’ statements that vaccine-caused myocarditis is ‘mild’ and ‘fully recovered in 90% of cases’ with only ‘10% having long-term consequences’ are misleading, since development of myocardial fibrosis in most patients with vaccine-caused myocarditis refutes these statements. Consequently, any conclusions that the authors make relying on these inaccurate statements are not supported. To promote accuracy, a correction should be issued to the above authors’ statements.

    Schauer J2 et al found that at 3-8 months’ follow-up, repeat cardiac MRI showed persistent late gadolinium enhancement, an indicator of cardiac injury and fibrosis, in 68.8% (11/15) of adolescents aged 12-17 years with COVID-19 vaccine–associated myocarditis.

    Cavalcante JL et al3 found that at...

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  • Trust, Review, Response and Ethical control

    Trust, Review, Response and Ethical control
    Hinpetch Daungsupawong1; Viroj Wiwanitkit2
    1. Private Academic Consultant, Phonhong, Lao People's Democratic Republic ORCID: 0009-0002-5881-2709
    2. Adjunct professor, Chandigarh University, India ORCID 0000-0003-1039-3728 Correspondence
    Hinpetch Daungsupawong
    Private Academic Consultant, Phonhong, Lao People's Democratic Republic
    Email: hinpetchdaung@gmail.com
    Post Publication correspondence Professor Viroj Wiwanitkit Chandigarh University, India Eamil: wviroj@yahoo.com
    Authors’ contribution
    HD 50 % ideas, writing, analyzing, approval
    VW 50 % ideas, supervision, approval Page 2 of 6 https://mc.manuscriptcentral.com/medethics Journal of Medical Ethics

    Conflict of interest : Authors declare no conflict of interest
    Acknowledgement: none

    Dear Editor, the article “Trust and the Goldacre Review: why trusted research environments are not about trust” give many concerns in the current practice [1]. The article highlights the significance of trust and trustworthiness in the exchange of health data. It emphasizes the importance of carefully considering where confidence is appropriate and desirable in different elements of data sharing, such as people, institutions, and data platforms. Because of the complexiti...

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  • Trust is dead, long live trust

    I had difficulty with the Goldacre report, when it starts with the apparent contradiction of dismissing trust (in no uncertain terms). yet then proposing these TREs. (Trusted research environments). Where do the authors actually stand?

  • A laudable but currently unfeasible goal

    McConnell et al. provide a cogent argument that psychiatrists should influence the moral development of their patients in a limited substantive approach.
    What interests me, as a practising psychiatrist, is how to achieve this task. The penultimate paragraph of the paper recommends a “pluralist approach where the psychiatrist draws on any moral reasons, arguments or insights that help the patient achieve moral growth”. This recommendation follows a vignette of a woman with autism with “underdeveloped moral conceptions”. It’s worth noting that moral reasoning differs between autistic and neurotypical individuals despite similar moral judgements (Dempsey et al.). I suspect that, for a sustained change in interpersonal function and moral development, the patient would require more than an explanation of social reciprocity by a benevolent and well-meaning psychiatrist.
    An earlier vignette describes a man with a possible antisocial personality disorder and unwelcome views about the acceptability of violence. There is an unfortunate paucity of evidence to suggest psychological interventions result in significant change in specific antisocial behaviours (Gibbon et al.). There are experimental therapies that may cultivate moral development in these individuals (Tuck & Glenn), however these are far from accepted in clinical practice.
    The article sensibly notes that the needs of people with serious mental disorders should take priority over the flourishing of...

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    Any claims by psychiatrists1 to be able to improve people morally should be extremely modest. It is helpful to be reminded that psychiatrists have attempted to do this and still do so, nowadays usually unconsciously or implicitly. In fact where therapeutic approach embodies moral positions, as clarified for the psychoanalytic tradition by Edward Harcourt2, it is important for these to be made explicit so that they can be scrutinised.
    People coming to see a psychiatrist are often in a personal crisis, whatever its cause (which may include the effects of mental disorder as well as factors in their lives contributing to that disorder). They may as a result may be driven to re-evaluate their lives, their choices and their relationships (there are parallels with the impact of serious physical illness and confrontation with disability and mortality). In fact any serious illness or intimation of mortality may generate the same kind of self-questioning. Such people are clearly faced with moral questions, whether that be regarding specific decisions, balancing their own needs with those of others, making hard choices or making amends. How they address these things will form part of their recovery and shape it. An important difference between physical and mental illness is that people living through the latter are more likely to be lonely, relatively unbefriended, isolated and short of support from family, friends or other social circles, or indeed alienated from them. They a...

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  • The Right to Safety and Freedom of Association

    This author agrees with the claim that freedom of association is a basic moral right and that the right to have visitors stems from this freedom. This author also agrees that the discussion around visitor policy should be framed as a discussion about rights infringement. However, this author suggests that the discussion around restriction is best described as a potential conflict between two rights: freedom of association and the right to safety. Accordingly, the rights infringement could go either way.

    It is reasonable to claim that people have a moral right to safety (or something like it), and it is reasonable to say that this right should be highly protected in a hospital, where the sick and injured seek treatment. If people do have a right to safety, then it follows that this right would be infringed if hospitals did not take reasonable precautions to reduce hospital-acquired infections. Limiting visitors during COVID-19 should be seen as an example of such a precaution.

    To be clear, McTernan recognizes that safety is an important consideration, but she does not state that it is a right. This affects the framing of the issue. Appealing to something as a right makes it substantially harder to act against that which is protected by that right. It is for this reason that McTernan correctly argues that restricting visitation is harder when we appeal to freedom of association.

    The issue, then, is one in which patients have potentially two conflicting...

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