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This paper discusses two approaches to climate ethics for practical reflection and decision-making in concrete local climate change governance. After a brief review of the main conceptual frameworks in climate ethics research, we show that none of these leading approaches is sufficiently context specific and pluralistic to provide guidance appropriate for concrete local climate governance. As alternatives, we present principlism as a methodology of mid-level principles and environmental pragmatism as an ethical approach. We argue that the two methodologies of principlism and pragmatism offer a new pluralistic framework that allows real-world conditions and contexts to be properly integrated into ethical analysis and decision-making in climate governance.

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With the growing application of machine learning models in medicine, principlist bioethics has been put forward as needing revision. This paper reflects on the dominant trope in AI ethics to include a new 'principle of explicability' alongside the traditional four principles of bioethics that make up the theory of principlism. It specifically suggests that these four principles are sufficient and challenges the relevance of explicability as a separate ethical principle by emphasizing the coherentist affinity of principlism. We argue that, through specification, the properties of explicability are already covered by the four bioethical principles. The paper finishes by anticipating an objection that coherent principles could not facilitate technology induced change and are not well-suited to tackle moral differences.

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BACKGROUND: Nowadays, patients in Thailand have easier access to public health services, resulting in an increased number of patients undergoing surgery. Therefore, the Royal College of Anesthesiologists produces nurse anesthetists to reduce the shortage of anesthesiologists who can perform general anesthesia under the physician's supervision. As a result, nurse anesthetists must have the consciousness to work on the basis of ethics and professional standards. Nurse anesthetists have work experience that aims to benefit patients and make them as safe as possible. OBJECTIVE: To investigate the working experience of nurse anesthetists with beneficence for patients. METHODS: This study employed qualitative research using in-depth interviews. The sample consisted of 33 nurse anesthetists who volunteered to participate in the research project with more than ten years of work experience and worked in tertiary care hospitals. The researcher used a qualitative content analysis method.Ethical considerations: Study after approval and certification of the research project from the Human Ethics Committee of Mahidol University, and Naval Medical Department. RESULTS: The working experience of nurse anesthetists with beneficence for patients involves communicating and listening with compassion, being considerate, knowledgeable, and standard operations, team communication, and awareness of patient safety, as a productive and non-harmful work experience. DISCUSSION: Nurse anesthetists working in situations of beneficial approaches to patient care need experience in appropriate communication, professional knowledge and skills to thoroughly assess patients, pass critical information to the team, and be aware of potential risks. Make patients receive care in a more suitable and safe way. CONCLUSION: Working experience of nurse anesthetists with beneficence for patients exists with communication and listening with compassion, being considerate, communicating and forwarding the patient's necessary information to the team to be aware of abnormalities, knowledgeable and standard operations, and awareness of patient safety in every phase of the performance consistently.

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It is perhaps most useful to approach the Doctor-Patient relationship (DPR) by admitting that it's complicated. We review some of the strategies that have been employed to mitigate this complexity, zeroing in on one that promises to capture the main features of the DPR without eliminating some of its more important, existential components; pieces of the puzzle that must be retained if we are to avoid oversimplification and the errors that can arise by ignoring important foundational properties. We believe that a useful way to look at the DPR and to capture essential features that must be balanced in the process is provided by Partnership Theory and its definition in terms of the so-called domination and partnership systems. We apply this theory to the DPR and investigate the implications of this application to health care. We see that in the absence of mitigating circumstances, adoption of the patient-as-partner model serves healthcare well and is flexible enough to accommodate circumstances that dictate modifications.

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In this paper I critically examine the implications of the uncodifiability thesis for principlism as a pluralistic and non-absolute generalist ethical theory. In this regard, I begin with a brief overview of W.D. Ross's ethical theory and his focus on general but defeasible prima facie principles before turning to 2) the revival of principlism in contemporary bioethics through the influential work of Tom Beauchamp and James Childress; 3) the widespread adoption of specification as a response to the indeterminacy of abstract general principles and the limitations of balancing and deductive approaches; 4) the challenges raised to fully specified principlism by the uncodifiability thesis and 5) finally offer a defense of the uncodifiability thesis against various critiques that have been raised.

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The difficulty of explaining the outputs of artificial intelligence (AI) models and what has led to them is a notorious ethical problem wherever these technologies are applied, including in the medical domain, and one that has no obvious solution. This paper examines the proposal, made by Luciano Floridi and colleagues, to include a new 'principle of explicability' alongside the traditional four principles of bioethics that make up the theory of 'principlism'. It specifically responds to a recent set of criticisms that challenge the supposed need for such a principle to perform an enabling role in relation to the traditional four principles and therefore suggest that these four are sufficient without the addition of explicability. The paper challenges the critics' premise that explicability cannot be an ethical principle like the classic four because it is explicitly subordinate to them. It argues instead that principlism in its original formulation locates the justification for ethical principles in a midlevel position such that they mediate between the most general moral norms and the contextual requirements of medicine. This conception of an ethical principle then provides a mold for an approach to explicability on which it functions as an enabling principle that unifies technical/epistemic demands on AI and the requirements of high-level ethical theories. The paper finishes by anticipating an objection that decision-making by clinicians and AI fall equally, but implausibly, under the principle of explicability's scope, which it rejects on the grounds that human decisions, unlike AI's, can be explained by their social environments.

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Should research projects involving epidemiological modelling be subject to ethical scrutiny and peer review prior to publication? Mathematical modelling had considerable impacts during the COVID-19 pandemic, leading to social distancing and lockdowns. Imperial College conducted research leading to the website publication of a paper, Report 9, on non-pharmaceutical interventions (NPIs) and COVID-19 mortality demand dated 16th March 2020, arguing for a Government policy of non-pharmaceutical interventions (e.g. lockdowns, social distancing, mask wearing, working from home, furlough, school closures, reduced family interaction etc.) to counter COVID 19. Enquiries and Freedom of Information requests to the institution indicate that there was no formal ethical committee review of this specific research, nor was there any peer review prior to their online publication of Report 9. This paper considers the duties placed upon researchers, institutions and research funders under the UK 'Concordat to Support Research Integrity' (CSRI), across various bioethical domains, and whether ethical committee scrutiny should be required for this research.

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Principlism is an ethical framework that has dominated bioethical discourse for the past 50 years. There are differing perspectives on its proper scope and limits. In this article, we consider to what extent principlism provides guidance for the abortion and euthanasia debates. We argue that whilst principlism may be considered a useful framework for structuring bioethical discourse, it does not in itself allow for the resolution of these neuralgic policy discussions. Scholars have attempted to use principlism to analyse the ethics and legality of abortion and euthanasia; but such efforts are methodologically problematic. We close with a consideration of the proper scope of principlism in bioethics-a vision that is more modest than the manner in which principlism is often deployed in contemporary academic bioethics and medical education.

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This article presents a radical claim: American medical ethics is broken, and it needs love to be healed. Due to a unique set of cultural and economic pressures, American medical ethics has adopted a mechanistic mode of ethical reasoning epitomized by the doctrine of principlism. This mode of reasoning divorces clinicians from both their patients and themselves. This results in clinicians who can ace ethics questions on multiple-choice tests but who fail either to recognize a patient's humanity or to navigate the ethical quandaries into which they are frequently thrown. Drawing on personal experience as well as the philosophical work of Augustine of Hippo, Simone Weil, and Iris Murdoch, we propose a novel ethical approach grounded in a conception of neighbor love, specifically, the virtue of love understood as attention to a sufferer's humanity. We conclude with five practical recommendations for reimagining medical ethics education oriented around the virtue of love.

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In this article, I reject the "principlism" of Tom Beauchamp and James Childress and argue that respect for autonomy is, and ought to be, the fundamental value of bioethics. To do so, I offer a reconstruction of what I call the field's "founding myth," a genealogy that affords primacy to the right to be respected as a human being with dignity. Next, I examine the relationship between this basic right and a derivative right of autonomy. I suggest that principlism has promulgated an uncharitable understanding of respect for autonomy, one that ensures that the principle cannot occupy the central position I claim for it. Finally, I sketch a more plausible understanding of respect for autonomy and explore its implications.

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Two articles in the March-April 2023 issue of the Hastings Center Report challenge principlism and propose new moral frameworks for bioethics. In the lead article, Tyler Tate and Joseph Clair argue that bioethics must be grounded in an understanding of ideal character and relationship to others. The virtue of love, they propose, provides the fundamental conceptual and emotional resources that physicians need. In the second article, Samuel Reis-Dennis offers historical and philosophical explorations of Kantian versus bioethical conceptions of autonomy as he argues that bioethics should be centered on the idea of dignity.

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Nanotechnology (NT)-enabled disease-free life is a form of reconstruction of the human body that promises a paradigm shift toward a new form of human existence in an imaginable life. However, as human reconstruction may be within the limits of the concept of "human enhancement," it is not clear to what extent "enhanced humans" will be ethically acceptable or desired. This study discusses the ethical implications of NT-embedded enhanced humans and this new imaginable life. First, ethical concerns arising from the existence of a grey zone of certain dilemmas regarding benefits and possible/unpredicted risks are addressed in terms of the four main principles of bioethics. Then, we focus on the ethical problems in human nano-enhancement. Finally, we study the methods of analyzing these ethical problems within the framework of principlism to conceive a comprehensive and coherent bioethical understanding.

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Whether gender selection should be conducted is a controversial topic in ethical research on mitochondrial replacement technology. Scholars put forward different moral judgments based on different positions, and after reviewing these judgments, it was found that those who support gender selection mainly rely on the utility theory and rights theory, while those who oppose gender selection mainly rely on the dignity theory and community theory. It is not difficult to find that relying on traditional moral theory to defend moral judgments or actions often leads to endless debates among "moral strangers" , and does not provide effective guidance for solving specific problems. Principlism is a systematic and comprehensive analytical approach constructed with a series of clear and effective frameworks, which can reasonably solve the differences and disagreements between different value systems and cultural concepts. In the discussion of whether gender selection should be conducted in mitochondrial replacement technology, principlism refined and balanced it through the method of reflective equilibrium, and finally obtained the best judgment plan that allows for gender selection. To truly achieve the humane purpose of avoiding harm in gender selection, it is necessary to clearly limit the objects and stages of use, and regulate them from the dual dimensions of ethics and morality, as well as policy regulation.

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A tuberculose (TB) é uma doença infecciosa, causada pelo bacilo Mycobacterium tuberculosis (MTB), que atinge os pulmões durante o contágio inicial e que pode ser transmitida através da tosse, fala ou espirro. A Organização Mundial da Saúde (WHO, 2019) classificou a TB como a principal causa de morte no mundo por único agente etiológico, à frente do Vírus da Imunodeficiência Humana (HIV), sendo ainda considerada como grave problema de Saúde Pública, e declarou, em 1993, a TB como estado de emergência mundial, diante dos altos índices de incidência e mortalidade existentes à época. Em 1999, o Brasil normatizou seu Programa Nacional de Controle da Tuberculose (PNCT) e isso aconteceu diante da permanência do "problema da TB", com índices elevados de abandono do tratamento, redução na taxa de cura e de identificação dos casos. O PNCT introduziu: a extensão da cobertura (com a distribuição de medicamentos gratuitamente), o tratamento diretamente observado (no qual o paciente deve tomar a medicação diante de um agente de saúde) e a busca ativa por pessoas portadoras de infecção latente da TB (ILTB). Há, de fato, questões sociais, políticas e econômicas que ainda influenciam na permanência da TB, considerada como Determinante Social de Saúde (DSS). Contudo, há questões éticas envolvidas na maneira como a TB é abordada pela Saúde Pública, tanto pelo PNCT quanto pela OMS, e que também influenciam nas altas taxas de casos de TB na sociedade e na diferenciação desta sociedade. Mesmo com medicamentos eficazes (incluindo o tratamento da ILTB), a TB permanece como um desafio ético para o governo pois, na prática, foi o governo que permitiu que o indivíduo ficasse doente. O principialismo, por ser uma das referências bioéticas da prática médica no Brasil, será a base dessa reflexão, com o intuito de ajudar na compreensão de como as políticas públicas de saúde são feitas no Brasil e quais devem ser suas prioridades, conciliando os interesses da sociedade e do indivíduo. A comparação com outras realidades que enfrentam o mesmo problema, como a Inglaterra, o debate sobre as justificativas da OMS para sua estratégia pelo Fim da TB e os direitos dos pacientes com TB igualmente contribuirão pela busca de quais são essas questões éticas e como podem colaborar na abordagem e erradicação da TB no mundo, mudando a narrativa e a perspectiva de como "enxergar" a doença e o doente. (AU)

Tuberculosis (TB) is an infectious disease caused by the bacillus Mycobacterium tuberculosis (MTB), which affects the lungs during the initial contagion and can be transmitted through coughing, talking, or sneezing. The World Health Organization (WHO, 2019) classified TB as the leading cause of death in the world by a single etiological agent, ahead of the Human Immunodeficiency Virus (HIV), still being considered a serious Public Health problem and, in 1993, declared TB a global state of emergency, given the high incidence and mortality rates existing at the time. In 1999, Brazil standardized its National Tuberculosis Control Program (PNCT) and this happened in the face of the permanence of the "TB problem", with high rates of treatment abandonment, reduction in the cure rate, and identification of cases. The PNCT introduced: the extension of coverage (with free distribution of medication), directly observed treatment (in which the patient must take the medication in front of a health agent), and the active search for people with latent TB infection (LTBI). There are, in fact, social, political, and economic issues that still influence the permanence of TB, considered a Social Determinant of Health (SDH). However, there are ethical issues involved in the way TB is approached by Public Health, both by the PNCT and the WHO, which also influence the high rates of TB cases in society and the differentiation of this society. Even with effective drugs (including LTBI treatment), TB remains an ethical challenge for the government because, in practice, it was the government that allowed the individual to get sick. Principlism, as one of the bioethical references of medical practice in Brazil, will be the basis of this reflection, to help understand how public health policies are carried out in Brazil and what their priorities should be, reconciling the interests of society and the individual. In comparison with other realities that face the same problem, such as England, the debate on the justifications of the WHO for its End TB Strategy and the rights of patients with TB will also contribute to the search for what these ethical issues are and how they can collaborate in the approach and eradication of TB in the world, changing the narrative and perspective of how to "see" the disease and the sick person. (AU)

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Psychiatrists face complex ethics dilemmas in the COVID-19 pandemic era when assessing dangerousness in patients or forensic evaluees who threaten to purposely infect others or spread the virus. Understanding local public health and medical quarantine laws for their jurisdictions can help guide treating psychiatrists in how to handle some of these situations; however, challenges occur when what is ethically best conflicts with the action that will confer the greatest protection against legal liability. Additionally, the calculus of weighing competing ethics considerations changes based on how relevant it is to the duties of a particular role (e.g., treatment, forensic, research, managed care, etc.) as well as the contextual factors of the situation. We present dialectical principlism as a framework to help psychiatrists resolve such ethics dilemmas related to the COVID-19 and future pandemics, illustrating how it can be applied in different roles (i.e., treatment versus forensic) and situations (i.e., when it is clear the danger of viral transmission is secondary to a delusion versus a delusion-like belief) to come to the best outcome that balances patient welfare, legal considerations, and societal safety. Occasionally, the most ethical action may entail small liability risks.

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Older people living in squalor present healthcare providers with a set of complex issues because squalor occurs alongside a variety of medical and psychiatric conditions, and older people living in squalor frequently decline intervention. To synthesise empirical evidence on squalor to inform ethical decision-making in the management of squalor using the bioethical framework of principlism. A systematic literature search was conducted using Medline, Embase, PsycINFO and CINAHL databases for empirical research on squalor in older people. Given the limited evidence base to date, an interpretive approach to synthesis was used. Sixty-seven articles that met the inclusion criteria were included in the review. Our synthesis of the research evidence indicates that: (i) older people living in squalor have a high prevalence of frontal executive dysfunction, medical comorbidities and premature deaths; (ii) interventions are complex and require interagency involvement, with further evaluations needed to determine the effectiveness and potential harm of interventions; and (iii) older people living in squalor utilise more medical and social resources, and may negatively impact others around them. These results suggest that autonomous decision-making capacity should be determined rather than assumed. The harm associated with squalid living for the older person, and for others around them, means a non-interventional approach is likely to contravene the principles of non-maleficence, beneficence and justice. Adequate assessment of decision-making capacity is of particular importance. To be ethical, any intervention undertaken must balance benefits, harms, resource utilisation and impact on others.

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Tom Beauchamp and James Childress are confident that their four principles-respect for autonomy, beneficence, non-maleficence, and justice-are globally applicable to the sorts of issues that arise in biomedical ethics, in part because those principles form part of the common morality (a set of general norms to which all morally committed persons subscribe). Inevitably, however, the question arises of how the principlist ought to respond when presented with apparent counter-examples to this thesis. I examine a number of strategies the principlist might adopt in order to retain common morality theory in the face of supposed counter-examples. I conclude that only a strategy that takes a non-realist view of the common morality's principles is viable. Unfortunately, such a view is likely not to appeal to the principlist.

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The dominant model for bioethical inquiry taught in medical schools is that of principlism. The heritage of this methodology can be traced to the Enlightenment project of generating a universalizable justification for normative morality arising from within the individual, rational agent. This project has been criticized by Alasdair MacIntyre who suggests that its failure has resulted in a fragmented and incoherent contemporary ethical framework characterized by fundamental intractability in moral debate. This incoherence implicates principlist conceptions of bioethics. Medical ethics as practiced, though, is partially in keeping with teleological alternatives to principlism. Nonetheless, the hegemony of principlism threatens to harm the practice of good medicine whenever it is used to provide justification for the sanction or prohibition of practices, despite not being equipped to grant moral authority to such justifications. An example of this failure and its resulting harm is expressed in the growing obsolescence of living donor liver transplantation.

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BACKGROUND: In our multicultural society, as well as when working internationally, emergency physicians (EPs) frequently see patients from cultures with communitarian or hierarchal structures. These groups may rely on traditional medical practices and view health care decisions through a lens other than patient autonomy. This leads to uncertainty about who can legitimately make decisions for patients and how to apply basic ethical principles. Because the commonly taught ethical principles (autonomy, beneficence, nonmaleficence, and distributive justice) are loosely defined, they provide little help to EPs when working with cultures that de-emphasize Western individualism. CASE REPORT: The case illustrates this complexity by detailing how visiting EPs dealt with leaders from a communitarian culture who demanded that a preteen be treated for a femur fracture by a traditional bone healer rather than with modern techniques. DISCUSSION: The Western-trained clinicians struggled with their ethical responsibility to protect the child's welfare within the social setting: What should beneficence look like in this situation and to whom did it apply? More broadly, this paper examines the bases on which health care professionals might justify overruling parental decisions. It also asks whether the lack of clarity of the most used Western ethical principles suggests the need to broaden clinical ethics education to include issues from other cultures and settings. CONCLUSIONS: Despite principlism's shortcomings, the ease of teaching ethics to health care providers by grouping basic philosophical ideas suggests that we continue to use its structure. As educators and practitioners, we should, however, expand the concept of principlism to better address ethical values and issues found across different cultures.

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After briefly sketching common-morality principlism, as presented in Principles of Biomedical Ethics, this paper responds to two recent sets of challenges to this framework. The first challenge claims that medical ethics is autonomous and unique and thus not a form of, or justified or guided by, a common morality or by any external morality or moral theory. The second challenge denies that there is a common morality and insists that futile efforts to develop common-morality approaches to bioethics limit diversity and prevent needed moral change. This paper argues that these two critiques fundamentally fail because they significantly misunderstand their target and because their proposed alternatives have major deficiencies and encounter insurmountable problems.

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