Fallacious, misleading and unhelpful:The case for removing ‘systematic review’ from bioethics nomenclature

Attempts to conduct systematic reviews of ethical arguments in bioethics are fundamentally misguided. All areas of enquiry need thorough and informative literature reviews, and efforts to bring transparency and systematic methods to bioethics are to be welcomed. Nevertheless, the raw materials of bioethical articles are not suited to methods of systematic review. The eclecticism of philosophy may lead to suspicion of philosophical methods in bioethics. Because bioethics aims to influence medical and scientific practice it is tempting to adopt scientific language and methods. One manifestation is the increasing innovation in, and use of, systematic reviews of ethical arguments in bioethics. Yet bioethics, as a broadly philosophical area of enquiry, is unsuited to systematic review. Bioethical arguments are evaluative, so notions of quality and bias are inapplicable. Bioethical argument is conceptual rather than numerical, and the classification of concepts is itself a process of argument that cannot aspire to neutrality. Any ‘systematic review’ of ethical arguments in bioethics thus falls short of that name. Furthermore, labels matter. Although the bioethics research community may find that adopting the language and the outward methods of clinical science offers apparent prospects of credibility, policy influence and funding, we argue that such misdirection carries risks and is unlikely to pay dividends in the long term. Bioethical sources are amenable to the review methods of the social sciences, and it is on these methods that specific methods of bioethics literature review should be built

Inclusivity in TAS research:An example of EDI as RRI

Responsible research and innovation (RRI) aims to achieve the goal of making research activities responsible and ethical. To those ends, it is vital for researchers to actively engage with equality, diversity and inclusion (EDI) which, if not attended to, may detrimentally affect both potential research participants and the research itself. Our paper offers an account of our ongoing discussions surrounding the importance of EDI when designing our research, how we employed EDI to intentionally make our recruitment process more inclusive, and our ongoing planning to make all our research activities as inclusive, diverse, and accessible as possible. There is no one-size-fits-all approach for adopting EDI principles in RRI, however, we posit that their consideration is essential for research communities who wish their work to represent the perspectives of those who will be affected by future novel technologies

Survey Of UK Clinicians’ Approaches To Decision-Making In Neonatal Intestinal Failure

BACKGROUND: Outcomes for neonatal intestinal failure (IF) have improved significantly over the past two decades, however, there is no consensus for decision making among UK paediatric subspecialists. OBJECTIVES: The aim was to describe clinician’s attitudes to decision making in neonatal IF and examine variation between subspecialties. METHODS: Neonatologists, paediatric surgeons and gastroenterologists were surveyed electronically. They were asked if they would recommend active or palliative care or allow the parents to decide in several scenarios; or if they considered treatment morally obligatory or impermissible. RESULTS: Of 147 respondents, 81% of gastroenterologists would recommend active care (34.6% regardless of parental decision) for a term infant with total gut Hirschsprung’s compared with 46% and 33% of surgeons and neonatologists. No gastroenterologist would recommend palliation while 23% of both neonatologists and surgeons would. Similarly, 77% of surgeons and 73% of neonatologists would recommend palliation for a 28-week infant with IF and bilateral parenchymal haemorrhages compared with 27% of gastroenterologists. Prognostic estimates also varied. A term baby with IF was estimated to have a survival of >80% at 5 years by 58% of gastroenterologists compared with 11.5% and 2.7% of surgeons and neonatologists. Only 11.5% of surgeons and 2.6% of neonatologist believed a 26-week preterm with IF would have a 5-year survival >60% compared with 59% of gastroenterologists. CONCLUSION: There is substantial variation in views about outcomes and management choices both within and between specialties; with gastroenterologists being consistently more positive. This is likely to lead to unjustified variation in counselling and parental choices