When the complete human genomehas been sequenced, everyone of us will becomea potential candidate for genetic counselingand testing. Within a short period of timeeveryone will obtain his personal geneticpassport identifying deleterious andsusceptibility genes. With the availability ofpresymptomatic tests for late-onset disordersand the possibilities of prevention andtreatment, the conflict between directivenessand non-directiveness will dominate thecounseling setting. Despite general consent onproviding genetic information in a nondirectivefashion to preserve value neutrality andenhance client's autonomy, there is no acceptedcommon definition of what non-directivenessreally is or (...) ought to be. The article tries toelaborate some aspects which might be fruitfuland clarifying in the complex issues involvedin the black box of genetic counseling. (shrink)

To integrate social robots in real-life contexts, it is crucial that they are accepted by the users. Acceptance is not only related to the functionality of the robot but also strongly depends on how the user experiences the interaction. Established design principles from usability and user experience research can be applied to the realm of human–robot interaction, to design robot behavior for the comfort and well-being of the user. Focusing the design on these aspects alone, however, comes with certain ethical (...) challenges, especially regarding the user’s privacy and autonomy. Based on an example scenario of human–robot interaction in elder care, this paper discusses how established design principles can be used in social robotic design. It then juxtaposes these with ethical considerations such as privacy and user autonomy. Combining user experience and ethical perspectives, we propose adjustments to the original design principles and canvass our own design recommendations for a positive and ethically acceptable social human–robot interaction design. In doing so, we show that positive user experience and ethical design may be sometimes at odds, but can be reconciled in many cases, if designers are willing to adjust and amend time-tested design principles. (shrink)

This essay argues that political, economic, and cultural developments have made the twentieth century disciplinary approach to philosophy unsustainable. It (a) discusses the reasons behind this unsustainability, which also affect the academy at large, (b) describes applied philosophy as an inadequate theoretical reaction to contemporary societal pressures, and (c) proposes a dedisciplined and interstitial approach??field philosophy??as a better response to the challenges facing the twenty-first century philosophy.

The purpose of this paper is to consider the role that values play in priority setting through the use of EBP. It is important to be clear about the role of values at all levels of the decision making process. At one level, society as a whole has to make decisions about the kind of health provision that it wants. As is generally accepted, these priority setting questions cannot be answered by medical science alone but involve important judgements of value. (...) However, as I hope to show values come into priority setting questions at another level, one not often explicitly recognised in much of the literature: that of the very definition of the effectiveness of treatments. This has important consequences for patient care. If we do not recognise that the effectiveness of a treatment involve subjective elements — a patient's own assessment of the value of the treatment — then this could lead to the belief that we can purchase one treatment that is the most effective for all patients. This might result in a detrimental reduction in the range of options that a patient is given with some patients not receiving the treatment that is most effective for them. (shrink)

Recent findings suggest that medical students’ moral competence decreases throughout medical school. This pilot study gives preliminary insights into the effects of two educational interventions in ethics classes on moral competence among medical students in Munich, Germany. Between 2012 and 2013, medical students were tested using Lind’s Moral Competence Test prior to and after completing different ethics classes. The experimental group participated in principle-based structured case discussions and was compared with a control group with theory-based case discussions. The pre/post C-scores (...) were compared using a Wilcoxon Test, ANOVA and effect-size calculation. The C-score improved by around 3.2 C-points in the EG, and by 0.2 C-points in the CG. The mean C-score difference was not statistically significant for the EG or between the two groups. There was no statistical significance for the teachers’ influence on C-score. In both groups, students with below-average C-scores improved and students with above-average C-scores regressed. The increase of the C-Index was greater in the EG than in the CG. The absolute effect-size of the EG compared with the CG was 3.0 C-points, indicating a relevant effect. Teaching ethics with PBSCDs did not provide a statistically significant influence on students’ moral competence, compared with TBCDs. Yet, the effect size suggests that PBSCDs may improve moral competence among medical students more effectively. Further research with larger and completely randomized samples is needed to gain definite explanations for the results. (shrink)

Recent results from neuroimaging appear to indicate that some patients in a vegetative state have partially intact awareness. These results may demonstrate misdiagnosis and suggest the need not only for alternative forms of treatment, but also for the reconsideration of end-of-life decisions in cases of disorders of consciousness. This article addresses the second consequence. First, I will discuss which aspects of consciousness may be involved in neuroimaging findings. I will then consider various factors relevant to ethical end-of-life decision-making, and analyse (...) whether and to what extent the above consequence applies to these factors. It will be shown that knowledge of the existence of partial awareness in patients with disorders of consciousness only influences end-of-life decision-making if certain background assumptions are made. (shrink)

BackgroundGenetic/genomic testing (GGT) are useful tools for improving health and preventing diseases. Still, since GGT deals with sensitive personal information that could significantly impact a patient’s life or that of their family, it becomes imperative to consider Ethical, Legal and Social Implications (ELSI). Thus, ELSI studies aim to identify and address concerns raised by genomic research that could affect individuals, their family, and society. However, there are quantitative and qualitative discrepancies in the literature to describe the elements that provide content (...) to the ELSI studies and such problems may result in patient misinformation and harmful choices.MethodsWe analyzed the major international documents published by international organizations to specify the parameters that define ELSI and the recognized criteria for GGT, which may prove useful for researchers, health professionals and policymakers. First, we defined the parameters of the ethical, legal and social fields in GGT to avoid ambiguities when using the acronym ELSI. Then, we selected nine documents from 44 relevant publications by international organizations related to genomic medicine.ResultsWe identified 29 ELSI sub-criteria concerning to GGT, which were organized and grouped within 10 minimum criteria: two from the ethical field, four from the legal field and four from the social field. An additional analysis of the number of appearances of these 29 sub-criteria in the analyzed documents allowed us to order them and to determine 7 priority criteria for starting to evaluate and propose national regulations for GGT.ConclusionsWe propose that the ELSI criteria identified herein could serve as a starting point to formulate national regulation on personalized genomic medicine, ensuring consistency with international bioethical requirements. (shrink)

In this article, I investigate whether states should regulate energy-drink marketing practices targeting gamers. Energy drinks are high-sugar, high-caffeine, non-alcoholic beverages that allegedly improve energy, stamina, cognitive performance, and concentration. First, I define what “gamer” means and identify the market agents that play a crucial role in the gaming community, including the energy-drink industry. In doing so, I analyze energy-drink marketing practices and explore calls for regulating them. Second, I draw parallels between regulation of energy-drink marketing and marketing of products (...) such as video games and comics with explicit violent and sexual content, tobacco, alcohol, and food high in fat, sugar, and salt. Third, I examine arguments to justify regulation of energy-drink marketing practices that target gamers. Lastly, I formulate an autonomy-based argument for regulating such marketing practices. (shrink)

Every day around the country, patients are discharged from hospitals without difficulty, as the interests of the hospital and the patient tend to align: both the hospital and the patient want the patient to leave and go to a setting that will promote the patient’s continued recovery. In some cases, however, this usually routine process does not go quite as smoothly. Patients may not want to leave the hospital, or they may insist on an unsafe discharge plan. In other cases, (...) there may simply be no good place for the patient to go. These complex hospital discharge situations often involve ethical, legal, financial, and practical considerations, but the ethical issues inherent in these dilemmas have received only sporadic attention from clinical ethicists at best, leaving patients, providers, administrators, and caregivers unsure about what to do. When the ethical issues are in fact brought to light, analysis usually proceeds based on a consideration of the principles of autonomy, beneficence, nonmaleficence, and justice. However, principled analysis often fails to present patients and providers with a satisfactory solution, as the principles inevitably conflict. In this paper, I argue that difficult discharges are ethical dilemmas worthy of scholarly attention that goes beyond principlism, and I argue that providers and those involved in discharge planning ought to cultivate what philosopher Alasdair MacIntyre calls “virtues of acknowledged dependence” in order to care for these patients and their families. I first trace the current conversation about difficult discharge and show that the principled approach to resolving discharge dilemmas is not sufficient. I then argue that a new approach is needed, and to that end, I offer practical ways in which MacIntyre’s account of the virtues of acknowledged dependence may help patients, providers, and family members to navigate issues of difficult discharge. (shrink)

Research conducted on Brain-Computer Interfaces has grown considerably during the last decades. With the help of BCIs, users can gain a wide range of functions. Our aim in this paper is to analyze the impact of BCIs on autonomy. To this end, we introduce three abilities that most accounts of autonomy take to be essential: the ability to use information and knowledge to produce reasons; the ability to ensure that intended actions are effectively realized ; and the ability to enact (...) intentions within concrete relationships and contexts. We then consider the impact of BCI technology on each of these abilities. Although on first glance, BCIs solely enhance self-determination because they restore or improve abilities, we will show that there are other positive, but also negative impacts on user autonomy, which require further philosophical and ethical discussions. (shrink)

Die ärztliche Schweigepflicht ist für die Vertrauensbeziehung zwischen Arzt und Patient von grundlegender Bedeutung. Von besonderer Brisanz sind Fälle, bei denen das Schweigegebot eine Gefährdung Dritter bewirkt. Ein aktuelles Urteil des Oberlandesgerichtes Frankfurt hat eine erhebliche medizinrechtliche und ethische Debatte ausgelöst: Eine Frau als Klägerin verlangte vom Hausarzt der Familie die Feststellung der Schadensersatzpflicht und ein hohes Schmerzensgeld aufgrund einer Pflichtverletzung, da der Arzt von der Aids-Erkrankung ihres uneinsichtigen Lebensgefährten wusste, die Patientin aber mit Verweis auf seine Schweigepflicht nicht über (...) die Gefahr informiert hatte. Problematisch ist die von den Richtern neben dem Offenbarungsrecht vertretene Rechtspflicht des Arztes zur Mitteilung des Sachverhaltes. Der Beitrag erörtert die ethischen und rechtlichen Implikationen dieses Urteils sowie die grundlegenden Regelungen des neuen Schuld- und Schadenersatzrechts in Bezug auf die ärztliche Schweigepflicht. Aus medizinethischer Perspektive ist bei der Güterabwägung für die höher rangigen Werte zu entscheiden (Prinzipien des Nichtschadens und der Benefizienz, "Tarasoff-Pflicht" zur Warnung), gleichwohl zeigen der genannte und andere Fälle Defizite in der Patient-Arzt-Beziehung in Bezug auf einen reflektierten Dialog und die Notwendigkeit von klaren Empfehlungen für den Alltag. Ein interdisziplinärer Ansatz kann medizinrechtliche und ethische Aspekte sinnvoll integrieren. (shrink)

The burdens of resource constraints in publicly funded healthcare systems urge decision makers in countries like Sweden, Norway and the UK to find new financial solutions. One proposal that has been put forward is co-payment—a financial model where some treatment or care is made available to patients who are willing and able to pay the costs that exceed the available alternatives fully covered by public means. Co-payment of this sort has been associated with various ethical concerns. These range from worries (...) that it has a negative impact on patients' wellbeing and on health care institutions, to fears that co-payment is in conflict with core values of publicly funded health care systems. This article provides an overview of the main ethical issues associated with co-payment, and ethical arguments both in support of and against it will be presented and analyzed. (shrink)

The growing use of interoperable electronic health records is likely to have significant effects on the physician-patient relationship. This relationship involves two-way trust: of the physician in patients, and of the patients in their providers. Interoperable records opens up this relationship to further view, with consequences that may both enhance and undermine trust. On the one hand, physicians may learn that information from their patients is — or is not — to be trusted. On the other hand, patients may learn (...) from the increased oversight made possible by electronic records that their trust in their physicians is — or is not — warranted. Release of information through new methods of surveillance may also undermine patient trust. The article concludes that because trust is fragile, attention to transparency and confidentiality in the use of interoperable electronic records is essential. (shrink)

The United States, like other countries facing rising health care costs, is pursuing a commitment to interoperable electronic health records. Electronic records, it is thought, have the potential to reduce the risks of error, improve care coordination, monitor care quality, enable patients to participate more fully in care management, and provide the data needed for research and surveillance. Interoperable electronic health records on a national scale — the ideal of a national health information network — seem likely to magnify these (...) advantages. Thus, the recent economic stimulus package contains considerable funding for the development of “health information technology architecture that will support the nationwide electronic exchange and use of health information in a secure, private, and accurate manner.”. (shrink)

Abstract Drawing on the features of “practical philosophy” described by Toulmin ( 1990 ), a “practical” ethic for animals would be rooted in knowledge of how people affect animals, and would provide guidance on the diverse ethical concerns that arise. Human activities affect animals in four broad ways: (1) keeping animals, for example, on farms and as companions, (2) causing intentional harm to animals, for example through slaughter and hunting, (3) causing direct but unintended harm to animals, for example by (...) cropping practices and vehicle collisions, and (4) harming animals indirectly by disturbing life-sustaining processes and balances of nature, for example by habitat destruction and climate change. The four types of activities raise different ethical concerns including suffering, injury, deprivation, and death (of individuals), decline of populations, disruption of ecological systems containing animals, and extinction of species. They also vary in features relevant to moral evaluation and decision-making; these include the number of animals affected, the duration of the effects, the likelihood of irreversible effects, and the degree to which the effects can be controlled. In some cases human actions can also provide benefits to animals such as shelter and health care. Four mid-level principles are proposed to make a plausible fit to the features of the four types of human activities and to address the major ethical concerns that arise. The principles are: (1) to provide good lives for the animals in our care, (2) to treat suffering with compassion, (3) to be mindful of unseen harm, and (4) to protect the life-sustaining processes and balances of nature. This “practical” approach arguably makes a better fit to the complex, real-life problems of animal ethics than the single foundational principles that have dominated much recent animal ethics philosophy. Content Type Journal Article Category Articles Pages 1-26 DOI 10.1007/s10806-011-9353-z Authors David Fraser, Animal Welfare Program, University of British Columbia, 2357 Main Mall, Vancouver, V6T 1Z4 Canada Journal Journal of Agricultural and Environmental Ethics Online ISSN 1573-322X Print ISSN 1187-7863. (shrink)

To quote Yogi Berra, writing this editorial is a “déja vu all over again” experience for us. It entails not only collaborating once more as coauthors but also reiterating some of the criticisms and concerns that have figured prominently in virtually all our previous publications about bioethics—most recently in our book Observing Bioethics.

The “doctrine of double effect” has a pleasing ring to it. It is regarded by some as the cornerstone of any sound approach to end-of-life issues and by others as religious mumbo jumbo. Discussions about “the doctrine” often generate more heat than light. They are often conducted at cross-purposes and laced with footnotes from Leviticus.

Liberal societies are characterized by respect for a fundamental value pluralism; i.e., respect for individuals’ rights to live by their own conception of the good. Still, the state must make decisions that privilege some values at the cost of others. When public ethics committees give substantial ethical advice on policy related issues, it is therefore important that this advice is well justified. The use of explicit tools for ethical assessment can contribute to justifying advice. In this article, I will discuss (...) one approach to ethical assessment, the ethical matrix method. This method is a variant of intuitionist balancing. Intuitionism is characterized by stressing the existence of several (at least two) fundamental prima facie moral principles, between which there is no given rank order. For some intuitionist approaches, coherentism has been proposed as a model of justification. This article will discuss justification of ethical advice and evaluate the appropriateness of coherentism as a justificatory approach to intuitionist tools. (shrink)

The purpose of this paper is to establish ethical guidelines for the use of paradoxical interventions in psychotherapy. These are defined as interventions which are counterintuitive, coercive, and which require non-observance by the client. Arguments are developed to show that such interventions are associated with a psychology that understands individuals solely in terms of their relationship: a 'strong interactionist' position. Ethical principles consistent with such a position are considered, and from these it is derived that: paradox is an ethical technique (...) with resistive patients; it requires consent; its content should be consistent with general ethical principles, especially those of beneficence and non-maleficence; non-paradoxical techniques should be preferred when possible; and it should not be used as an assessment procedure. It is concluded that research is needed to explore the effect of such ethical guidelines of effectiveness, though preliminary impressions are encouraging. (shrink)

Social robots are robots that can interact socially with humans. As social robots and the artificial intelligence that powers them becomes more advanced, they will likely take on more social and work roles. This has many important ethical implications. In this paper, we focus on one of the most central of these, the impacts that social robots can have on human autonomy. We argue that, due to their physical presence and social capacities, there is a strong potential for social robots (...) to enhance human autonomy as well as several ways they can inhibit and disrespect it. We argue that social robots could improve human autonomy by helping us to achieve more valuable ends, make more authentic choices, and improve our autonomy competencies. We also argue that social robots have the potential to harm human autonomy by instead leading us to achieve fewer valuable ends ourselves, make less authentic choices, decrease our autonomy competencies, make our autonomy more vulnerable, and disrespect our autonomy. Whether the impacts of social robots on human autonomy are positive or negative overall will depend on the design, regulation, and use we make of social robots in the future. (shrink)

With their comprehensive categorization of “ambivalence-related phenomena,” Moore et al. helpfully clarify and contextualize these decisional states as they arise in patient care. Given the...

Health care organization foundations and other fund-raising departments often function at an arm’s length from the system at large. As such, operations related to their mandate to raise funds and market the organization do not receive the same level of ethical scrutiny brought to bear on other arms within the organization. An area that could benefit from a more focused ethics lens is the use of language and rhetoric employed in order to raise funds and market the organization. Such departments (...) and divisions often utilize overblown promises of miracles and extraordinary advances to convince donors to contribute and to persuade the general public. The result can be a heightened sense of expectation on the part of patients, their families, and the general public as to what can realistically be achieved by the health care system, leading to disappointment and conflict when these expectations are not or cannot be met. This article suggests that such advertising and marketing be subject to the same advertising standards as other businesses. (shrink)

BackgroundThe biopharmaceutical industry operates at the intersection of life sciences, clinical research, clinical care, public health, and business, which presents distinct operational and ethical challenges. This setting merits focused bioethics consideration to complement legal compliance and business ethics efforts. However, bioethics as applied to a biopharmaceutical industry setting often is construed either too broadly or too narrowly with little examination of its proper scope.Main textAny institution with a scientific or healthcare mission should engage bioethics norms to navigate ethical issues that (...) arise from the conduct of biomedical research, delivery of clinical care, or implementation of public health programs. It is reasonable to assume that while bioethics norms must remain constant, their application will vary depending on the characteristics of a given setting. Context “specification” substantively refines ethics norms for a particular discipline or setting and is an expected, needed and progressive ethical activity. In order for this activity to be meaningful, the scope for bioethics application and the relevant contextual factors of the setting need to be delineated and appreciated. This paper defines biopharmaceutical bioethics as: the application of bioethics norms (concepts, principles, and rules) to the research, development, supply, commercialization, and clinical use of biopharmaceutical healthcare products. It provides commentary on this definition, and presents five contextual factors that need to be considered when applying bioethics norms to a biopharmaceutical industry setting: (1) dual missions; (2) timely and pragmatic guidance; (3) resource stewardship; (4) multiple stakeholders; and (5) operational complexity.ConclusionUnderstanding the scope of the biopharmaceutical enterprise and contextual factors of a biopharmaceutical industry setting is foundational for the application of bioethics norms. Establishing a common language and approach for biopharmaceutical bioethics will facilitate breadth and depth of discussion and subsequent implementation to benefit patients, the healthcare system and society. (shrink)

In pedagogy, as in life generally, there are moral complexities and ambiguities intrinsic to the teaching–learning process. Within the context of the knowledge economy and globalization those complexities and ambiguities are proliferating. How we as educators address the interface between these complexities is critical to how well we and those we serve fare in the educational and practice environment. With the emergent corporate university culture it would seem that the major goal is to become a ‘knowledge factory’ or a site (...) of knowledge creation. Increasingly its scientific and technological agenda is to focus on generating knowledge that would further the means and ends of economic growth and public policy. Traditionally, however, education has meant much more than this. Indeed, the original purpose of university education was designed to foster a desire for right conduct and good things which ultimately cannot be neatly packaged and delivered. Within this view, university educators would thus be expected to cultivate a climate of self‐reflection in which learning can be fulfilling in itself. This paper explores the notion of globalization and its hegemonic influence on the university agenda and addresses how corporatism, a key dimension of globalization, is in effect usurping the very essence of the teaching–learning process. (shrink)

Xenotransplantation is any transplantation, implantation, or infusion of either live cells, tissues, or organs from a nonhuman animal source, or human bodily fluids, cells, tissues, or organs that have had ex vivo contact with live nonhuman animal cells, tissues, or organs into a human recipient. Most scientists agree that clinical xenotransplantation should not be performed in the absence of accompanying public health safeguards The science upon which that consensus is based has been extensively described in the literature. By and large (...) the most compelling reason for public health safeguards is the possible introduction of new infectious agents into the human life cycle as a result of xenotransplantation.The most frequent source of new infectious diseases in human populations is the transfer of agents, such as viruses, bacteria, or prions, from animals to man. Human diseases and infectious agents that are thought to have originated from animals include influenza, rabies, malaria, lassa fever, lyme disease, AIDS, yellow fever, tuberculosis, the human t-cell lymphotropic virus, the herpes B virus, the hantavirus, and even the bubonic and pneumonic plagues. (shrink)

Xenotransplantation is any transplantation, implantation, or infusion of either live cells, tissues, or organs from a nonhuman animal source, or human bodily fluids, cells, tissues, or organs that have had ex vivo contact with live nonhuman animal cells, tissues, or organs into a human recipient. Most scientists agree that clinical xenotransplantation should not be performed in the absence of accompanying public health safeguards The science upon which that consensus is based has been extensively described in the literature. By and large (...) the most compelling reason for public health safeguards is the possible introduction of new infectious agents into the human life cycle as a result of xenotransplantation.The most frequent source of new infectious diseases in human populations is the transfer of agents, such as viruses, bacteria, or prions, from animals to man. Human diseases and infectious agents that are thought to have originated from animals include influenza, rabies, malaria, lassa fever, lyme disease, AIDS, yellow fever, tuberculosis, the human t-cell lymphotropic virus, the herpes B virus, the hantavirus, and even the bubonic and pneumonic plagues. (shrink)

This paper distinguishes two ways in which to think about the freedom of extremists. Non-pluralists claim to have identified the general rule for resolving moral conflicts, and conceptualize freedom as liberty of action in accordance with that rule. It follows, if extremist violence breaks the rule in question, removing this option does not infringe the freedom of extremists. In contrast, for pluralists there is no one general rule to resolve moral conflicts, and freedom is simply the absence of interference. I (...) argue here that pluralism provides a principled defense of freedom, as it allows us to see that removing options from extremists is worse, on prima facie grounds, than not doing so. Also, non-pluralists cannot show that they have identified the general rule for resolving moral conflicts, and in particular, are forced to rely on quite different principles altogether when justifying paternalistic responses to extremism. (shrink)

This article contributes to the development of a professional responsibility theory of public relations ethics. Toward that end, we examine the roles of a public relations practitioner as a professional, an institutional advocate, and the public conscience of institutions served. In the article, we review previously suggested theories of public relations ethics and propose a new theory based on the public relations professional's dual obligations to serve client organizations and the public interest.

This paper poses questions regarding the ethical prioritisation in qualitative research studies on assessing a person's or a group's fitness to provide informed consent, arguing that this may have unwanted as well as desirable consequences, particularly in relation to rights of citizenship for socially marginalised populations who tend to be labelled vulnerable. Drawing on three theoretical perspectives (Arendt, Honneth and Bourdieu), it is suggested that the emphasis placed on a research participant's capacity to provide informed consent cannot be regarded solely (...) as a protective measure for ?vulnerable? groups, but is also bound up with their social positioning as socially ?deficient? according to liberal (classical and neo-liberal) models of citizenship. Participation in a qualitative study can be seen as a dimension of the civil and human right to freedom of expression, and this can be particularly important for those labelled vulnerable as freedom of expression is a precondition for recognition and parity of status. Nevertheless, the importance of informed consent is not rejected; instead, it is posited that the protective rights accorded to vulnerable groups in qualitative research need to be considered alongside other human goods, such as the promotion of voice, agency and active citizenship. (shrink)

Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates (...) against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective. (shrink)

FEX A, FLENSNER G, EK A‐C and SÖDERHAMN O. Nursing Inquiry 2011; 18: 336–347 Living with an adult family member using advanced medical technology at homeAn increased number of chronically ill adults perform self‐care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self‐care at home, either using (...) long‐term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent‐care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent‐care and transition, which may have an influence on the self‐care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context. (shrink)

In Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justice and the constitutionally guaranteed right to health, the ethical considerations (...) that arise from considering a prediabetic person as a potential kidney donor. (shrink)

This extended essay seeks to unpack some of the key aspects of philosophy which are applicable to medical thought and practice. It proceeds via an analytical discussion of the contemporary debate in three key areas of medical ethics: euthanasia, concepts of health & disease and psychiatry. The main claims are as follows: 1. The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles. 2. Elements from the normative and naturalistic definitions of disease are necessary (...) for a thorough definition that dodges common objections to either. 3. Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine. The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles. Elements from the normative and naturalistic definitions of disease are necessary for a thorough definition that dodges common objections to either. Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine. Through a detailed discussion of three salient issues in the philosophy of medicine, it is argued that the application of profound philosophical thought to medicine and its practices reveals a depth that necessitates exploration before simply following the aims of curing all. Philosophical rigour matched with modern medicine has the potential to engage patients and help them make independent, informed decisions and assist physicians to think more clearly, analytically and empathetically. (shrink)

This extended essay seeks to unpack some of the key aspects of philosophy which are applicable to medical thought and practice. It proceeds via an analytical discussion of the contemporary debate in three key areas of medical ethics: euthanasia, concepts of health & disease and psychiatry.The main claims are as follows:1.The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles.2.Elements from the normative and naturalistic definitions of disease are necessary for a thorough definition that (...) dodges common objections to either.3.Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine.Through a detailed discussion of three salient issues in the philosophy of medicine, it is argued that the application of profound philosophical thought to medicine and its practices reveals a depth that necessitates exploration before simply following the aims of curing all. Philosophical rigour matched with modern medicine has the potential to engage patients and help them make independent, informed decisions and assist physicians to think more clearly, analytically and empathetically. (shrink)

In this article, we develop the concept of Transparency by Design that serves as practical guidance in helping promote the beneficial functions of transparency while mitigating its challenges in automated-decision making environments. With the rise of artificial intelligence and the ability of AI systems to make automated and self-learned decisions, a call for transparency of how such systems reach decisions has echoed within academic and policy circles. The term transparency, however, relates to multiple concepts, fulfills many functions, and holds different (...) promises that struggle to be realized in concrete applications. Indeed, the complexity of transparency for ADM shows tension between transparency as a normative ideal and its translation to practical application. To address this tension, we first conduct a review of transparency, analyzing its challenges and limitations concerning automated decision-making practices. We then look at the lessons learned from the development of Privacy by Design, as a basis for developing the Transparency by Design principles. Finally, we propose a set of nine principles to cover relevant contextual, technical, informational, and stakeholder-sensitive considerations. Transparency by Design is a model that helps organizations design transparent AI systems, by integrating these principles in a step-by-step manner and as an ex-ante value, not as an afterthought. (shrink)

With robots being introduced into caregiving, particularly for older persons, various ethical concerns are raised. Among them is the fear of replacing human caregiving. While ethical concepts like well-being, autonomy, and capabilities are often used to discuss these concerns, this paper brings forth the concept of social dignity to further develop guidelines concerning the use of robots in caregiving. By social dignity, we mean that a person’s perceived dignity changes in response to certain interactions and experiences with other persons. In (...) this paper, we will first present the concept of social dignity, and then identify a niche where robots can be used in caregiving in an ethical manner. Specifically, we will argue that, because some activities of daily living are performed in solitude to maintain dignity, a care recipient will usually prefer robotic assistance instead of human assistance for these activities. Secondly, we will describe how other philosophical concepts, which have been commonly used to judge robotic assistance in caregiving for the elderly so far, such as well-being, autonomy, and capabilities, are less useful in determining whether robotic assistance in caregiving is ethically problematic or not. To conclude, we will argue that social dignity offers an advantage to the other concepts, as it allows to ask the most pressing questions in caregiving. (shrink)

The American Journal of Bioethics, Volume 12, Issue 3, Page 19-21, March 2012.