It is still probably widely believed that a new doctor “takes” the Hippocratic “oath,” and that somehow this is the basis of public ethical protection, that in the swearing of an oath the profession is restrained and safe. The idea that this apparently time-honoured practice should summarize and guide the ethics of medical practice in the twenty-first century is fanciful, and few medical schools now have such a ceremony, requirement, or rite of passage at graduation that includes such an oath.

Fiddes and Komesaroff (2021) analyse the first aphorism and trace its textual history. While life may be short and the art long, these authors conclude that the second part of this famous passage that requires the patient to effectively do what he or she is told by the doctor, should be scrapped as paternalistic and out of touch with today’s world and community expectations. Whilst there is much to commend this viewpoint, it is nonetheless surely true that if you embark on a course of treatment or an intervention of some sort, it is indeed wise to follow instructions, and that the contract is two-way. It is also clear that at a time when holism is being discovered, or re-discovered as the case may be, the patient’s will needs to be engaged and active patient participation is a central pathway to success for most therapeutic journeys. The Hippocratic writings are clearly out of date, and despite their prominence in the teachings of, for example, modern medical education pioneer William Osler, they can now be safely abandoned as sexist, paternalistic, and elitist. It is interesting that medicine has for so long sought to derive a marching tune from its own history, the virtuous practitioner passing down his art to the venerating pupil, akin to the mason passing on the secrets of building, from one generation to another. The Hippocratic tradition derives from a time when poisoning was common, and doctors had the most knowledge about the agents available, hence the interdict on provision of poisons. The complete prohibition on any causal contribution to patient death is often cited in assisted dying debates, and no doubt this will continue, as is the case for abortion too. Adages such as “first do no harm” and many of those in the Hippocratic canon, have little viability in the era of therapeutic ratios, risk/benefit analysis, and the use of toxic treatments or massive surgery to attempt cure at the brink of possibility. It is surely important for the public to know that it is protected by both ethics and law, in a far more sophisticated way than any oath could do, and that in the age of transparency, accountability, and community engagement, that they themselves help to set the standards.

In a ruling in New South Wales (Lee (a pseudonym) v Dhupar [2020] NSWDC 717), the District Court determined that the cost of rearing a child following a failed sterilization procedure (tubal ligation) caused by the negligence of the medical practitioner cannot be recovered. However, other losses such as economic loss associated with psychiatric or physical injuries due the conception, pregnancy, and birth of a healthy child can be recovered. The court awarded the plaintiff $408,700 (AUD) following a surgical error made during a tubal ligation which resulted in an unplanned pregnancy. The key issue for the court to determine in this case was whether a medical practitioner had negligently performed an elective tubal ligation procedure (sterilization) that led to an unwanted pregnancy. The lengthy, three hundred or so page judgment required the court to consider various issues, some of which are discussed below—including expert professional opinion and issues that concerned the reliability and credibility of factual testimony.

This historiographic survey of extant English translations and interpretations of the renowned Hippocratic first aphorism has demonstrated a concerning acceptance and application of ancient deontological principles that have been used to justify a practice of medicine that has been both paternalistic and heteronomous. Such principles reflect an enduring Hippocratism that has perpetuated an insufficient appreciation of the moral nature of the aphorism’s second sentence in the practice of the art of medicine. That oversight has been constrained by a philological discourse that has centred on the meanings of the aphorism’s first sentence, while little consideration has been given to the more important ethical consideration within the second sentence’s imperatives.

Past anatomical dissection practice has received recent attention in the humanities and social science literature, especially in a number of popular format books. In these works, past ethically dubious dissection practices (mostly from the 1700 to 1800s, though they had their origins much earlier on) are again revisited, including stealing the dead for dissection. There are extremely simple, yet very important, lessons to be had in these analyses, including: do not exploit the dead and treat the dead with dignity, respect, and reverence. In this paper, we highlight that these principles apply not just to anatomists but to all parties concerned with bodies for dissection, including journalists and authors from the humanities writing on anatomical dissection whether in the historical or modern-day context. Not too infrequently these same authors/publishers resort to sensationalist language in titles, text, and/or promotion blurbs in a bid to grab attention and sell books. These actions, yet again, exploit dissection subjects for commercial purposes. The use of insensitive and sensationalist language that is designed to shock, fails to set good precedent for young impressionable students and paints an entirely backward picture of modern-day anatomy for intending or existing donors and their families. We suggest that all who participate in anatomical endeavours should strive to do so with reverence toward the dead, including armchair journalists and humanities authors who, just like their hands-on anatomical colleagues, should employ dignified, sensitive, and respectful language that is not sensationalist.

It is often maintained that, since the buying and selling of organs—particularly the kidneys—of living people supposedly constitutes exploitation of the living vendors while the so-called “altruistic” donation of them does not, the former, unlike the latter, should be a crime. This paper challenges and rejects this view. A novel account of exploitation, influenced by but different from those of Zwolinski and Wertheimer and of Wilkinson, is developed. Exploitation is seen as a sort of injustice. A distinction is made between justice and fairness. To exploit someone is to take advantage of him or her unjustly. Exploitation pertains to the nature of actions, interactions, and transaction rather than to their outcomes or to how they are perceived by exploitees. Desperation on the part of one or other of the parties to a transaction does not preclude the giving of valid consent to the transaction. Disparities of power or wealth between the parties to a transaction do not indicate or entail that the transaction will be exploitative. A disparity in the benefits that arise from a transaction between the parties does not indicate or entail that exploitation has taken place.

Reports of children participating in hunger strikes while detained in offshore detention centres raise interrelated ethical issues and recognizable challenges for the medical decision-makers at these sites. A composite case study, informed by reports in the public domain, is employed to explore the unique challenges of consent and decision-making in these circumstances and the perennial issues inherent in adolescents’ developing capacity and autonomy. We present an amalgamated case of a fourteen-year-old adolescent who refused to consent to medical reversal of her hunger strike protest. The medical team became the final arbiter when her parents, who were also in detention, could not agree with each other even after mediation. The case explores the complexity of evaluating the adolescent’s capacity to provide informed consent while influenced by the opinions of co-detainees in this extreme setting. We argue that the parents and the child had compromised decisional capacity due to the effects of detention. The challenges to the medical team are recognized and discussed. The team members faced a difficult dilemma and considered the competing values of the multiple cultural and ethical factors. Each team member integrated his or her own roles, duties, and discipline-specific professional guidelines with the primary goal of mitigating potential harms.

Educating young people about how to interact with patients at the end of their lives is challenging. A qualitative study based on Husserl’s phenomenological approach was performed to describe the learning experience of secondary education students after watching, analysing, and reflecting on two videoclips featuring Cameron Duncan, a young man suffering from terminal cancer (DFK6498 and Strike Zone). Students from three vocational centres providing training in ancillary nursing, pharmacy, and dependent care in the Community of Madrid visited the Palliative Care (PC) Hospital. A total of 110 students (102 female and 8 male), with a median age of nineteen years, participated in the study. The students’ learning experience through the videoclips reveals the essential aspects required in palliative care, since the character suffers in every dimension of his being: physically as well as psychologically, socially, and spiritually. Therefore, this requires healthcare professionals to understand their experience, putting themselves in their place, to provide affectionate care and to display communication skills leading to a quality helping relationship. Four comprehensive educational categories were identified in the study. The students learned the importance of: 1) providing comprehensive and affectionate care to patients, 2) the need for communication skills in caring for patients, 3) being aware of the end of life and time left, 4) valuing life and fighting for what one wishes to attain. A visit to a PC hospital and the viewing of videoclips and reflection upon these, represents a useful strategy for secondary education healthcare students. The study indicates that videoclips are an innovative method for becoming aware of the various issues pertaining to palliative care.

In June 2019 Victoria became the first state in Australia to permit “voluntary assisted dying” (VAD), with its governance detailed in the Voluntary Assisted Dying Act 2017 (Vic) (“VAD Act”). While taking lead from the regulation of medically assisted death practices in other parts of the world, Victoria’s legislation nevertheless remains distinct. The law in Victoria only makes VAD available to persons determined to be “already dying”: it is expressly limited to those medically prognosed to die “within weeks or months.” In this article, we discuss the emergence of the Victorian legislation across key formative documents. We show how, in devising VAD exclusively for those “already at the end of their lives”, the Victorian state mobilizes the medico-legal category of the already dying. We argue that this category functions to negotiate a path between what are seen as the unacceptable alternatives of violent suicide on the one hand, and an unlimited right to die on the other. Further, we argue that the category of the already dying operates to make medical practitioners the gatekeepers of this new life-ending choice and effectively limits the realization of autonomy at the end of life.

During the debates about the legalization of Voluntary Assisted Dying (VAD) in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection (CO) to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants’ moral commitments included personal, professional, and political commitments. In some cases, one’s CO was specific to Victoria’s current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context.

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent , p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families.

Australian law affirms a binary construction of fertility/infertility. This model is based upon the medical categorization of infertility as a disease. Law supports medicine in prioritizing technology, such as in vitro fertilization, as treatment for infertility. This prioritization of a medico-legal model of infertility in turn marginalizes alternative means of family creation such as adoption, fostering, traditional surrogacy, and childlessness. This paper argues that this binary model masks the impact of medicalization upon reproductive choice and limits opportunity for infertile individuals to create families. While medical technology should be available to enhance reproductive opportunity, infertile individuals will benefit from regulatory change which disentangles the medico-legal construct of infertility as a disease from the desire to create a family. This paper suggests that the medico-legal model of infertility should be reframed to support all opportunities for family creation equally, including non-medical opportunities such as adoption, fostering, and childlessness.

Treating physicians have key roles to play in expanded access to investigational drugs, by identifying investigational treatment options, assessing the balance of risks and potential benefits, informing their patients, and applying to the regulatory authorities. This study is the first to explore physicians’ experiences and moral views, with the aim of understanding the conditions under which doctors decide to pursue expanded access for their patients and the obstacles and facilitators they encounter in the Netherlands. In this mixed-methods study, semi-structured interviews (n = 14) and a questionnaire (n = 90) were conducted with medical specialists across the country and analysed thematically. Typically, our respondents pursue expanded access in “back against the wall” situations and broadly support its classic requirements. They indicate practical hurdles related to reimbursement, the amount of time and effort required for the application, and unfamiliarity with the regulatory process. Some physicians are morally opposed to expanded access, with an appeal to safety risks, lack of evidence, and “false hope.” Some of these moral concerns and practical obstacles may be essential targets for change, if expanded access to unapproved drugs is to become available for wider groups of patients for whom standard treatment options are not—or no longer—available, on a more consistent and equal basis.

Like other Arab countries, Jordan must find ways of responding to the rapid processes of change affecting many aspects of social life. This is particularly urgent in healthcare, where social and technical change is often manifested in tensions about ethical decision-making in the clinic. To explore the attitudes, beliefs and concerns relating to ethical decision-making among health professionals in Jordanian hospitals, a qualitative study was conducted involving face-to-face interviews with medical personnel in four hospitals in Amman, the capital of Jordan. Data were analysed thematically in relation to a pre-existing set of ethical categories. Interviews were conducted with thirty-eight doctors covering most medical specialities. Five major themes emerged from the interviews: ethical awareness, ethical issues, the impact of religion on ethical decision-making, practical and theoretical resources for ethical decision-making, and challenges. While uncertainty was expressed about some aspects of Western approaches to ethics, participants strongly supported adoption of a range of Western bioethical principles, including cultural and ethical diversity, along with adherence to Islamic religious norms. A range of serious ethical challenges facing the Jordanian health system were identified, covering social, legal, managerial, and technical issues. Ethical decision-making in Jordan is complex, having to accommodate the needs of patients, the opinions of doctors and their families, the views of religious authorities, managerial considerations, and both local norms and international standards. Health professionals struggle with three sets of tensions that emerge out of the struggle between traditional, community-embedded forms of social organization and the demands generated by globalization and the influence of Western culture: the tensions between tradition and modernity, conservatism and pragmatism, and religion and secularism. Doctors in Jordan prefer approaches to ethical decision-making that realize a balance between the extremes, although the exact nature of where that balance should lie remains uncertain.

This paper describes maslahah, a fundamental concept in Islam and its application in deliberating permissibility of human germline gene editing from an Islamic perspective. This paper refers to He Jiankui’s research that led to the birth of the world’s first gene edited babies, who were edited to be protected from HIV. The objective, procedure, and output of the research were assessed against the conditions of maslahah. It can be concluded that the experiment did not meet the conditions; it is inconsistent with the objectives of shariah (maqasid al-shariah) and some fundamental Islamic teachings that it did not preserve greater benefit, hence it could be considered impermissible.

Last year marked a decade since the publication of the book “Islamic Biomedical Ethics” by religious studies professor Abdulaziz Sachedina in which he called for a critical and rigorous analytical approach to the ethical inquiry of biomedical issues from an Islamic perspective. Since the publication of this landmark work, some authors have continued to call into question the ways in which Islam as a religious tradition is engaged with in the secular bioethics literature. This paper describes common argumentative issues with current Islamic bioethics scholarship and offers general pearls and strategies to facilitate better engagement with religious approaches to bioethical issues.