Future of global regulation of human genome editing: a South African perspective on the WHO Draft Governance Framework on Human Genome Editing

WHO in 2019 established the Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing, which has recently published a Draft Governance Framework on Human Genome Editing. Although the Draft Framework is a good point of departure, there are four areas of concern: first, it does not sufficiently address issues related to establishing safety and efficacy. Second, issues that are a source of tension between global standard setting and state sovereignty need to be addressed in a more nuanced fashion. Third, it fails to meaningfully engage with the extent to which the conceptualisation of human dignity may justifiably vary between jurisdictions. Fourth, the meaning of harm to the interests of a future person requires clarity. Provided these four areas of concern can be addressed, the future of the global governance of human genome editing may hold promise.

Sexual assault and fatal violence against women during the Irish War of Independence, 1919-1921: Kate Maher's murder in context

At the height of the Irish War of Independence, 1919-1921, 45-year-old Kate Maher was brutally raped. She subsequently died of terrible wounds, almost certainly inflicted by drunken British soldiers. This article discusses her inadequately investigated case in the wider context of fatal violence against women and girls during years of major political instability. Ordinarily her violent death would have been subject to a coroner's court inquiry and rigorous police investigation, but in 1920, civil inquests in much of Ireland were replaced by military courts of inquiry. With the exception of medical issues, where doctors adhered to their ethical responsibility to provide clear and concise evidence on injuries, wounds and cause of death, courts of inquiry were cursory affairs in which Crown forces effectively investigated and exonerated themselves. This article adopts a microhistory approach to Maher's case to compare how civilian and military systems differed in their treatments of female fatalities. Despite the fact that the medical evidence unequivocally showed that the attack was of a very violent sexual nature, the two soldiers directly implicated were not charged with rape or any other sexual offence. In her case, and in those of other women who died violently while in the company of soldiers and policemen, prosecutions of the men involved resulted in acquittal by military court martial. This was so both for women portrayed as of immoral character and for others assumed to be 'respectable'. It also reflects on the wider question of sexual violence during the Irish War of Independence, concluding that while females experienced a range of gender-determined threats and actions such as armed raids on their homes, the 'bobbing' of hair and other means of 'shaming', rape, accepted as the most serious act of sexual assault, was regarded by all combatants as beyond the pale.

Toward a Typology of Office-based Buprenorphine Treatment Laws: Themes From a Review of State Laws

OBJECTIVES

Buprenorphine is a gold standard treatment for opioid use disorder (OUD). Some US states have passed laws regulating office-based buprenorphine treatment (OBBT) for OUD, with requirements beyond those required in federal law. We sought to identify themes in state OBBT laws.

METHODS

Using search terms related to medications for OUD, we searched Westlaw software for state regulations and statutes in 51 US jurisdictions from 2005 to 2019. We identified and inductively analyzed OBBT laws for themes.

RESULTS

Since 2005, 10 states have passed a total of 181 OBBT laws. We identified the following themes: (1) provider credentials: state licensure for OBBT providers and continuing medical education requirements; (2) new patients: objective symptoms patients must have before receiving OBBT and exceptions for special populations; (3) educating patients: general informed consent requirements, and specific information to provide; (4) counseling: minimum counselor credentials, minimum counseling frequency, counseling alternatives; (5) patient monitoring: required prescription drug monitoring checks, frequency of drug screening, and responses to lost/stolen medications; (6) enhanced clinician monitoring: evidence-based treatment protocols, minimum clinician-patient contact frequency, health assessment requirements, and individualized treatment planning; and (7) patient safety: reconciling prescriptions, dosage limitations, naloxone coprescribing, tapering, and office closures.

CONCLUSIONS

Some laws codify practices for which scientific consensus is lacking. Additionally, some OBBT laws resemble opioid treatment programs and pain management regulations. Results could serve as the basis for a typology of office-based treatment laws, which could facilitate empirical examination of policy impacts on treatment access and quality.

Critiquing the Conception of "Crimes Against Nature": The Necessity for a New "Natural" Law

Drawing upon historical developments and legal interpretations of "crimes against nature" as it relates to bestiality, this paper endeavors to promote further discussions surrounding the conception of "natural" and/or extant law, by which an understanding of historical and modern objections to crimes against nature opens them up to the critique of thin-universalism-that is, that despite disparate socio-moral fundaments, laws of prohibition coalesce around evangelical totalities. We contend that a paradigm shift in respect of naturalness is necessitated-naturalness should be packaged and represented, in part, by the empirical. Thus, conceptions of vulnerability and sentience rooted in social scientific understandings and in hospitable forms of rights protections ought to provide a new understanding of governance of the natural. In turn, this naturalness ought to be reflected in law so long as the boundaries we propose are not unduly transgressed. If unnatural acts like bestiality have their prohibitions in the legal tethering points of Judeo-Christian and, later Victorian roots, the new natural law ought to be apprised of rights-based constitutionalism and informed by green criminological and animal rights logics. Law, apprised of these ethics, would evolve to expand protections for animals, human and non-human alike. Laws based on the new naturalness could protect species and environments as evidence demands.

Four levers of reciprocity across human societies: concepts, analysis and predictions

This paper surveys five human societal types - mobile foragers, horticulturalists, pre-state agriculturalists, state-based agriculturalists and liberal democracies - from the perspective of three core social problems faced by interacting individuals: coordination problems, social dilemmas and contest problems. We characterise the occurrence of these problems in the different societal types and enquire into the main force keeping societies together given the prevalence of these. To address this, we consider the social problems in light of the theory of repeated games, and delineate the role of intertemporal incentives in sustaining cooperative behaviour through the reciprocity principle. We analyse the population, economic and political structural features of the five societal types, and show that intertemporal incentives have been adapted to the changes in scope and scale of the core social problems as societies have grown in size. In all societies, reciprocity mechanisms appear to solve the social problems by enabling lifetime direct benefits to individuals for cooperation. Our analysis leads us to predict that as societies increase in complexity, they need more of the following four features to enable the scalability and adaptability of the reciprocity principle: nested grouping, decentralised enforcement and local information, centralised enforcement and coercive power, and formal rules.

Redefining nursing solidarity

The idea of solidarity is in vogue, especially since the eruption of the COVID-19 pandemic. However, the term "solidarity," as used in nursing, is imprecise and vague, lacking clear definition and connoting a variety of general meanings. Based on the original meaning of "solidarity" in ancient Roman law, this article captures the archetypical idea of solidarity from a historical and interdisciplinary perspective. This archetypical or primary meaning comes before the development of any other meanings of the word, and it is therefore authentic and genuine because it does not derive from something else. After establishing the archetypical meaning of solidarity, the article translates this meaning into the area of nursing and demonstrates a deep connectivity between healthcare and solidarity. The second part of the article offers and develops a new definition of nursing solidarity as the responsibility for the healthcare of a person (unit) shared as a whole (entirety) by that person and a nurse or a nursing team (plurality). This new definition has some implications for nursing practice and education, since the definition emphasizes the idea that solidarity helps to (a) foster respect and avoid discrimination, (b) promote cohesion in health communities, (c) increase individual responsibility and a spirit of service, (d) stimulate motivation, (e) improve communication, (f) create an engaging workplace, and (g) develop leadership.

An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint

Background

Psychiatry has long needed a better and more scalable way to capture the dynamics of behavior and its disturbances, quantitatively across multiple data channels, at high temporal resolution in real time. By combining 24/7 data—on location, movement, email and text communications, and social media—with brain scans, genetics, genomics, neuropsychological batteries, and clinical interviews, researchers will have an unprecedented amount of objective, individual-level data. Analyzing these data with ever-evolving artificial intelligence could one day include bringing interventions to patients where they are in the real world in a convenient, efficient, effective, and timely way. Yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications (ELSI).

Objective

The goal of the Ethics Checklist is to promote careful design and execution of research. It is not meant to mandate particular research designs; indeed, at this early stage and without consensus guidance, there are a range of reasonable choices researchers may make. However, the checklist is meant to make those ethical choices explicit, and to require researchers to give reasons for their decisions related to ELSI issues. The Ethics Checklist is primarily focused on procedural safeguards, such as consulting with experts outside the research group and documenting standard operating procedures for clearly actionable data (eg, expressed suicidality) within written research protocols.

Methods

We explored the ELSI of digital health research in psychiatry, with a particular focus on what we label “deep phenotyping” psychiatric research, which combines the potential for virtually boundless data collection and increasingly sophisticated techniques to analyze those data. We convened an interdisciplinary expert stakeholder workshop in May 2020, and this checklist emerges out of that dialogue.

Results

Consistent with recent ELSI analyses, we find that existing ethical guidance and legal regulations are not sufficient for deep phenotyping research in psychiatry. At present, there are regulatory gaps, inconsistencies across research teams in ethics protocols, and a lack of consensus among institutional review boards on when and how deep phenotyping research should proceed. We thus developed a new instrument, an Ethics Checklist for Digital Health Research in Psychiatry (“the Ethics Checklist”). The Ethics Checklist is composed of 20 key questions, subdivided into 6 interrelated domains: (1) informed consent; (2) equity, diversity, and access; (3) privacy and partnerships; (4) regulation and law; (5) return of results; and (6) duty to warn and duty to report.

Conclusions

Deep phenotyping research offers a vision for vastly more effective care for people with, or at risk for, psychiatric disease. The potential perils en route to realizing this vision are significant; however, and researchers must be willing to address the questions in the Ethics Checklist before embarking on each leg of the journey.

Partnership for International Development: Finland-Argentina Conference on Circular Economy and Bioeconomy with Emphasis on Food Sovereignty and Sustainability

A joint collaboration between the Cuarto region of Argentina championed by the National University of Rio Cuarto and the Arctic Centre of the University of Lapland, Finland organised a conference on several topics that are related to food sovereignty, sustainability, circular economy and bioeconomy. The efficient utilisation of natural resources in both regions is an important theme in meeting the sustainable development goals agenda. Hence, this partnership between the partner institutions will lead to the cocreation of knowledge. The topics were multidisciplinary, and the discussion focussed on research and teaching opportunities for institutions in both countries. The experts from both countries will continue to engage on the possibility of promoting the research agenda in these important areas.

'A woman and now a man': The legitimation of sex-assignment surgery in the United States (1849-1886)

Throughout much of recorded history, societies that assigned rights and duties based on sex were confounded by people with unclear sex. For the sake of maintaining social and legal order in those contexts, legal systems assigned these people to what they figured was the 'most dominant' sex. Then, in mid-19th century United States, a new classification mechanism emerged: sex-assignment surgery, which was imagined by some surgeons to 'fix' one's physical and legal sex status permanently. Other surgeons, however, fiercely opposed the new practice. This article traces the controversy around sex-assignment surgery through three high-profile cases published in US medical journals from 1849 to 1886. Its central argument is that the more general effort to transform surgery into a scientific field helped legitimate the practice of sex-assignment surgery. Although such surgery was subject to intense moral criticism because it was thought to breach the laws of men and nature, over time, these concerns were abandoned or transformed into technical or professional disagreements. In a secondary argument, which helps explain that transformation, this article shows that surgeons gradually became comfortable occupying the epistemic role of sex-classifiers and even sex-makers. That is, whereas sex classification was traditionally a legal task, the new ability to surgically construct one's genitals engendered the notion that sex could be determined and fixed in the clinic in a legally binding manner. Accordingly, I suggest that surgery became an epistemic act of fact-making. This evolution of the consensus around sex-assignment surgery also provides an early origin story for the idea of sex as plastic and malleable by surgeons, thus offering another aspect to the history of plastic sex.

Ethics, Guidelines, Standards, and Policy: Telemedicine, COVID-19, and Broadening the Ethical Scope

The coronavirus crisis is causing considerable disruption and anguish. However, the COVID-19 pandemic and consequent explosion of telehealth services also provide an unparalleled opportunity to consider ethical, legal, and social issues (ELSI) beyond immediate needs. Ethicists, informaticians, and others can learn from experience, and evaluate information technology practices and evidence on which to base policy and standards, identify significant values and issues, and revise ethical guidelines. This paper builds on professional organizations' guidelines and ELSI scholarship to develop emerging concerns illuminated by current experience. Four ethical themes characterized previous literature: quality of care and the doctor-patient relationship, access, consent, and privacy. More attention is needed to these and to expanding the scope of ethical analysis to include health information technologies. An applied ethics approach to ELSI would addresses context-specific issues and the relationships between people and technologies, and facilitate effective and ethical institutionalization of telehealth and other health information technologies.

Towards a Standardized Definition of Medical Nutrition Therapy and Regulatory Reform in Canada

Various definitions have been proposed to describe Medical Nutrition Therapy (MNT). Broadly, MNT encompasses the provision of nutrition information and advice aimed to prevent, treat, and/or manage health conditions. In Canada, the provision of such information and advice is unregulated, thus allowing anyone to provide MNT services regardless of their education and training. This inevitably poses risks of harm such as the provision of unsafe and/or ineffective nutrition advice as well as delayed evidence-based treatment. Canadian research has further demonstrated that the general public is unable to properly differentiate between regulated, evidence-based nutrition providers (registered dietitians) and those who are unregulated. Therefore, the public is at risk. To reduce nutrition misinformation and ultimately improve the health and well-being of the public, the objective of this paper is, first, to propose a standardized definition of MNT for use across Canada and, second, to propose province- and territory-specific legislative amendments for the regulation of MNT throughout the country. We also present an opposing perspective to the proposed viewpoint. Ultimately, health care regulation across the country requires an overhaul before we expect that nutrition information and advice communicated to the public may be consistently evidence based.

The Impact of Cognitive Biases on Professionals' Decision-Making: A Review of Four Occupational Areas

The author reviewed the research on the impact of cognitive biases on professionals' decision-making in four occupational areas (management, finance, medicine, and law). Two main findings emerged. First, the literature reviewed shows that a dozen of cognitive biases has an impact on professionals' decisions in these four areas, overconfidence being the most recurrent bias. Second, the level of evidence supporting the claim that cognitive biases impact professional decision-making differs across the areas covered. Research in finance relied primarily upon secondary data while research in medicine and law relied mainly upon primary data from vignette studies (both levels of evidence are found in management). Two research gaps are highlighted. The first one is a potential lack of ecological validity of the findings from vignette studies, which are numerous. The second is the neglect of individual differences in cognitive biases, which might lead to the false idea that all professionals are susceptible to biases, to the same extent. To address that issue, we suggest that reliable, specific measures of cognitive biases need to be improved or developed.

Harmful practices prevail despite legal knowledge: a mixed-method study on the paradox of child marriage in Bangladesh

Child marriage is a globally recognised human rights violation that disproportionately affects girls, especially in developing countries. It has serious negative consequences on girls' physical, mental, sexual, and reproductive health and rights. Although well-pronounced laws against child marriage were enacted in Bangladesh, the practice remains a significant challenge. Lack of law enforcement and persistent social norms ultimately allow child marriage to persist around the country. Social norms have an impact on the prevalent attitudes toward child marriage. Therefore, this mixed-method study aimed to explore the legal knowledge, perception, and practice of child marriage in Bangladesh. This study was part of a broader evaluation of a UNICEF media programme. Adolescent boys and girls aged between 10 and 19 years and their parents were interviewed in three Bangladeshi districts. All the respondents were aware of the legal age of marriage and knew that child marriage is punishable by law. This study illuminated the reasons, including early marriage among boys, poverty, dowry, and sexual harassment. Communities and policymakers need to be engaged to trigger larger structural and cultural changes to remedy the harmful social norm and its practice.

Laws Forbidding Pregnancy Discrimination in Substance Use Disorder Treatment Are Not Associated With Treatment Access

OBJECTIVES

To determine if state laws that forbid substance use disorder treatment providers from refusing services based on pregnancy are associated with improved ability to secure an initial appointment for opioid use disorder treatment with methadone and buprenorphine.

METHODS

Ten states in which a "secret shopper" study was conducted were stratified based on whether they have a law that forbids substance use disorder treatment providers from refusing to treat individuals because of pregnancy. We tested for differences in percent of pregnant versus nonpregnant callers offered an initial appointment for medication for opioid use disorder treatment between states with a law and those without. We also tested for differences in acceptance based on caller insurance type.

RESULTS

Four states with 1461 callers had relevant laws; 6 states with 2495 callers did not. None of the laws apply to all providers. In both groups of states, nonpregnant callers were significantly more likely to obtain a buprenorphine appointment (75.1% vs 60.1% in states with a law, P < 0.01; 73.1% vs 62.3% in states without, P < 0.01). No significant differences were found in methadone appointment access either between pregnant and nonpregnant callers or between pregnant callers in states with a law compared to those without.

CONCLUSIONS

Laws that forbid providers from refusing to treat potential patients because they are pregnant were not associated with success in obtaining an initial appointment for medication for opioid use disorder treatment. States should consider expanding those laws to apply to all treatment providers and ensure that currently covered providers are in compliance.

When law and science part ways: the criminalization of breastfeeding by women living with HIV

Stigma and discrimination are a constant reality for the 37.7 million people living with human immunodeficiency virus (HIV) around the globe. Fear over vertical transmission has fuelled HIV criminalization: laws that target people living with HIV for acts deemed to be a transmission risk. Research has now shown that many of these behaviours, including breastfeeding, pose an extremely low risk of transmission when people have proper medical care, access to treatment and open relationships with medical professionals. Yet, we are witnessing a wave of criminal cases against women living with HIV for breastfeeding, an act which is actively promoted worldwide as the best infant feeding strategy. In this review, we will place the criminalization of breastfeeding within the context of current medical recommendations and cultural views of breastfeeding. We will highlight the criminal cases against women living with HIV for breastfeeding around the globe and the criteria for justifiable criminalization. Finally, we will provide recommendations for moving towards decriminalization, removing this barrier to HIV prevention, treatment and care.

[The Basics of Decision-Making Capacity: The Top-10 Principles for the Clinical Practice]

The Basics of Decision-Making Capacity: The Top-10 Principles for the Clinical Practice Abstract. Decision-making capacity (decisional competence) as the ability to act rationally is a prerequisite for self-determination and is presumed in adults. In case of justified doubts, a cursory exam and, if necessary, an in-depth evaluation should be carried out. In this article, the concept of decision-making capacity is presented for the clinical practice based on the ten most important legal, ethical, and clinical principles. The criteria for assessing decision-making capacity, the relativity of decision-making capacity in terms of time and subject matter, and a possibly fluctuating decision-making capacity are highlighted. It becomes clear that decision-making incapacity is an attribution based on ethical-normative considerations. It should be noted that the decision of a person with decision-making capacity doesn't necessarily have to be reasonable. Finally, the assessment tool U-Doc is presented to support evaluation.

Addressing choice of law challenges in multi-state precision medicine research: experts' assessment of key factors

Precision medicine research implicates numerous state laws that may affect participants' rights and protections and are not preempted by federal law. The choice of which state's laws apply, and under what circumstances, can have significant impact on research design and oversight. But neither of the traditional approaches to choice of law issues-contractual agreement or determination by a court after a dispute arises-fit the research context well. We hosted a series of workshops with choice of law experts and research law and ethics experts to identify factors that are most crucial to account for in a future choice of law precision medicine research framework. Our workshops focused on precision medicine 'places' and choice of law factors; there was consensus that 'place where the harm occurred' was relevant and best represented by where the participant resides and/or where the research/institution is located. Our experts identified factors that need to be accounted for in a future choice of law framework. They also identified potential approaches, including a federal law or model state law as ways of achieving more uniformity of protections and a comprehensive database of laws, which merit further consideration to provide IRBs and researchers the guidance they require.

Heritable genome editing and cognitive biases: why broad societal consensus is the wrong standard for moving forward

Heritable genome editing (HGE) may one day safely correct mutations that cause serious monogenic diseases. Nevertheless, some scientists and bioethicists argue that HGE should be subject to a moratorium. In their view, no nation should proceed with clinical use absent broad societal consensus in favor of moving forward with HGE and a specific use. This article critiques this plan in light of two cognitive biases. First, human beings favor the status quo. We are primed to favor human reproduction and the human genome in their current forms and resist HGE. Second, human beings also dwell on negative information. Dr He Jiankui's unethical and premature experiment encourages us to judge HGE and its offspring harshly. By reinforcing these biases, the proposed moratorium would make it difficult to achieve broad societal consensus in support of using HGE even to correct dangerous mutations. As an alternative, this article recommends HGE be regulated for safety and efficacy. This approach will keep scientists from using HGE prematurely, while giving society time to discuss this new technology and enact further legislation if necessary.

Public Health Strategies: A Pathway for Public Health Practice to Leverage Law in Advancing Equity

This article outlines a pathway for public health departments and practitioners to incorporate law into their efforts to advance equity in health outcomes. We assert that examining and applying law can accelerate public health efforts to mitigate structural and systemic inequities, including racism. Recent events such as the COVID-19 pandemic and the community impacts of policing have brought into sharp relief the inequities faced by many populations. These stark and explosive examples arise out of long-standing, persistent, and sometimes hidden structural and systemic inequities that are difficult to trace because they are embedded in laws and accompanying policies and practices. We emphasize this point with a case study involving a small, majority Black community in semirural Appalachia that spent almost 50 years attempting to gain access to the local public water system, despite being surrounded by water lines. We suggest that public health practitioners have a role to play in addressing these kinds of public health problems, which are so clearly tied to the ways laws and policies are developed and executed. We further suggest that public health practitioners, invoking the 10 Essential Public Health Services, can employ law as a tool to increase their capacity to craft and implement evidence-based interventions.

High court should not restrict access to puberty blockers for minors

Gender dysphoria (GD) is a clinically significant incongruence between expressed gender and assigned gender, with rapidly growing prevalence among children. The UK High Court recently conducted a judicial review regarding the service provision at a youth-focussed gender identity clinic in Tavistock. The high court adjudged it 'highly unlikely' that under-13s, and 'doubtful' that 14-15 years old, can be competent to consent to puberty blocker therapy for GD. They based their reasoning on the limited evidence regarding efficacy, the likelihood of progressing to cross-sex hormone therapy and the 'life-changing consequences' of puberty blockers. In this article, I offer two concurrent arguments to dispute their reasoning. First, I argue that minors can be competent to consent to puberty blockers for GD, because the decision to undergo puberty blocker therapy is no more complex or far-reaching than other medical decisions that we accept a child should be able to make. Second, I argue that-irrespective of competence-such legal restriction for all children fundamentally contradicts the central ethical tenet of child healthcare: best interests. For these two reasons, the high court should not restrict access to puberty blockers for competent GD children.

Digital Biomarkers in Psychiatric Research: Data Protection Qualifications in a Complex Ecosystem

Psychiatric research traditionally relies on subjective observation, which is time-consuming and labor-intensive. The widespread use of digital devices, such as smartphones and wearables, enables the collection and use of vast amounts of user-generated data as "digital biomarkers." These tools may also support increased participation of psychiatric patients in research and, as a result, the production of research results that are meaningful to them. However, sharing mental health data and research results may expose patients to discrimination and stigma risks, thus discouraging participation. To earn and maintain participants' trust, the first essential requirement is to implement an appropriate data governance system with a clear and transparent allocation of data protection duties and responsibilities among the actors involved in the process. These include sponsors, investigators, operators of digital tools, as well as healthcare service providers and biobanks/databanks. While previous works have proposed practical solutions to this end, there is a lack of consideration of positive data protection law issues in the extant literature. To start filling this gap, this paper discusses the GDPR legal qualifications of controller, processor, and joint controllers in the complex ecosystem unfolded by the integration of digital biomarkers in psychiatric research, considering their implications and proposing some general practical recommendations.

Easing of Regulatory Barriers to Telemedicine Abortion in Response to COVID-19

For many people seeking abortion during the continuing COVID-19 pandemic, telemedicine abortion is the safest and most acceptable method, posing lower risk of exposure to the virus. In addition, by reducing in-person visits with health care providers, increased use of telemedicine for abortion can reduce pressure on overburdened health systems. Given the benefits of telemedicine during the pandemic, government agencies in several countries took measures to temporarily allow telemedicine abortion. We conducted key-word English-language searches to identify examples of government action to remove regulatory barriers to the practice of telemedicine abortion in response to the pandemic. We found instances of government agencies in eight countries taking steps to ease regulatory barriers to telemedicine abortion. Telemedicine abortion is safe, cost-effective, and may be the preferred method of abortion during acute periods of COVID-19 transmission, as well as after the pandemic has abated. As one step to expanding access to abortion with medicine where abortion is legal, health agencies and other regulatory bodies can take steps to remove barriers specific to telemedicine abortion.

[Dignity and access to care in psychiatry]

The notion of dignity is not synonymous with autonomous freedom (autonorma). It has an objective dimension, which is based on the individual's belonging to humanity. This is often neglected in psychiatry, even though it is what leads to the universal prevailing over singular preferences when a value specific to the human condition and to the suffering that inhabits it is at stake. To be of this universality while being a clinic of singularity representes the nobility of psychiatry and its vocation to make mental health live.

Operationalizing legal rights in end-of- life decision-making: A qualitative study

BACKGROUND

For a patient's legal right to make end-of-life treatment decisions to be respected, health care practitioners, patients and their substitute decision-makers must know what rights exist and how to assert them (or support others to assert them). Yet very little is known about what enhances or obstructs the operationalization of legal rights from the perspective of patients, family members and substitute decision-makers.

AIM

To explore barriers and facilitators to the operationalization of rights in end-of-life decision-making from the perspectives of terminally-ill patients and family members and substitute decision-makers of terminally ill patients in Australia.

DESIGN

Semi-structured interviews (face to face and telephone) with patients, family or substitute decision-makers experienced in end-of-life decision-making completed between November 2016 and October 2017. A thematic content analysis of interview transcripts.

SETTING/PARTICIPANTS

Purposive sampling across three Australian states provided 16 terminally-ill patients and 33 family and/or substitute decision-makers.

RESULTS

Barriers and facilitators emerged across three overlapping domains: systemic factors; individual factors, influenced by personal characteristics and decision-making approach; and communication and information. Health care practitioners play a key role in either supporting or excluding patients, family and substitute decision-makers in decision-making.

CONCLUSION

In addition to enhancing legal literacy of community members and health practitioners about end-of-life decision-making, support such as open communication, advocacy and help with engaging with advanced care planning is needed to facilitate people operationalizing their legal rights, powers and duties. Palliative care and other support services should be more widely available to people both within and outside health systems.

Understanding the anatomy of a malpractice suit. In the United States this is a doctor's best defence

In the United States, the majority of physicians have been sued and those who have not, will be. Defendants share the notion that the lawsuit is totally fallacious. To be fallacious, the outcome of a medical intervention must be an unpreventable random maloccurrence. This is the only alternative to a medical error. The conflict over outcomes that are random and outcomes that are medical errors results in 46,000 malpractice suits every year in the USA. The burden of proof is a preponderance of evidence, but this is insufficient to do more than just infer, not prove, a relationship between the medical intervention and the outcome. Plaintiffs, generally, prove a malpractice case using inductive reasoning. Inductive reasoning leaves much to intuition. They use inductive reasoning because, by definition, preponderance of evidence, also, leaves much to intuition. Deductive reasoning is objective and there is no place for intuition. With deductive reasoning, the burden of proof is now sufficient to distinguish whether or not the cause relates to the effect with 95% confidence. A model for deductive reasoning in malpractice which is completely consistent with the scientific method is presented. This should and would derail frivolous lawsuits.

Courtwatching: Visibility, publicness, witnessing, and embodiment in legal activism

Courtwatching involves grassroots efforts to observe the day-to-day work of decision making in justice systems, usually undertaken by activists as a way to scrutinise and challenge the power of legal professionals such as judges. This paper argues for closer attention to courtwatching in legal geographical research. Numerous courtwatching programmes exist around the world, and the first part of the paper surveys some of these, giving a sense of their diversity, the challenges they can face, and the influence that they have. The second part of the paper uses courtwatching to explore questions of visibility, publicness, witnessing, and embodiment in legal research into courts, trials, and hearings. It argues that courtwatching highlights the complexity of legal publicness, problematising the binary notion of "closed" or "open" hearings, and also raises important questions about the ethical differences between watching and witnessing. Finally, in the context of proliferating ways in which courts are becoming public via digital means of watching, such as TV and podcasts, the paper asks what difference it makes to actually be there, in the flesh, to watch legal processes.

[Healthcare professionals and COVID-19 in Morocco: accident at work or occupational disease?]

L´abnégation et le sens de l´engagement au devoir sont des principes éthiques fondamentaux de la profession médicale. Depuis le début de la crise sanitaire, le personnel soignant fut le premier rempart contre la propagation du coronavirus, par conséquent, la catégorie professionnelle la plus exposée aux risques de contamination. A cet égard, dans un communiqué datant du 23 mars 2020, l´Organisation mondiale de la santé a recommandé la prise en charge -au titre de législation professionnelle- de la maladie provoquée par la COVID-19 pour les salariés du secteur médical, mais également ceux de tous les secteurs exposés aux risques de contamination. Au Maroc, le ministère de la Santé a publié le 6 avril, sur son site officiel, un communiqué de condoléance destiné aux familles des deux premiers médecins décédés à la suite de leur contraction du coronavirus tout en précisant que la cause du décès des deux médecins n´est pas due à l'exercice de leurs fonctions professionnelles. Le Ministre du travail et de l'insertion professionnelle a récemment chargé une commission interne d´entreprendre une réflexion sur cette question. Qu´en est-il à ce jour, compte tenu de l´assise juridique marocaine, de la possibilité de reconnaître le caractère professionnel de la maladie provoquée par le coronavirus?

Legal Matters: The Legal Context of Health Informatics in Global Pandemics

Law and regulation have not received much attention as part of the context shaping and being shaped by health informatics. Telemedicine, data, devices and software, and electronic health records (EHRs) are examples of how technologies are affected by privacy, intellectual property protections, and other law and regulation.

The impact of voluntariness of apologies on victims' responses in restorative justice: findings of a quantitative study

Apologies are ordered in law without certainty about whether or not recipients perceive ordered and voluntary apologies differently. This exploratory study investigates whether or not the voluntariness of apologies influences recipients' perceptions of their sincerity, acceptance of apologies, willingness to forgive and intended retributive behaviour. We manipulated the voluntariness of apologies whilst considering offender (age, gender, ethnicity and prior wrongful behaviour) and offence (seriousness) characteristics in 3 studies (ns = 164, 121, 236). Participants adopting the role of a hypothetical victim received either a voluntary or an ordered apology. The voluntary apologies were found to have a significantly more positive impact than the ordered apologies on acceptance and perception of sincerity in all 3 studies and on forgiveness in 2 studies, but did not significantly change participants' retributive behaviour in any study. Age was the only other variable found to make a significant difference, with younger offenders' apologies being rated as sincerer.

Legal Issues: Advocacy by and Disabilities of School Nurses

This article summarizes the facts and rulings of a recent representative federal appeals court decision concerning the legal claims of two school nurses who lost their positions after advocating on behalf of students with diabetes. Their primary claim was the anti-retaliation protection under the pair of federal laws prohibiting disability discrimination-Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. The second of the two nurses additionally asserted protection under this pair of laws based on her own asserted disabilities. The discussion reveals the sometimes significant difference between legal requirements, as determined by appellate courts, and professional norms, as perceived by practitioners and professors in school nursing.

Characteristics and outcome of patients transported by police to emergency departments under section 351 of the Mental Health Act 2014 (Vic)

OBJECTIVE

To determine characteristics, precipitating circumstances, clinical care, outcome and disposition of patients brought to the ED under section 351 (s351, police detention and transport) powers of the Mental Health Act 2014 (Vic) (MHAV).

METHODS

This is an observational cohort study conducted in two metropolitan teaching hospitals in Victoria. Participants were adult patients brought to ED under s351 of the MHAV. Data collected included demographics, event circumstances, pre-hospital and ED interventions and outcome. Analyses are descriptive.

RESULTS

The present study included 438 patient encounters. Median age was 34 years. In 84% of encounters (368/438) patients were co-transported with ambulance. The most common primary reason for detainment was suicide risk/intent (296/438, 67.6%) followed by abnormal behaviour without threat to self or others (92/438, 21%). In ED, parenteral sedation was administered in 11% (48/438). Physical restraint was applied in 17.6% (77/438). Psychiatric admission was required in 23.5% (103/438). In 63 cases, psychiatric admission was involuntary (14.4%). Most patients (297/438, 67.8%) were discharged home. A subset of patients had recurrent s351 presentations. Eighteen (5.6%) patients accounted for 22% (96/438) of all events.

CONCLUSION

Most patients brought to ED under s351 of the MHAV had expressed intention to self-harm, did not require medical intervention and were discharged home. It could be questioned whether the current application of s351 is consistent with the least restrictive principles of the MHAV, especially as there is no apparent monitoring or reporting of the use of these powers. There were a concerning number of patients with multiple s351 events over a short period.

[Patient's Personal Data Protection Awareness: A Survey of Clinical Nurses]

BACKGROUND

The aim of the Personal Data Protection Act (PDPA) is to regulate the collection, processing, and use of personal information; to avoid the infringement of personal rights; and to promote the reasonable use of personal information. Clinical nurses are frontline patient caregivers, and they are the most likely to have access to patients' personal information. If these nurses do not clearly understand the PDPA, they may violate the law and affect patients' rights.

PURPOSE

The purpose of this study was to investigate the knowledge level of clinical nurses regarding the PDPA and related factors, with the findings intended to serve as a reference for continuing education.

METHODS

A cross-sectional research design was adopted. A purposive sample of nurses working at a regional hospital in southern Taiwan was selected. A self-administered survey incorporating the self-developed Nurses Knowledge Scale for Patient Personal Data Protection Act (NKSPPDPA) was used to collect data from May to June 2017.

RESULTS

A total of 269 valid responses were received (return rate: 89.67%). The mean score on the NKSPPDPA was 68.80 out of a total-possible 100 points. Knowledge related to patient privacy and penalties was relatively low. Moreover, working department, job title, and participation in PDPA-related on-the-job education were found to be significant predictors of NKSPPDPA score, while years of experience was found to have a low correlation only.

CONCLUSIONS

The results suggest that clinical nurses have knowledge gaps regarding PDPA, especially in terms of privacy and penalties. Nurses should participate in continuing education to address these knowledge gaps.

Mandatory Prescription Limits and Opioid Use After Anterior Cruciate Ligament Reconstruction

Background:

Because of the need for perioperative pain management, orthopaedic surgeons play an important role in opioid use.

Purpose/Hypothesis:

To evaluate the impact of opioid-limiting legislation on postoperative opioid use and pain-related complications after anterior cruciate ligament reconstruction (ACLR). The hypothesis was that the opioid-limiting legislation would reduce postoperative opioid use after ACLR.

Study Design:

Cohort study; level of evidence, 3.

Methods:

We retrospectively reviewed patients who underwent ACLR 1 year before and 1 year after Ohio's opioid-limiting legislation, which was passed in August 2017. Clinicians were prohibited from prescribing more than 30 morphine milligram equivalents (MMEs) per day, with a maximum duration of 7 days for adults. The Ohio Automated Rx Reporting System database and patients’ medical charts were reviewed for prescriptions of all controlled substances (oral oxycodone, hydrocodone, morphine, codeine, tramadol, and hydromorphone) filled from 30 days before and 90 days after ACLR. The total number of postoperative prescriptions, total MMEs, the number of pills in each patient’s prescription, and pain-related complications (emergency department visits, office calls for pain control issues, unplanned readmissions, unplanned surgeries, and provider notes indicating opioid prescription refill demands) were evaluated.

Results:

A total of 243 patients (127 prelegislation, 116 postlegislation) were included in the study. There were no significant differences in demographics or preoperative opioid use between the study groups. The number of pills prescribed initially decreased by 34% after legislation (63.5 ± 16.7 [prelegislation] vs 42 ± 15.7 pills [postlegislation]; P < .001). Correspondingly, there was a significant decrease in total quantity of initial prescriptions in the postlegislation period (474.6 ± 123.8 vs 310.7 ± 115.3 MMEs; P < .001). The number of documented pain medication refill demands and pain-related complications did not increase in the postlegislation period (42 prelegislation vs 43 postlegislation; P = .514). Preoperative opioid use was the strongest predictor of opioid-refill demand (odds ratio, 4.19 [95% CI, 1.76-9.99]; P = .001).

Conclusion:

After the Ohio legislation was passed limiting opioid prescription, there was a significant reduction in opioids provided for patients undergoing ACLR. In spite of this decrease, no rebound increase in refill demands or postoperative pain-related complications were observed.

Uterine transplantation: legal and regulatory implications in England

Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications for fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. TWEETABLE ABSTRACT: Uterine transplantation warrants a closer look at the legal frameworks on fertility treatment and transplantation in England.

A high-level overview of AI ethics

Artificial intelligence (AI) ethics is a field that has emerged as a response to the growing concern regarding the impact of AI. It can be read as a nascent field and as a subset of the wider field of digital ethics, which addresses concerns raised by the development and deployment of new digital technologies, such as AI, big data analytics, and blockchain technologies. The principle aim of this article is to provide a high-level conceptual discussion of the field by way of introducing basic concepts and sketching approaches and central themes in AI ethics. The first part introduces concepts by noting what is being referred to by "AI" and "ethics", etc.; the second part explores some predecessors to AI ethics, namely engineering ethics, philosophy of technology, and science and technology studies; the third part discusses three current approaches to AI ethics namely, principles, processes, and ethical consciousness; and finally, the fourth part discusses central themes in translating ethics in to engineering practice. We conclude by summarizing and noting the inherent interdisciplinary future directions and debates in AI ethics.

Digital Mega-Studies as a New Research Paradigm: Governing the Health Research of the Future

'Digital Mega-Studies' are entirely or extensively digitised, longitudinal, population-scale initiatives, collecting, storing, and making available individual-level research data of different types and from multiple sources, shaped by technological developments and unforeseeable risks over time. The Australian 'Gen V' project exemplifies this new research paradigm. In 2019, we undertook a multidisciplinary, multi-stakeholder process to map Digital Mega-Studies' key characteristics, legal and governance challenges and likely solutions. We conducted large and small group processes within a one-day symposium and directed online synthesis and group prioritisation over subsequent weeks. We present our methods (including elicitation, affinity mapping and prioritisation processes) and findings, proposing six priority governance principles across three areas-data, participation, trust-to support future high-quality, large-scale digital research in health.

Governance Choices of Genome Editing Patents

There are a variety of governance mechanisms concerning the ownership and use of patents. These include government licenses, compulsory licenses, march-in rights for inventions created with federal funding, government use rights, enforcement restrictions, subject-matter restrictions, and a host of private governance regimes. Each has been discussed in various contexts by scholars and policymakers and some, in some degree, have been employed in different cases at different times. But scholars have yet to explore how each of these choices are subject to-or removed from-democratic control. Assessing the range of democratic implications of these patent governance choices is important in understanding the social and political implications of controversial or wide-ranging technologies because their use has a significant potential to affect the polity. This paper seeks to unpack these concerns for genome editing, such as CRISPR, specifically. Patents covering genome editing make an interesting case because, to date, it appears that the polity is concerned less with certain kinds of access, and more with distribution and limits on the technology's particular uses, such as human enhancement and certain agricultural and environmental applications. Here, we explore what it means for patents to be democratic or non-democratically governed and, in so doing, identify that patents covering many of the most controversial applications-that is, ones most likely to gain public attention-are effectively controlled by either non- or anti-democratic institutions, namely, private restrictions on licensing. This may be effective-for now-but lawmakers should be wary that such restrictions could rapidly reverse themselves. Meanwhile, other choices, like compulsory licenses, more broadly touch on democratic deliberation but, as currently structured, are aimed poorly for particular applications. Insofar as the public wants, or perhaps deserves, a say in the distribution and limits of these applications, illuminating the ways in which these governance choices intersect-or fail to intersect-with democratic institutions is critical. We offer some concluding thoughts about the nature of patents and their relationship with democratic governance as distributed claims to authority, and suggest areas for scholars and policymakers to pay close attention to as the genome editing patent landscape develops.

War of conscience: antivaccination and the battle for medical freedom during World War I

The nineteenth century British antivaccination movement attracted popular and parliamentary support and ultimately saw the 1853 law which had made smallpox vaccination compulsory nullified by the 1898 'conscientious objector' clause. In keeping with popular public health discourse of the time, the movement had employed rhetoric associated with sanitary science and liberalism. In the early twentieth century new discoveries in bacteriology were fuelling advances in vaccination and the medical establishment was increasingly pushing for public health to move towards more interventionist medical approaches. With the onset of war in 1914, the medical establishment hoped to persuade the government to introduce compulsory typhoid inoculation for soldiers. This article analyses antivaccination literature, mainstream newspapers and medical press along with parliamentary debates to examine how the British antivaccination movement engaged with this new threat of compulsion by expanding the rhetoric of 'conscience' and emphasising medical freedom while also asserting scientific critique concerning the effectiveness of vaccines and the new laboratory based diagnostic practices. In spite of 'conscience' fitting well with an emerging public health discourse of individual subjectivity, the mainstream press ridiculed the idea of working-class soldiers having a conscience, coalescing around the idea that 'conscientious objection' be reserved for spiritual, philosophical and educated men who objected to military service. Moreover, in spite of engaging in reasoned scientific critique, parliament and press consorted in the demarcation of scientific knowledge as exclusive to medical scientists, reflecting a growing allegiance between the state and the medical establishment during the war. Any scientific arguments critical of medical orthodoxy were subjugated, labelled as 'crank' or 'faddist' as well as unpatriotic. The antivaccination narratives around conscience contributed to or were part of an evolving discourse on consent and ethics in medicine. Potential parallels are drawn with current and likely future debates around vaccination and counterhegemonic scientific approaches.

On the Basis of Gender: A Medical-Legal Review of Barriers to Healthcare for Transgender and Gender-Expansive Patients

Transgender individuals will seek medical intervention for transition-related services as well as medical treatment for general health needs similar to cisgender individuals. However, people in the transgender community face unique barriers to treatment such as the lack of knowledge among health-care professionals, insurance coverage, and legal protections. This paper reviews barriers, major legal cases, and federal policy related to the health needs for transgender and gender expansive individuals. The authors call for a social work response at the macro and micro level. Advocacy for health care access for transgender individuals is a social justice issue social workers are uniquely positioned to work toward. At the micro level, social workers must help educate and advocate for their clients to bring transgender-sensitive practices to the health care system.

HIV Disclosure-Professional Body Guidelines, the Law and the Boundaries of Medical Advice

This article examines the current BHIVA/BASHH guidelines on the disclosure of HIV+ status in the context of sexual activity. It assesses whether the guidance provided on how to avoid criminal prosecution accurately reflects the prevailing position in law. Given that aspects of the guidance related to non-disclosure of HIV infection in the context of low or negligible risk are as yet untested in UK law, it is argued that there is some uncertainty as to whether the professional body guidelines and the law can be reconciled with each other. The article also considers whether the BHIVA/BASHH guidelines stray beyond the boundaries of medical advice as normally understood (focused on the protection of health and the prevention of onward transmission), by posing both as legal advice on how to avoid prosecution and offering what could be viewed as a moral judgement as to when disclosure is required. While a bio-medical assessment of risk naturally shapes clinical guidelines and may also inform views as to appropriate sexual behaviour and risk-taking, it is unclear whether scientific assessment of risk should be the sole guide when it comes to determining the nature of any disclosure obligation or the medical advice to be given on this matter.

[The law to combat violence against women]

Concern about the issue of violence against women emerged in society in the second half of the 20th century. The development of networks of associations favours the creation of laws to defend women's rights on a national level and to respond to the European convention. While it is not easy for victims to assert their rights, a protection order is a key tool for protecting women. Through their actions, health professionals can facilitate the use of existing mechanisms.

[The Legal Risks Faced in Nursing and Smart Healthcare]

Smart healthcare and telemedicine are shortening the gap in the quality of medical and healthcare available to urban and rural communities and allowing care to be provided free of space and time limitations. The COVID-19 pandemic has hastened the general adoption of telemedicine as a protocol in hospitals and healthcare and led to a rapid paradigm shift from medical expertise to telemedicine eHealth. Because nurses play a significant role as members of interdisciplinary teams, we are expected to quickly adapt to and use artificial intelligence and other new technology innovations. This article elucidates the intellectual-property-right-related responsibilities and obligations of nurses and attendant legal risks in the context of smart medical research, clinical care standards, information laws and rules, and related policymaking. In addition, the legal issues related to telemedicine are discussed and analyzed.

Challenging misconceptions about clinical ethics support during COVID-19 and beyond: a legal update and future considerations

The pace of change and, indeed, the sheer number of clinical ethics committees (not to be confused with research ethics committees) has accelerated during the COVID-19 pandemic. Committees were formed to support healthcare professionals and to operationalise, interpret and compensate for gaps in national and professional guidance. But as the role of clinical ethics support becomes more prominent and visible, it becomes ever more important to address gaps in the support structure and misconceptions as to role and remit. The recent case of Great Ormond Street Hospital for Children NHS Foundation Trust v MX, FX and X ([2020] EWHC 1958 (Fam), [21]-[23] and [58]) has highlighted the importance of patient/family representation at clinical ethics committee meetings. The court viewed these meetings as making decisions about such treatment. We argue that this misunderstands the role of ethics support, with treatment decisions remaining with the clinical team and those providing their consent. The considered review by clinical ethics committees of the moral issues surrounding complex treatment decisions is not a matter of determining a single ethical course of action. In this article, we consider current legal understandings of clinical ethics committees, explore current concepts of ethics support and suggest how they may evolve, considering the various mechanisms of the inclusion of patients and their representatives in ethics meetings which is not standard in the UK.

The perils of a broad approach to public interest in health data research: a response to Ballantyne and Schaefer

The law often calls on the concept of public interest for assistance. Privacy law makes use of this concept in several ways, including to justify consent waivers for secondary research on health information. Because the law sees information privacy as a means for individuals to control their personal information, consent can only be set aside in special circumstances. Ballantyne and Schaefer argue that only public interest, and only a broad conception of public interest, can do the special 'normative justificatory work' to override consent requirements. Other, similar-sounding concepts, such as public benefit, public good and social value, also provide useful services. But none more so than public interest. In fact, they argue, public interest is the superior concept precisely because it can capture those concepts as well as a range of other interests. Our response focuses on this claim. We argue their strategy is not as promising as it might first seem. Ballantyne and Schaefer construe the important role that public interest plays in this context as their endpoint. They claim that unless the concept is open and content-rich, it will lose some of its importance. But by refusing to place limits around it, their inquiry leads us back to a catch-all concept that lacks clear focus or meaning. In reply, we argue that, for practically minded theorists, a narrow conception of public interest is more useful. Further, the narrowing of public interest in this context can be achieved by first analysing it in its legal, rather than ethical, sense.

Of Screening, Stratification, and Scores

Technological innovations including risk-stratification algorithms and large databases of longitudinal population health data and genetic data are allowing us to develop a deeper understanding how individual behaviors, characteristics, and genetics are related to health risk. The clinical implementation of risk-stratified screening programmes that utilise risk scores to allocate patients into tiers of health risk is foreseeable in the future. Legal and ethical challenges associated with risk-stratified cancer care must, however, be addressed. Obtaining access to the rich health data that are required to perform risk-stratification, ensuring equitable access to risk-stratified care, ensuring that algorithms that perform risk-scoring are representative of human genetic diversity, and determining the appropriate follow-up to be provided to stratification participants to alert them to changes in their risk score are among the principal ethical and legal challenges. Accounting for the great burden that regulatory requirements could impose on access to risk-scoring technologies is another critical consideration.

Safety of Medical Devices in Poland - Analysis of Withdrawn and Suspended Certificates of Compliance

Introduction

In the European Union, the process of controlling currently used medical devices is carried out and determined by legal provisions. The law stipulates that each entity responsible for using medical equipment must confirm its safety with an appropriate certificate issued by a notifying body. In Poland, the entity responsible for keeping records as to the withdrawn and suspended certificates, is the Office for Registration of Medicinal Products, Medical Devices, and Biocidal Products (URPL). Certification is required for all medical devices prior to their introduction onto the market and during their use.

Purpose

The article presents data concerning the number of medical devices that failed to meet the certification criteria.

Methods

The research method is an analysis of available subject literature and a report on withdrawn and suspended certificates of medical devices in Poland.

Results

In the years 2014–2020, the notified bodies withdrew and suspended 13,354 certificates for medical devices, of which 9792 certificates were withdrawn, 2852 suspended and one falsified.

Conclusion

The suspension or withdrawal of a certificate for medical devices due to the inefficiency, obsolescence, imprecision, or safety of the devices is an action that improves the safety of patients. Such action reduces the number of medical damages and the obligation to pay compensation to those injured.

The Epistemic Revolution Induced by Microbiome Studies: An Interdisciplinary View

Simple Summary

This interdisciplinary study, conducted by experts in evolutionary biology, ecology, ecosystem studies, arts, medicine, forensic analyses, agriculture, law, and philosophy of science describe how microbiome studies are convergently affecting the concepts and practices of diverse fields and practices, that now consider microbiomes within their legitimate scope. Consequently, it describes what seems to be an ongoing pluridisciplinary epistemic revolution, with the potential to fundamentally change how we understand the world through an ecologization of pre-existing concepts, a greater focus on interactions, the use of multi-scalar interaction networks as explanatory frameworks, the reconceptualization of the usual definitions of individuals, and a de-anthropocentrification of our perception of phenomena.

Abstract

Many separate fields and practices nowadays consider microbes as part of their legitimate focus. Therefore, microbiome studies may act as unexpected unifying forces across very different disciplines. Here, we summarize how microbiomes appear as novel major biological players, offer new artistic frontiers, new uses from medicine to laws, and inspire novel ontologies. We identify several convergent emerging themes across ecosystem studies, microbial and evolutionary ecology, arts, medicine, forensic analyses, law and philosophy of science, as well as some outstanding issues raised by microbiome studies across these disciplines and practices. An ‘epistemic revolution induced by microbiome studies’ seems to be ongoing, characterized by four features: (i) an ecologization of pre-existing concepts within disciplines, (ii) a growing interest in systemic analyses of the investigated or represented phenomena and a greater focus on interactions as their root causes, (iii) the intent to use openly multi-scalar interaction networks as an explanatory framework to investigate phenomena to acknowledge the causal effects of microbiomes, (iv) a reconceptualization of the usual definitions of which individuals are worth considering as an explanans or as an explanandum by a given field, which result in a fifth strong trend, namely (v) a de-anthropocentrification of our perception of the world.