Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as (...) it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women’s vulnerability and undermines women’s agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability. (shrink)

In many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well (...) as the reasons provided for this. A random sample of general practitioners and orthopaedic surgeons as well as members of the general public received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy. Response rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains. There is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”. (shrink)

Fear appeals are used in many domains. Cybersecurity researchers are also starting to experiment with fear appeals, many reporting positive outcomes. Yet there are ethical concerns related to the use of fear to motivate action. In this paper, we explore this aspect from the perspectives of cybersecurity fear appealdeployersandrecipients. We commenced our investigation by considering fear appeals from three foundational ethical perspectives. We then consulted the two stakeholder groups to gain insights into the ethical concerns they consider to be pertinent. (...) We first consulteddeployers: (a) fear appeal researchers and (b) Chief Information Security Officers (CISOs), and then potential cybersecurity fear appealrecipients:members of a crowdsourcing platform. We used their responses to develop aneffects-reasoning matrix, identifying the potential benefits and detriments of cybersecurity fear appeals for all stakeholders. Using these insights, we derived six ethical principles to guide cybersecurity fear appeal deployment. We then evaluated a snapshot of cybersecurity studies using the ethical principle lens. Our contribution is,first, a list of potential detriments that could result from the deployment of cybersecurity fear appeals andsecond, the set of six ethical principles to inform the deployment of such appeals. Both of these are intended to inform cybersecurity fear appeal design and deployment. (shrink)