This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir (...) and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions. (shrink)

Biomarker-based predictive tests for subjectively asymptomatic Alzheimer’s disease (AD) are utilized in research today. Novel applications of artificial intelligence (AI) promise to predict the onset of AD several years in advance without determining biomarker thresholds. Until now, little attention has been paid to the new ethical challenges that AI brings to the early diagnosis in asymptomatic individuals, beyond contributing to research purposes, when we still lack adequate treatment. The aim of this paper is to explore the ethical arguments put forward (...) for AI aided AD prediction in subjectively asymptomatic individuals and their ethical implications. The ethical assessment is based on a systematic literature search. Thematic analysis was conducted inductively of 18 included publications. The ethical framework includes the principles of autonomy, beneficence, non-maleficence, and justice. Reasons for offering predictive tests to asymptomatic individuals are the right to know, a positive balance of the risk-benefit assessment, and the opportunity for future planning. Reasons against are the lack of disease modifying treatment, the accuracy and explicability of AI aided prediction, the right not to know, and threats to social rights. We conclude that there are serious ethical concerns in offering early diagnosis to asymptomatic individuals and the issues raised by the application of AI add to the already known issues. Nevertheless, pre-symptomatic testing should only be offered on request to avoid inflicted harm. We recommend developing training for physicians in communicating AI aided prediction. (shrink)

Intelligibility and interpretability related to artificial intelligence (AI) are crucial for enabling explicability, which is vital for establishing constructive communication and agreement among various stakeholders, including users and designers of AI. It is essential to overcome the challenges of sharing an understanding of the details of the various structures of diverse AI systems, to facilitate effective communication and collaboration. In this paper, we propose four fundamental terms: “I/O,” “Constraints,” “Objectives,” and “Architecture.” These terms help mitigate the challenges associated with intelligibility (...) and interpretability in AI by providing appropriate levels of abstraction to describe structure of AI systems generally, thereby facilitating the sharing of understanding among various stakeholders. The relationship between the Objective of AI designers and the Purpose of AI users is linked to the issues of AI alignment. (shrink)

In this article, I assess the prospects for the limitarian thesis that someone has too much wealth if they exceed a specific wealth threshold. Limitarianism claims that there are good political and/or ethical reasons to prevent people from having such ‘surplus wealth’, for example, because it has no moral value for the holder or because allowing people to have surplus wealth has less moral value than redistributing it. Drawing on recent literature on distributive justice, I defend two types of limitarian (...) principles of justice. First, limitarian midlevel principles draw on the limitarian thesis to specify normative commitments for guiding institutional design and individual actions. Second, the limitarian presumption draws on that thesis to specify what a just allocation of wealth requires under epistemic constraints. Such a presumption says that without substantive reasons to the contrary, we should regard a distribution as unjust if some people’s wealth exceeds the limitarian threshold. Furthermore, I will argue that we must reject a possible but implausible interpretation of limitarianism as an ideal distributive pattern. Yet both as a midlevel principle and as a presumption, limitarianism can play an important role in theorizing about justice in the real world. (shrink)

This chapter examines whether high prices for gene therapies are justified and whether the problems associated with high prices can be solved by the "pay for performance" (P4P) reimbursement model. To this end, we first describe how prices for new drugs, including gene therapies, are set in Germany (section 2.). P4P is then presented as an example of a reimbursement model (section 3.). The subsequent ethical analysis (section 4.) first examines whether P4P models can sustainably guarantee the right to health (...) and healthcare for all people (section 4.1; cf. on the "sustainable right to health" already Alex, 2021). It is then shown that cost-benefit analyses for setting prices for new gene therapies must be viewed critically from an ethical perspective and pose a problem for equity of access and thus also for the sustainable guarantee of a right to health (section 4.2). The final question is whether P4P is compatible with the idea of human dignity (Article 1 I 1 of the German Basic Law) (section 4.3; cf. already König et al., 2020). -/- Alex, K. (2021): Ethical conceptualization of a sustainable right to health(care). In: Schildmann, J. et al. (eds.): Defining the value of medical interventions. Normative and empirical challenges. Kohlhammer, Stuttgart: 29-48. PMID: 36256802 König, J. et al. (2020): Am individuellen Therapieergebnis orientierte Erstattungsverfahren in der Onkologie: ethische Implikationen am Beispiel der CAR-T-Zelltherapie. In: Ethik Med 32: 85–92. doi: 10.1007/s00481-020-00565-3. (shrink)

: The Islamic jurists utilized the discipline of maqāṣid al-sharīʿah,in its capacity as the philosophy of Islamic law, in their legal and ethicalinterpretations, with added interest in addressing the issues of modern times.Aphoristically subsuming the major themes of the Sharīʿah, maqāṣid play apivotal role in the domain of decision-making and deduction of rulings onunprecedented ethical discourses. Ethics represent the infrastructure of Islamiclaw and the whole science of Islamic jurisprudence operates in the lightof maqāṣid to realize the ethics in people’s lives. (...) Scrutinizing the key themesof maqāṣid-based ijtihād and scope of ethics in maqāṣid, this article delvesinto the discourse on the application of maqāṣid to medical ethics. As a casestudy, this research analyses the extent of medical confidentiality in the light ofmaqāṣid and arrives at the conclusion that limited confidentiality goes more inline with the maxims of maqāṣid. (shrink)

The Covid-19 pandemic raises the need for an ethical framework that addresses the unique ethical challenges and questions arising from airborne infectious diseases. For example, are we ever ethically obliged to wear a face mask? If so, why and when? The Respiratory Ethics Framework (REF) herein proposes pathways to answers grounded in ethical norms and the moral principles of non-harm, beneficence and respect for personal autonomy. REF is a personal ethics wherein your ethical duty to increase your respiratory hygiene efforts—such (...) as by donning a mask—is proportional to your estimation of an increase in the likelihood that your respiratory effluent poses a risk of harmful infection to others. REF includes illustrated decision models that instantiate a framework of proportionality between levels of risk, ethical duty and mitigation that shapes risk mitigation across domains. (shrink)

This paper argues, against the prevailing view, that consent to privacy policies that regular internet users usually give is largely unproblematic from the moral point of view. To substantiate this claim, we rely on the idea of the right not to know (RNTK), as developed by bioethicists. Defenders of the RNTK in bioethical literature on informed consent claim that patients generally have the right to refuse medically relevant information. In this article we extend the application of the RNTK to online (...) privacy. We then argue that if internet users can be thought of as exercising their RNTK before consenting to privacy policies, their consent ought to be considered free of the standard charges leveled against it by critics. (shrink)

The concept of “Time” seems to play out differently at various phases of our lives: In our teens and twenties, we experience the luxury of youth; we may feel invincible or even indomitable. Generally, we feel our whole lives are ahead of us, and we “take” time to enjoy, explore and experience our world. Concurrently, our physiology also goes through the phases of childhood, adolescence, puberty and into adulthood, or the “reproductive years”; and ultimately (for women) through menopause and “ageing”, (...) or, the “non- reproductive years”. In this paper I will submit, on what I believe, is the obligation of the health care community to disseminate information early to their patients. This might ensure that the choices that people make in specific phases of their lives are educated and informed choices. Early education would be invaluable if backed up by the benefit of research that already exists, some of it presented in this paper. If this research was to be made available, say, on a patient’s first visit to a gynaecologist, (presumably in their late teens, early twenties), to start the education process, I believe many patients could benefit from it. (shrink)