Clinical Ethics–Challenges of the Past, the Present, and the Future

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Comments to

“Clinical ethics, development, field, philosophical background – challenges of past, present, and the future”

The following suggestions are provided to improve the submitted text.

1.

Lines  21-30

Among the questions raised in this inquiry is the relationship between bioethics and clinical ethics. It is a complex relationship, but it distracts from the central topic, which remains the “clinical ethics”. In any case, we should also bear in mind the work of Albert R. Jonsen, The Birth of Bioethics.

1.1

Line 63

The metaphor of the “bridge” (bio-ethics) used by Van Rensselaer Potter could be better exploited.

1.2

Ethical aspects should be emphasised, with possible references to the WMA: International Code of Medical Ethics (1949 – 2022), Medical Ethics Manual (2015), …).

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2.

Lines 32-38

Readers are advised not to expect an article on the practice of clinical ethics (CE). However, even in the context of a “narrative review”, operational aspects must be addressed, because clinical ethics cannot be detached from its practical application.

The title of § 4 (lines 124-125) poses the question: “Who is an expert in clinical ethics?”. The answer can be provided by better specifying the areas of application of CE, which are referred to in lines 86-88.

Some advice is provided below.

2.1

• CE applied to clinical research/experimentation (“institutional review boards” – line 110), which refers to international declarations or documents (see WMA, Declaration of Helsinki, 1964-2024; ICH E6(R3), and various regulations, etc.). What are its aims? How does it work?

2.2

• CE within “clinical ethics committees or hospital ethics committees” (line 109): What is their function? How is clinical ethics implemented? Where is this method of applying CE most commonly used?

2.3

• CEC as “bedside ethics”. Author/Authors are therefore invited to reinforce these aspects, explicitly mentioning also the Clinical Ethics Consultation (CEC).

In this context, methodological aspects (discussed in § 5, lines 162 ff.) can be reinforced with incisive references to more operational issues:

• the relevant regulatory and institutional context (“canon of clinical ethics”);
• ethical pluralism;
• the methodology of “shared decision making” in the context of the “care relationship”;
• better clarification of the role of the clinical ethics expert as a “facilitator of discussion” (line 258), to be better linked to the hermeneutic-phenomenological method (lines 201 ff.);
• What is the meaning of the “good” of the patient? Mediation is the means to achieve this end (see E. Pellegrino, D. C. Thomasma, "For the Patient's Good").

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3

Lines 263 ff.

I would invite the Author/Authors to a nod to the challenges ahead that await clinical ethics:

- applications of artificial intelligence;

- issues in neonatal medicine;

- progressive spread in the Western world of medically assisted death;

- spread of new viruses or new diseases, (…).

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4

Please provide additional references regarding the improvements that will be made.

 

Comments on the Quality of English Language

The English title is not convincing.

Author Response

Dear Reviewers,

I thank you for your comments. They were all included in the revised text of the manuscript. I hope I have implemented all the changes successfully.  The text that was rewritten or added, along with the newly added references, is in red.  I have put the whole text through the Grammarly Pro programme for the English spelling check and grammar.

I thank you again for your review and suggestions. I am looking forward to hearing from you.

Best regards,

Reviewer 2 Report

Comments and Suggestions for Authors

The article provides a useful review of the topic of clinical ethics, its historical roots, current state, and future perspectives. The analysis is clear and well-structured, and it may serve as a helpful overview for those approaching this discipline for the first time. However, it does not present any particularly original elements.

I would recommend adding a section that explains more clearly how the material was gathered, how the most relevant texts were selected, and what the author’s perspective is. Additionally, where possible, I would suggest making a greater effort to further develop the section on future challenges, which I believe is the most interesting part of the article.

Finally, there are four typos that should be corrected:

1. “the concept of bioethics in the works of Joseph Francis Fletcher...” - unclear formulation;

2. “The first introduction the term bioethics was...” - missing of;

3. “unprecedent ethical dilemmas” - incorrect form, should be unprecedented;

4. “This overview presents a narrative review of someone who is interested in the field” - awkward and unclear phrasing.

Author Response

Dear Reviewers,

I thank you for your comments. They were all included in the revised text of the manuscript. I hope I have implemented all the changes successfully.  The text that was rewritten or added, along with the newly added references, is in red.  I have put the whole text through the Grammarly Pro programme for the English spelling check and grammar.

I thank you again for your review and suggestions. I am looking forward to hearing from you.

Best regards,

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Lines 181-185

Please, make it clearer in the text that this position refers to the MCD (Moral Case Deliberation) model, which differs from "shared decision making" model in several respects. Expressions taken directly from the source indicated (note 35) should be indicated in the text.

In any case, ethical counseling supports the decision-making process, which does not disregard the "care relationship" (physician-patient), but does non replace the physician's decision regarding treatment, nor the patient's will. 

 

Author Response

Dear Reviewers,

I thank you for your comments. They were all included in the revised text of the manuscript. I thank you again for your review and suggestions. I am looking forward to hearing from you.

Best regards,