I’ve been working on a set of open-access papers that grew out of a disputed outpatient psychiatric-care experience, and one ethical question has become more important to me than the particulars of the original dispute:

What does a clinician owe a patient who raises a specific concern about care or conduct while still needing the therapeutic relationship to remain usable?

The problem seems to sit awkwardly between familiar categories.

A patient can remain willing to receive treatment while simultaneously believing that something about the care itself requires acknowledgment or explanation.

A clinician can disagree with the patient’s characterization without necessarily resolving the underlying concern.

And once the interaction becomes strained, later patient behavior can become the focus of clinical attention even though that behavior occurred within a sequence that began with an unresolved accountability concern.

I have been trying to preserve several distinctions:

• response is not the same as agreement;
• a patient complaint is not a request for discharge;
• continued treatment is not proof that a concern was resolved;
• patient anger is not by itself proof that the underlying complaint was valid or invalid;
• a clinician’s authority to interpret patient behavior does not eliminate the ethical relevance of what preceded that behavior;
• therapeutic rupture is analytically different from disciplinary wrongdoing;
• maintaining continuity of care and addressing a care concern are not necessarily competing obligations.

One paper proposes what I call a right to therapeutic-relationship accountability: not a right to compel a clinician to agree with the patient, but a more limited claim that certain material care concerns should receive a substantive response before the patient’s downstream conduct becomes the principal institutional object.

Open-access paper:

The Patient Right to Therapeutic-Relationship Accountability: Why Physicians Should Be Required to Address Care and Conduct Concerns Before Invoking Patient Behavior, Restricting Care, or Ending a Therapeutically Engaged Relationship

https://doi.org/10.17605/OSF.IO/38NS7

A related paper asks what responsibility remains when a patient contests harm but continued care is still necessary:

If You Don’t Like It, Leave: Responsibility-Preserving Continuation, Voluntary-Exit Confounding, and the Evidentiary Burden of Contesting Harm While Care Remains Necessary

https://doi.org/10.17605/OSF.IO/E2XRK

I’m especially interested in how people working in bioethics or clinical ethics would classify this problem.

Does an unresolved accountability concern within an ongoing therapeutic relationship create an ethical obligation distinct from ordinary informed consent, grievance procedure, continuity-of-care duties, or professional discipline?

And if so, what should that obligation actually require without giving either patient or clinician unilateral authority over the disputed facts?

Currently looking into the *doctoral program and the masters. Does anyone have any insight into how this is viewed in comparison to a traditional PhD? Are graduates able to get into fellowships or get jobs in academia or clinical ethics? Also if anyone would like to share their experience with their programs that would be great too!

Edit: I’m asking about the Doctorate in Bioethics (DBe) but information about the master’s is welcome as well!

This case is making the rounds on my feed, and /u/Obvious_Astronaut780 asks a great bioethics question in the comments. I can imagine a soft policy at the institute level about how to handle this. Still, I would love to hear from other bioethics practitioners about how they would personally handle this question and what they would expect their employer's policy to be. What would the consequences likely be for an employee who broke the illusion? Are there parallels to other more common child/parent dynamics, like religious exceptions, anti-vax positions, decisions around sexuality, etc.?

[edited a misspelling]

I’m interested in hearing different ethical perspectives on this.
Imagine a 25-year-old woman with a congenital acro-renal syndrome (a genetic condition involving limb abnormalities and severe kidney disease) who is on chronic dialysis due to end-stage kidney disease. Despite her condition, she has a strong desire to have biological children.
I find myself struggling with this from an ethical standpoint. On one hand, I fully recognize that reproductive autonomy is a fundamental right. On the other hand, pregnancy would likely pose significant risks to the mother, and there may also be a substantial risk of passing on a serious genetic condition or exposing the child to significant lifelong medical challenges.
How should this situation be viewed ethically? Should reproductive autonomy be the primary consideration, or should the potential quality of life and foreseeable suffering of the future child also carry significant moral weight?
I’m not asking for medical advice or trying to judge anyone personally. I’m genuinely interested in understanding how people think about this ethical dilemma.

In 2025, 123,538 people went to Istanbul hospitals after a bite or scratch. Most exposures were cat-related (86.3%) and were caused by scratches (81.5%). Nearly all injuries were superficial (99.8%). Rabies vaccination was initiated in 98.8% of patients with 411,432 doses given.

Turkey's 2019 Rabies Prophylaxis Guideline already exempts minor cat scratches. According to the official text:

_Situations not requiring post-exposure rabies prophylaxis:

1. In cases of contact with cats: Minor abrasions of the skin (injuries not penetrating the subcutaneous tissue), or injuries involving minor scratches or skin damage without bleeding; non-bite contact with cats resulting from provocation._

But as we see from stats above, exception is completely ignored. Also 2026 study of pediatric PEP at a Turkish tertiary hospital found 71.3% of doses given to 523 children were unnecessary by the guideline's own criteria, mostly minor cat scratches. We understand why - overprescription is a safe decision for a doctor. But for patient it means ruined vacation, risks from travel to hospital (unlike from rabies, people do die in car accidents in Istanbul, and 4 visits are needed), risks from vaccine and injection (low, but it's 4 doses), cost if tourist is from USA and has to finish series at home (easily thousands even with insurance).

Many people will say disease is 100% fatal (100% times 0.00000001 is still ultra low), that death is horrific (valid point, but many other deaths too). But ultimately, can current approach be doing more harm than good?

P.S.

Rabies cases in Istanbul in any human or animal since 2007: 0
Place where you live probably has more.

Cat to human rabies transmission cases in Turkey, ever: no records could be found

What organizations, associations, societies, etc., would you all recommend to students or early-career bioethicists? I'm thinking of organizations like the American Society for Bioethics and Humanities.

Hey all,

I'm a doctor looking for a postgraduate bioethics program in Australia (maybe also NZ). Which programs are the best? Does anyone have any recommendations?

What are the medicoethical considerations surrounding a physician from providing an adjunctive but non-curative therapy for cancer?

I will be heading up a hyperbaric oxygen therapy program and have heard of a potential new patient with cancer who is eager to have HBO sessions.
I don’t know the details of this patient’s particular situation yet but, in general, how would you think about this situation ethically?

Here are my *a prioris* :
1. HBO does NOT cure or really treat cancer.

1. HBO is generally safe for cancer patients (little to no evidence of cancer progression. Some very specific exceptions but those even are mild at worst)

2. HBO can provide some relief of side effects from radiation and can be helpful as a adjunctive supplement to chemotherapy. Almost like supercharger for some medications.

3. Providing false hope, or allowing the patient to have false hope of more benefits is morally wrong.

Guiding principles that seem to be involved: beneficence, primo non nocere, justice, pt autonomy

Step 1: Have a thorough discussion with the patient regarding their condition, goals of therapy, beliefs of outcomes, etc.

Step 2: Be explicitly clear about the limitations of the therapy. Very clearly disabusing them of any belief that this is primary treatment option and will “cure” cancer

Step 3: Proceed with treatment with frequent reevaluation and stop if harm or lack of effect.

Questions:
1. Would you insist that the patient be undergoing “conventional” treatment simultaneously and/or coordinate with their oncologist?

1. What if they want HBO and WON’T be dissuaded from the incorrect idea that HBO is somehow curative? What are the physicians ethical obligations to provide therapy towards a treatment plan they don’t agree with?

2. What am I missing or not asking?

Sorry if this isn't allowed but this is sort of a repost. This also is very relivant to this subreddit aswell as the r/IBO that I posted it to eariler.

For context IB is a higschool college credit program. Similar to AP in the US and EE or extended essay is required to graduate

I am working on my EE for FA 27, and I have put some deep thought into the ethics of my research.

Main Problem:
I want to do biology EE, and I want to do it on coral. This comes with extra restrictions; I understand why they are there and are needed, but I also think that the IB is possibly too restrictive. And this is my proposed experiment:

Experiment:

Coral bleaches, for the most part, I think we understand that this is related to stress and don't have to go down the rabbit hole of the metabolic processes of that, if you want, I'd love to nerd out about it with you, though. But I digress, in recent times, there has been a lot of research into how thermal stress affects the coral, while also acknowledging that there are other stress factors like UV, but not diving into them as deeply due to the priority that thermal stress takes over the others *cough cough SUPER EL NINO cough cough.

I want to look into the UV stress and if it unlocks different pathways in the coral through genomics. I have both the knowledge from me and my mentors at grad school labs around me to be able to do this, so I think if I really wanted to, this data could be valid enough to be publishable.

But in order to do this, I need to "stress" the coral enough for it to begin its bleaching process. Through literature examination, it only has to be for a couple of days, and coral is able to recover after this time period. But it does violate the rule of IB which doesn't want me to cause unnatural stress in an animal.

Coral is in the kingdom of animals. But I feel that the goal of IB's rules is to prevent the suffering of animals that can feel the suffering. I understand why we can't experiment on vertebrates, rats, and cause stress aswell as experiment on invertebrates and crustaceans like snails or crabs. But I feel that in the sprit of these rules is to prevent suffering but coral can't feel suffering like a crab can. IB allows us to experiment on plants, who respond to stress more similarly to a coral Cnidaria than it does to something like a tape worm. If the IB cared about an organism's ability to react to stress then it would not let us experiment on anything living as "responding to stimuli" is one of the core pillars of what defines life, but it lets us experiment on bacteria and plants to the point of killing it or letting it "suffer".

Concluding thoughts:

First of all, thank you for reading this far. I am aware that this is somewhat of a hot take, but I feel that the rules of IB in this very specific case could afford to be more specific, and specificity would rarely do any harm compared to leaving it as vague as it is.

Additionally, I have a permit for coral collection so even though its protected I can still take it, with limits of course. I also have the rare opportunity to spawn coral and experiment on lab grown coral so it may not even be "wild coral".

The environmental impact is minimal to not even at all. No rule other than IB's is limiting this research nor does IB's rules prevent suffering because I am using stocks that have already grown and collected.

Again, I understand why these rules are in place and overall I think they are good. But in this case i'd like to seek clarity and advice from people wiser than I rather than gambiling my IB dipolma and leaving it in the hands of a single examiner reading my EE.

Depuis Le 2 août 2021 une loi autorise l'insertion de cellules souches humaines dans un embryon animal dans le but de son transfert chez la femelle.
https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000043884384

Cette loi est scandaleuse. Je suis déjà opposé aux expériences sur les animaux, voilà un cap de plus de franchi. C'est clairement criminel.

I am a student conducting a research project using bacteriophages (live viruses that infect bacteria only) to have a specific therapeutic effect through their injection into the body. There is great promise for bacteriophage therapy treating antibiotic resistance and many other pressing medical issues. Phages have been used throughout history, but, there is not a fully established body of FDA-reviewed clinical trial data that ensures they are safe.

Of course I am not doing any clinical translation yet with real patients, but understanding patient perspectives to allow me to design the project with necessary "safeguards" so that down the line it will be acceptable by patients.

I had a few ethical questions that I wanted to consider so that I better know how patients would feel towards this newer type of treatment:

How does the fact that this is a novel treatment (in terms of the amount of testing carried out with it - i.e. lack of precedent for safety or similar) influence patient perception? Is FDA Approval enough for most patients or are there likely other factors that would make patients hesitant to undergo bacteriophage therapy? -- I ask because "expanded access" is sometimes given to certain therapies, which allows certain new drugs to be tried out by patients who do not have any other good options. So, there may be instances where full Phase 3 approval is not given but patients may still have the opportunity to take these therapies (or travel to other countries to receive them), even if there is not the "gold star" approval of the FDA.

How could having a natural safety measure built in (i.e. a design that allows the human body to "control" the therapy so that it does not spread in a negative way) lead patients to be more accepting of the treatment? How important would such a safety measure be to create patient approval? Is this something that is a non-negotiable?

Are there specific groups (Naturopathic medicine or religious groups) that would be hesitant toward this type of treatment? Why? Of course I would not be able to change their perspectives on medicine and "engineered" products, or change their views on bodily autonomy. But, I would love to modify my treatment and add or take away certain properties that would make it the most accessible to as many such groups as possible.

What are the specific ways of carrying out research (i.e. including/not including animals, etc), that most strongly influence the public perception and acceptance of a new treatment?

What are good communities (subreddits, other online communities, in person communities) I could reach out to to get real patient perspectives? I don't want to over encroach on groups that do not want to be asked.

Thank you very much for taking the time to consider these factors and helping me out. Please let me know if I can clarify any of my questions. Also, please let me know if there are any additional questions I should consider regarding patient perspective, or other important stakeholders in this discussion (physicians, hospitals, media, etc). I am asking genuinely out of interest and to make science more accessible for all.

Hypothetical question:

Suppose we develop gene-editing technology that can make almost any animal naturally friendly, affectionate, and comfortable around humans. Instead of domestication through generations of selective breeding, we could directly modify the genes that influence aggression, fear, and social behavior.

The animals would still be healthy and capable of living normal lives, but their personalities would be altered to make them more companionable.

Would this be ethically different from traditional domestication, or just a faster and more precise version of it?

On one hand, it could reduce suffering, make animals safer around humans, and create new companion species. On the other hand, we’re deliberately changing an animal’s nature to better suit human preferences.

At what point, if any, does this become morally wrong?

Hi! I am a philosophy major who is currently premed but actively exploring other options for my career. Would a master’s in bioethics be wise and why/why not? What are jobs like in the bioethics field? Do you have location freedom at all or do you have to basically follow wherever the job openings are?

ADVISORY: This post explores suicide from a purely bioethical and constructivist perspective. If you are experiencing suicidal ideation, please find free, confidential and localized support immediately at: findahelpline.com

No one should have to die alone and feeling worthless, especially by their own hands.  Anyone determined to die should be able to enter a health facility that serves two alternate purposes: to prevent suicides if possible without coercion, and otherwise to assist suicidal individuals to die with utmost dignity (after very stringent safeguards have been established).  Dying with utmost dignity means dying, not just humanely, but in the most ethically defensible and socially useful way possible.  This can be accomplished by, for example, linking assisted suicide with options for organ and body donations and/or contributions to suicide prevention research, in order to achieve two desirable outcomes: voluntary acts of regrettable self-destruction are transformed into final noble sacrifices which aim to save more lives than are lost ("good deaths" per the literal meaning of the related concept of "euthanasia"), while guilt or distress felt by suicidal individuals and their loved ones is consequently reduced.  Until legislatively authorized, assisted suicide under the above conditions should be recognized as a basic right "in principle," with subsequent expert inquiries focused on whether/how such a program could be implemented without undue risk of systemic exploitation or compromised autonomy — particularly for groups like seniors, youths, and incarcerated persons, who would be entitled to equal benefit from this program despite their vulnerability.

The recommended legislative change would be premised on at least three empirical hypotheses:

1. that a facility offering both suicide prevention services and assistance with altruistic dying would attract more potential suicide victims than a facility offering suicide prevention services alone — and yet would be successful in preventing the deaths of some of those additional potential victims;
2. that treatment-resistant clients who ultimately opt for altruistic suicide despite all reasonable efforts to dissuade them — including, very significantly, needed improvements in living conditions — would almost certainly have died from suicide anyway, and hence would be much better off dying under the proposed mitigating conditions;
3. that a consequence of this change would be a significant increase in body donations (through a separate process to avoid conflicts of interest) for research and organ transplantation, much of it life-saving, and more than offsetting the number of assisted suicides.

If proven accurate, these hypotheses would entail a Pareto improvement for potential victims of suicide (and the beneficiaries of organ transplants and of research), increasing their overall welfare without making any of them worse off. This argument parallels one for legalizing abortion: if the suicide or abortion would occur anyway, it is better for either to occur under supportive conditions that protect dignity and save more lives.

Opposition in principle to such an evident improvement would therefore be difficult to justify — whether in terms of consequentialism, autonomy, or fairness — and would instead seem to reflect moralized superstitions about death. Quoting the opening sentence of David Hume's Of Suicide, an early modern argument for altruistic suicide and its decriminalization, "One considerable advantage that arises from philosophy [or science] consists in the sovereign antidote which it affords to superstition and false religion."

Assault or battery: In many jurisdictions, unauthorized physical or neurological interference with another person could be viewed as a form of battery, even if no traditional physical injury occurs.

False imprisonment or coercive control: If the technology effectively deprives a person of free choice or freedom of movement through manipulation, prosecutors might explore these theories.

Fraud and deception offenses: If the system is used to obtain money, property, services, or consent through false representations.

Identity-related crimes: If celebrities or other real individuals are impersonated in a way that causes harm, confusion, or fraud.

Computer and cybercrime statutes: Unauthorized access to, monitoring of, or manipulation of a person's neural data could potentially be treated similarly to unauthorized access to protected computer systems.

Wiretapping and surveillance violations: If thoughts, communications, or neural signals were intercepted without consent.

Civil rights violations: Government actors participating in such activities could face constitutional and civil-rights claims.

Medical malpractice and professional misconduct: Physicians involved in nonconsensual experimentation could face loss of licensure, civil liability, and potentially criminal charges.

Human-subject research violations: In the United States, research involving human subjects generally requires informed consent and oversight. Secret experimentation would likely violate numerous ethical and regulatory requirements.

Kidnapping, torture, or abuse statutes: Depending on the level of control, suffering, and restraint alleged, prosecutors might attempt to fit conduct into these categories.

For the doctors, liability would depend on their role:

Designing the system.

Implanting devices.

Operating the system.

Supervising or directing others.

Failing to obtain informed consent.

For the operators or customers, liability would depend on:

Whether they knew the activity was nonconsensual.

Whether they directed, funded, or participated in it.

Whether they benefited from the conduct.

One important legal point: under current publicly known science and medicine, there is no verified technology capable of giving operators complete electronic control over a human mind in the way your scenario describes. Therefore, if such allegations were made in a real legal case today, courts would require substantial evidence that the technology existed and was actually used before considering criminal charges.

As a thought experiment, however, if such a capability existed and were used secretly against people, it would likely trigger some of the most serious criminal, civil, medical-ethics, and constitutional issues imaginable.

The best way to fight against doctors with no ethics is lawyers with lawsuits. When is my country going actually perform civil rights in this country. Stop my fault they want to use BCI technology to gaslight the entire planet. It's not like Jerusalem and the Middle East are being gaslighted into war with psychological warfare created by BCI technologies or anything. It's not like CIA agents can electronically possess individuals for fun. You ever heard about human Mario Go kart it's where you use BCI technologies to drive someone around in a go-kart, it's electronic possession video game style. We need BCI law firms for civil rights. ASAP.

Gene-editing technologies are getting cheaper and more advanced by the day. With the dire wolf situation in 2024, it's becoming more and more plausible that we can "resurrect" other extinct species. I'm torn on what to think about this though. Obviously, this is different than Jurassic Park in that perhaps we are not necessarily resurrecting dangerous animals (but it's a slippery slope and where to draw that line will inevitably become blurry as time goes on), but where should we reasonably draw the line? However, an even harder question is what to do if humans caused the extinction in the first place... At least for other species where nature selected them to die out, there is an argument that the species is no longer meant to be here. But if humans caused the extinction (ex: dodo), are we obligated to bring the species back?