Approved medicines are not always sufficient to address the needs of patients so several legal pathways exist to enable access to unapproved medicines for treatment purposes. This article is the first to provide an in-depth analysis of this regulatory framework that governs access to unapproved medicines in Australia with a specific focus on affordability-motivated access.

As a field, ethics is driven by the desire to help guide human life and human activities. Yet, what are the standards or guideposts indicating that a given policy or practice change actually contributes meaningfully to such desires and aspirations? In other words, how do we know if we have achieved meaningful ethical outcomes and enactment processes? Unfortunately, there are many examples of ethically oriented actions that were well intentioned but carried out in a way that undermined some of the values they intended on promoting or led to unexpected undesirable outcomes. In this paper, building on an account of ethics as a pragmatist pursuit of deliberative wisdom, I identify and discuss four procedural guideposts which can help evaluate if a process of inquiry is an ethical one oriented toward human flourishing. First, situational awareness and continuity designates the need to keep in sight the nature of the situation at stake to ensure that the enactment process does not derail from a cardinal human flourishing orientation. Second, a meaningful ethical enactment should distribute opportunities for participation such that it is not only one's autonomy (e.g., the ethicist) that is developed and exercised but that positive relationships are also fostered through the growth of others. Third, enactments must strive for more than simple avoidance of encroachment of wrongs but aim for the promotion of praiseworthy practices that pursue what is envisioned as being the better and most compelling vision. Fourth, an ethics process should be conducive of personal growth and mutual learning.

Hospital ethics committees (HECs) traditionally focus on clinical ethics but are increasingly recognized for their potential role in addressing organizational ethics, particularly in the allocation of charity care resources. This commentary explores the expanded role of HECs in charity care allocation, emphasizing the core ethical principles of justice, transparency, and accountability. We discuss the need for HECs to develop expertise in organizational ethics, differentiate between emergency and chronic resource allocation, and apply value-based insurance design principles to set service boundaries. By adopting an egalitarian approach to justice, HECs can help reduce health disparities and ensure equitable access to charity care. Enhanced transparency and accountability through clear criteria, regular audits, and public reporting are also vital. This paper underscores the importance of integrating these ethical principles into healthcare resource allocation to promote health equity and maintain the financial sustainability of healthcare institutions.

Background Psychedelic medicine is a rapidly growing area of research and policy change. Australia recently became the first country to legalize the prescription of psychedelics and serves as a case study of issues that may emerge in other jurisdictions. Despite their influence as a stakeholder group, there has been little empirical exploration of psychedelic researchers' views on the development of psychedelic research and the ethical concerns. Methods We thematically analysed fourteen interviews with Australian psychedelic researchers. Results Three themes were constructed from the data: 1) coming out of the shadow of the 1960s, 2) challenges and affordances in engaging stakeholders, and 3) growing pains in innovation and translation. Conclusion The results illustrated tensions arising from the rapid growth of psychedelic research from a small group of dedicated individuals with a similar worldview, to a multi-interest, regulated industry. Participants' experiences and viewpoints were influenced by the history of psychedelic research, and this was met with an overarching concern for protecting the field from premature discontinuation, as well as maximizing potential positive impacts. Targets for stakeholder collaboration and initiatives to support responsible innovation in psychedelics include equitable access, sustainable industry involvement, productive research agendas, responsible reporting of evidence, and risk-taking within the relative safety of clinical trials.

The transplantation of non-human organs into humans, or xenotransplantation (XTx), has recently garnered new attention and is being developed to help address the problem of organ scarcity in transplantation. Ethical issues surrounding XTx have been studied since initial interest arose decades ago and have experienced renewed discussion in the literature. However, the distinct and relevant differences when applied to children has largely been overlooked with few groups attending to the concerns that XTx in children raises. In this paper, we explore ethical challenges to be expected in paediatric XTx, in particular exploring organ sizing concerns, infectious risks, psychological burdens, and issues of moral hazard. We review these domains with the aim of highlighting the implications of pursuing paediatric XTx and the cross-disciplinary approach needed to solve these issues. Children require a unique analysis from a bioethical perspective to best prepare for the issues XTx presents.

Medicine-and specifically surgery and surgical ethics-have long been part of the history of science. Surgical ethics play a pivotal role in ensuring successful outcomes and maintaining the highest standards of patient care. It includes the ethics of surgeons, the responsibility of surgeons, surgical errors, and the competence of a surgeon. Many works have been written about surgery, including during Iran's Safavid period (1501 to 1736)-a period in which a surgeon needed to have a set of moral principles in addition to practical surgical skills. One of the most valuable is Dhakhīrıh Kāmılıh, written by military surgeon Hakim Mohammad in the sixteenth and seventeenth centuries. In this work, Ḥakim Muhāmmad dedicates a chapter specifically to the topic of surgical ethics, aiming to provide moral and legal recommendations for surgeons in addition to explaining surgical techniques and methods. Some of these recommendations include improving surgical skills through observation and practical training, paying attention to hygiene to prevent the spread of infection, and giving patients hope for recovery. Dhakhīrıh Kāmılıh is a landmark text in the history of surgical ethics.

Memory modification technology (MMT) refers to the use of neurotechnologies to intervene in memories. Many scholars have reflected on the ethical issues in MMT, but a comprehensive review of this topic has not been seen. This article presents the first scoping review study of ethical issues in MMT using a bibliometric and systematic approach. After thorough examination, 133 records of key literature are included in this scoping review. Six core ethical themes are extracted: (1) self, identity, and authenticity; (2) autonomy and informed consent; (3) welfare and happiness; (4) safety and risks; (5) responsibility and obligation; (6) social and legal justice. More detailed analyses are conducted on the moral stances and reasons held by different scholars concerning these ethical themes. As can be seen, current debates exhibit certain shortcomings, including ambiguous ethical concepts and a restricted scope of analysis. Therefore, we call for deeper reflections on the philosophical foundations, more precise definitions of ethical terms, and more comprehensive examinations of neurotechnological applications, in order to better address the ethical challenges in the future.

Australia is committed to looking at ways to modernize its healthcare delivery further by integrating digital health. Advance Care Planning (ACP) is an area of healthcare that would likely benefit from further digitalization. However, while greater integration of technology in the delivery of ACP could help improve practices and lead to increased uptake, the extent to which this is achievable will be influenced, in part, by current approaches to ACP regulation. This article canvasses recent developments and trends in Australian law relevant to ACP and reflects on how these developments may impact the further digitalization of ACP.

Political opportunism of the far-right threatens the efficacy of public health policies and political stability in general. In this commentary, we outline some of the ways that the European far-right has misused public health concerns as propaganda tools. This is a significant threat to the goals of making health and science more inclusive, and we recommend some policies for mitigating the racist effect of the far-right. Notably, we recommend (a) transparency in health policies and robust implementation of the rule of law, (b) the use of operative public values and human rights in health policy making, and (c) investment in decolonizing mindsets which may be corrosive of health policies.

In British Columbia, Canada, many physicians providing care to individuals with high-risk opioid use disorder adopted safer supply (SS) opioid prescribing in the spring of 2020 with the goal of facilitating public health measures for COVID-19. This prescribing practice continued after measures were lifted. This study aimed to explore prescribers' perspectives following several years of local experience in prescribing SS opioids, primarily in the form of hydromorphone tablets, and to apply ethical concepts to explore current challenges and ongoing sources of provider distress. Addiction medicine SS prescribers participated in individual or small group semi-structured interviews. Each interview was transcribed and analysed for recurrent themes. Themes were then integrated into a narrative ethics discussion. Eleven addiction medicine physicians practicing in various settings within Vancouver participated in this study. Six themes were identified: clinical assessment, clinician distress, gaps in care, models of safer supply, research, and special populations. Ethical dilemmas in prescribing SS are identified and explored through a discussion of biomedical ethics principles and the physician role.

This perspective highlights a growing and concerning trend within the scientific publishing community: the increasing incidence of manuscript rejections within twenty-four hours of submission without peer review, followed by offers of transfer to a sister journal with a high article processing fee. Recommendations to address such issues, including increased transparency in the manuscript review process, the establishment of more robust editorial guidelines, and the promotion of equitable publishing opportunities regardless of financial capability have also been proposed.

Paediatric Intensive Care Units (PICU) are complex interdisciplinary environments where challenging, high stakes decisions are frequently encountered. We assert that appropriate decisions are more likely to be made if the decision-making process is comprehensive, reasoned, and grounded in thoughtful deliberation. Strategies to overcome barriers to high quality decision-making including, cognitive and implicit bias, group think, inadequate information gathering, and poor quality deliberation should be incorporated. Several general frameworks for decision-making exist, but specific guidance is scarce. In this paper, we provide specific guidance on collaborative complex decision-making for PICUs. The proposed approach is on principles of procedural justice and pragmatic hermeneutics. The process encompasses set-up/planning, information gathering, question formulation, analysis (perspectives, values, and principles), action plan development, decision documentation, and a review and appeal mechanism. The process can be adapted to suit other clinical contexts. Research evaluating the process, exploring how best to develop education for clinicians, and how to build a culture that values high quality deliberation, is worthwhile.

Rising rates of female incarceration within the United States are incompatible with the lack of federal standards outlining the rights of incarcerated mothers and their children. A robust body of evidence demonstrates that prison nurseries, programmes designed for mothers to keep their infants under their care during detainment or incarceration, provide essential and beneficial care that could not otherwise be achieved within the current carceral infrastructure. These benefits include facilitation of breastfeeding, bonding during a critical period of child development, and decreased recidivism rates for participants. Legal precedent exists to support the rights of the mother to continue to parent their child but remains in stark opposition to current prison infrastructure that could allow them to do so. Existing state policies also have inconsistent mechanisms for determining child eligibility and should move to centre decision-making on a case-by-case basis. This work will demonstrate that a just society, supported by law and ensuring maternal-child welfare supports the establishment of prison nursery programmes as a part of the existing right to healthcare for incarcerated individuals.

Spivak's contribution to this symposium invites us to think beyond ethics in the abstract and instead to ground it in the "epistemology of the subaltern," placing emphasis on a "humanities-style education" in thinking precisely from those margins in the interests of "social justice for all." In my response to her essay, I take up her invitation to "abstract up" my reading of her intervention through the specifics of Gaza.

I consider cases of multifetal pregnancy in which one fetus with a fatal birth defect poses a risk to the survival of another healthy fetus to show that the substance view anti-abortion position leads to a contradiction. In cases of complicated multifetal pregnancy, if intervention by selective abortion to terminate the defective fetus is not performed, both fetuses will die due to the conditions created by the defective fetus's fatal birth defect. Because abortion is wrong on the anti-abortion position, and a moderate anti-abortion position cannot make an exception for selective abortion in cases of complicated multifetal pregnancy if it operates on the substance view, choosing selective abortion must be wrong, so one must let both fetuses die. However, the substance view anti-abortion position must take letting both fetuses die to be wrong, otherwise it will undermine itself as an anti-abortion position. Further, the substance view provides grounds for why letting fetuses die would be wrong anyway. Thus, the substance view anti-abortion position must take both having an abortion and not having an abortion to be wrong, which is a contradiction. Therefore, cases of complicated multifetal pregnancy show that the substance view anti-abortion position is false.

Principlism appears to be the prevailing applied ethical framework in bioethics. Despite the view's various strengths, critics point out that since the principles are ad hoc, conflicts indubitably emerge leading to inconsistency. There is debate around whether principlism can provide definitive action-guiding moral prescriptions or only help structure intelligent analyses and justifications of moral choices. In this paper, I contend that applying concepts of moral symmetry and moral asymmetry allows us to modify one of principlism's principles-the principle of beneficence-into what I will call the principle of compassion. I argue that the principle of compassion can function as an arbitrating or primary principle within the principlist framework. The result is a view we might call compassionate principlism. Arguably, compassionate principlism leads to fewer inconsistencies and provides more acceptable action-guiding moral prescriptions than traditional principlism.

With the increasing prices of newly approved anti-cancer treatments contributing to rising healthcare costs, healthcare systems are facing complex economic and ethical dilemmas. Especially in countries with universal access and mandatory health insurance, including many European countries, the organizing of funding or reimbursement of expensive new treatments can be challenging. When expensive anti-cancer treatments are deemed safe and effective, but are not (yet) reimbursed, ethical dilemmas arise. In countries with universal healthcare systems, such as the Netherlands, this gives rise to a rather new ethical dilemma: should patients be allowed to pay out of pocket, using private funds, for medical treatments? On the one hand, to allow patients to pay for treatments out of pocket would be in line with the medical-ethical principles of beneficence and autonomy. On the other hand, allowing patients to pay out of pocket for anti-cancer treatments may lead to unequal access to medical treatments and could be considered unfair to patients who are less well-off. Thus, it could undermine the values of equality and solidarity, on which the Dutch healthcare system is built. Furthermore, out-of-pocket payments could potentially lead to financial hardship and distress for patients, which would conflict with the principle of non-maleficence. Does this mean that patients can rightfully be denied access to approved but not (yet) reimbursed anti-cancer treatments? In this article, we will use the Dutch healthcare system, which is based on equal access and solidarity, as a case study to draw attention to this-currently relatively unknown and unresolved-dilemma and to clarify the values at stake. This article contributes to current discussions about the societal problem of rising healthcare costs by informing policymakers, healthcare professionals, and ethicists about the ethical dilemma of out-of-pocket payments in universal healthcare systems, and aims to support health authorities, policymakers and health professionals in developing policy for whether to allow out-of-pocket payment-based access to newly approved but (too) expensive anti-cancer treatments.