Evaluation of quality of life, psychic and bodily well-being is becoming increasingly important in oncology aftercare. This type of assessment is mainly carried out by medical psychologists. In this paper I will seek to show that body experience valuation has, besides its psychological usefulness, a normative and practical dimension. Body experience evaluation aims at establishing the way a person experiences and appreciates his or her physical appearance, intactness and competence. This valuation constitutes one’s ‘body image’. While, first, interpreting the meaning (...) of body image and, second, indicating the limitations of current psychological body image assessment, I argue that the normative aspect of body image is related to the experience of bodily wholeness or bodily integrity. Since this experience is contextualized by a person’s life story, evaluation should also focus on narrative aspects. I finally suggest that the interpretation of body experience is not only valuable to assess a person’s quality of life after treatment, but that it can also be useful in counseling prior to interventions, since it can support patients in making decisions about interventions that will change their bodies. To apply this type of evaluation to oncology practice, a rich and tailored vocabulary of body experiences has to be developed. (shrink)

In this paper, I explore the meaning of bodily integrity in disfiguring breast cancer. Bodily integrity is a normative principle precisely because it does not simply refer to actual physical or functional intactness. It rather indicates what should be regarded and respected as inviolable in vulnerable and damageable bodies. I will argue that this normative inviolability or wholeness can be based upon a person's embodied experience of wholeness. This phenomenological stance differs from the liberal view that identifies respect for integrity (...) with respect for autonomy (resulting in an invalidation of bodily integrity's proper normative meaning), as well as from the view that bodily integrity is based upon ideologies of wholeness (which runs the risk of being disadvantageous to women). I propose that bodily integrity involves a process of identification between the experience of one's body as “Leib” and the experience of one's body as “Körper.” If identification fails or is not possible, one's integrity is threatened. This idea of bodily integrity can support breast cancer patients and survivors in making decisions about possible corrective interventions. To implement this idea in oncology care, empirical-phenomenological research needs to establish how breast cancer patients express their embodied self-experiences. (shrink)

Laacke et al. argue that an extended concept of patient autonomy—Health-Related Digital Autonomy —is required to address the autonomy-related ethical challenges associated with the pot...

A growing number of consumer technology companies are aiming to convince older people that humanoid robots make helpful tools to support aging-in-place. As hybrid devices, socially assistive robots (SARs) are situated between health monitoring tools, familiar digital assistants, security aids, and more advanced AI-powered devices. Consequently, they implicate older people’s privacy in complex ways. Such devices are marketed to perform functions common to smart speakers (e.g., Amazon Echo) and smart home platforms (e.g., Google Home), while other functions are more specific (...) to older people, including health and safety monitoring and serving as companions to mitigate loneliness. Privacy is a key value central to debates about the ethics of using SARs in aged care, yet there has been very little interchange between these debates and the robust theoretical discussion in the legal literature about the future of privacy and AI governance. Drawing on two qualitative studies of older people’s views on consumer SARs, the paper contributes novel findings about older people’s thinking on privacy and data governance at the intersection of their experiences with present day digital technologies and projections for future AI systems, and places their views in dialogue with debates about the future of privacy protection and AI governance. (shrink)

Two clusters of essays in this issue of The Journal of Medicine and Philosophy provide a critical gaze through which to explore central moral, phenomenological, ontological, and political concerns regarding human moral agency and personal responsibility. The first cluster challenges common assumptions in bioethics regarding the voluntariness of human actions. The second set turns the debate towards morally responsible choice within the requirements of distributive justice. The force of their collective analysis leaves us with a well-founded basis critically to approach (...) any account of bioethics or health policy that is insufficiently attentive to the central challenges of human freedom and responsible free choice. (shrink)

In healthcare ethics there is a discussion regarding whether autonomy of personal preferences, what sometimes is referred to as authenticity, is necessary for autonomous decision-making. It has been argued that patients’ decisions that lack sufficient authenticity could be deemed as non-autonomous and be justifiably overruled by healthcare staff. The present paper discusses this issue in relation certain psychiatric disorders. It takes its starting point in recent qualitative studies of the experiences and thoughts of patients’ with anorexia nervosa where issues related (...) to authenticity seem particularly relevant. The paper examines different interpretations of authenticity relevant for autonomy and concludes that the concept, as it has been elaborated in recent debate, is highly problematic to use as a criterion for autonomous decision-making in healthcare. (shrink)

Decision-making capacity is a key concept in contemporary healthcare ethics. Previous research has mainly focused on philosophical, conceptual issues or on evaluation of different tools for assessing patients’ capacity. The aim of the present study is to investigate how the concept and its normative role are understood in Swedish psychiatric care. Of special interest for present purposes are the relationships between decisional capacity and psychiatric disorders and between health law and practical ethics.

The present study examined the ethical judgements of Turkish counselors using a translation of the Gibson and Pope ethical judgements survey. Items predominantly judged as ethical and unethical, and group differences regarding gender, taking ethics as a course, professional affiliation, and level of academic degree, were investigated. Chi-square analysis, Fishers’s exact test, and Fisher–Freeman–Halton tests were used in statistical analysis. Results revealed that participants predominantly judged breach of confidentiality in cases of child abuse and potential harm toward oneself or others (...) as ethical. Items concerning sexual dual relationships were predominantly perceived as unethical, and male participants were more likely to judge items regarding sexual and nonsexual dual relationships as ethical. Implications for future research and practice are discussed. (shrink)

One of the goals of medicine is to improve well-being, in line with the principle of beneficence. Likewise, scientists claim that the goal of human embryonic stem cell research is to find treatments for diseases. In hESC research, stem cells are harvested from a 5-day-old embryo. Surplus embryos from infertility treatments or embryos created for the sole purpose of harvesting stem cells are used in the research, and in the process the embryos get destroyed. The use of human embryos for (...) research purpose raises ethical concern. In this context, the religious leaders play the role to be the moral compass and “reality check” to engage with the public. In Malaysia, the Ministry of Health has outlined the Guidelines for Stem Cell Research and Therapy, reflecting on Islamic principles. Since there has not been much focus on the viewpoints of other faiths in Malaysia, this study attempts to explore the ethical guiding principles deliberated by religious leaders from the Buddhist, Hindu and Catholic traditions and identify if there is a common ground between the mainstream religious views and principles of medical ethics, in relation to hESC research. Eleven religious leaders representing the Buddhist, Hindu and Catholic traditions were interviewed. Interestingly, though reasoning of religious leaders came from different angles, their underlying concerns revolve around the values of “do no harm” and “intention to save lives”. These values are also the key principles in medical ethics. The findings are applied to answer the question as to whether religious and medical guiding principles can co-exist and complement in ethical decision-making, without compromising the values. (shrink)

Feminists have argued that oppressive socialization undermines the liberal model of autonomy. We contend that this argument can also be employed effectively as a challenge to the standard bioethical model of informed consent. We claim that the standard model is inadequate because it relies on presumptions of procedural autonomy and rational choice that overlook the problem of how agents are often socialized so that they adopt and internalize oppressive norms as part of their motivational structure. The argument that oppressive socialization (...) undermines liberalism’s view of autonomy is most relevant to what Beauchamp and Childress call the threshold elements of informed consent—competence and voluntariness. We show how these elements fail to account for morally relevant factors such as oppressive socialization. (shrink)

Feminists have argued that oppressive socialization undermines the liberal model of autonomy. We contend that this argument can also be employed effectively as a challenge to the standard bioethical model of informed consent. We claim that the standard model is inadequate because it relies on presumptions of procedural autonomy and rational choice that overlook the problem of how agents are often socialized so that they adopt and internalize oppressive norms as part of their motivational structure. The argument that oppressive socialization (...) undermines liberalism’s view of autonomy is most relevant to what Beauchamp and Childress call the threshold elements of informed consent—competence and voluntariness. We show how these elements fail to account for morally relevant factors such as oppressive socialization. (shrink)

The Human Organ Transplantation Act came into officially force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors. The Act was amended by the Parliament on January 8, 2018, with the changes coming into effect shortly afterwards on January 28. The Act was revised to extend a living donor pool from close relatives to include certain other relatives such as grandparents, grandchildren, and first cousins. The Act was also revised to allow individuals to prioritize (...) family members in receiving their organs after their death. The aim of this paper is not to carry out an ethical analysis of the Act as a whole but only to focus on aspects relating to priority access for family members to organs. Despite Islam encouraging Muslims to be sympathetic, and to save the life of any member of humankind, saving the life of a relative through organ donation is even more highly valued. The collective and extended structure of the family impacts on the provisions of the Act that only allows Bangladeshis to legally donate their organs to save the lives of relatives and allows individuals to prioritize family members. Recent progress in the practice of organ transplantation raises a number of ethical dilemmas around the allocation of available organs in the context of organ scarcity. A key purpose of introducing incentive into the system of organ allocation is to increase the number of donations from living relatives and initiation of vital organ donations from brain-dead donors. However, allocation criteria based on a living organ donation incentive system would appear to be unethical because there is no provision in the Act with regard to financial compensation for a distant relative donor’s post-operative care in the absence of healthcare coverage. Receiving organs from a distant relative without giving financial compensation for post-operative care places them in a grave health condition and violates the biomedical principle of non-maleficence. An incentive system around brain-dead donors would appear to be ethical as the amended Act allows individuals to prioritize relatives in receiving their organs after death. This provision is intended to initiate the transplantation of vital organs from brain-dead donors as families might bear the cost of keeping the organs alive for transplantation. Regular reassessment of the impact of the Act is necessary to maximize the donation rate of transplantable organs using ethical means. (shrink)

Clinical work in Alcohol and Other Drugs has not generally been an area of focus for ethicists. Likewise, ethics is not usually part of Alcohol and Other Drugs training or practice. This means that resources available to Alcohol and Other Drugs clinicians navigating ethical challenges are not widely available. This paper describes a systematic review of literature at the intersection of ethics and clinical practice in Alcohol and Other Drugs. The review will potentially benefit Alcohol and Other Drug practitioners by (...) outlining what resources currently available and will also highlight potential directions for future research. The review searched for all published work in ethics at the intersection with Alcohol and Other Drugs. Searches within academic databases, the World Wide Web, and within journal Tables of Contents identified 18 relevant papers from 1985 onwards. An inductive process of categorisation produced two categories of this literature. The first was codes of ethics, further divided into rule-... (shrink)

The concept of dignity has occasioned a robust conversation in recent healthcare scholarship. When viewed as a whole, research on dignity in healthcare has engaged each of the four bioethical principles popularized by Beauchamp and Childress, but has paid the least attention to beneficence. In this paper, we look at dignity and beneficence. We focus on the dignity promotion component of a model of dignity derived from a grounded theory study. After describing the study and presenting a précis of the (...) resulting model, we review the principle of beneficence and look at the ways in which the notion of dignity promotion can be used to complement our understanding of this principle. Specifically, we explore what we can learn from dignity promotion about the relational nature of beneficence in healthcare and how dignity promotion can be marshaled to help address the epistemological quandary of soft paternalism. (shrink)

Individuals’ food choices are intimately connected to their self-images and world views. Some dietary choices adopted by consumers pose restrictions on their use of genetically modified food (GMF). It is quite generally agreed that some kind of labeling is necessary for respecting consumers’ autonomy of choice regarding GMF. In this paper, we ask whether the current practice of mandatory labeling of GMF products in the European Union is a sufficient administrative procedure for respecting consumers’ autonomy. Three issues concerning this question (...) are discussed. First, we argue that labeling needs to be accompanied by relevant and understandable information on genetic modification, genetically modified food, and the European practice of GMF labeling. Second, we claim that this type of informing makes it less likely that consumers start to avoid GMF products just because labels make them suspicious of the products. It is further noted that even though some consumers may react to labels this way, labels do not restrict their autonomy of choice. Third, a need for more precise labels indicating the source of the transferred gene is considered. It is found out that such labels are not morally necessary when also non-GMF products are available and no relevant differences (such as differences in price and healthiness) exist between them and GMF products. However, in some other cases more precise labels may be needed for respecting consumers’ autonomy of choice. (shrink)

The European Union’s policies regarding genetically modified food are based on the precautionary principle and the requirement of respecting consumers’ autonomy. We ask whether the requirement of respecting consumers’ autonomy regarding GMF implies that both GMF and non-GMF products should be available in the market. According to one line of thought, consumers’ choices may be autonomous even when the both types of products are not available. A food market with only GMF or only non-GMF products does not strictly speaking compel (...) people to buy the type of products available, and a possibility to refuse to buy is enough for consumers’ choice to be autonomous. According to another line of thought, the unavailability of GMF or non-GMF products restricts the autonomy of those consumers who are unwilling to use the only type of products available in the market. From the point of view of autonomy, a food market with only GMF or only non-GMF products does not offer enough alternatives for consumers. Moreover, the whole point of the European Union’s requirement of respecting consumers’ autonomy is to enable an autonomous choice between GMF and non-GMF—not just to give a possibility to refrain from buying. However, this does not imply that producers, processors, wholesalers, retailers, or public authorities have a moral duty to see that there are both GMF and non-GMF products available in the market. The requirement to respect autonomy is prima facie in nature, and in the context of GMF, other prima facie requirements are often stronger and override it. Not only the consumers’ autonomy of choice but also environmental values, other people’s well-being, and the autonomous choice of farmers, retailers, and other relevant parties should be respected. Thus, according to the both lines of thought, the requirement to respect consumers’ autonomy of choice does not imply that there should be both GMF and non-GMF products available in the market. (shrink)

Prenatal diagnosis challenges the issue of parental autonomy. Two ethical aspects of the parental decision making process with reference to PND have been taken into consideration: the duty to know and the right not to know. Whilst the first approach has been widely discussed in literature, the latter seems to be overlooked. In order to find good moral reasons supporting the right not to know, firstly the duty to know approach was critically analysed. Subsequently, the emphasis was put on the (...) unconditional parental love and the issue of child’s best interests as the features supporting parental right not to know. The clarification of what is good parenthood was presented as the best normative approach supporting the parental right not to know in case of PND. Apart from parental autonomy, raising the question of the right not to know is important in the debate about the place and role of people with disabilities in society. (shrink)

Physicians play a critical role in preventing and treating firearm injury, although the scope of that role remains contentious and lacks systematic definition. This piece aims to utilize the fundamental principles of medical ethics to present a framework for physician involvement in firearm violence. Physicians' agency relationship with their patients creates ethical obligations grounded on three principles of medical ethics — patient autonomy, beneficence, and nonmaleficence. Taken together, they suggest that physicians ought to engage in clinical screening and treatment related (...) to firearm violence. The principle of beneficence also applies more generally, but more weakly, to relations between physicians and society, creating nonobligatory moral ideals. Balanced against physicians' primary obligations to patient agency relationships, general beneficence suggests that physicians may engage in public advocacy to address gun violence, although they are not ethically obligated to do so. A fourth foundational principle — justice — requires that clinicians attempt to ensure that the benefits and burdens of healthcare are distributed fairly. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 21-31, March‐April 2022.

US testing of nuclear weapons has resulted in about 800,000 premature fatal cancers throughout the globe, and the nuclear tests of China, France, India, Russia, and the UK have added to this total. Surprisingly, however, these avoidable deaths have not received much attention, as compared, for example, to the smaller number of US fatalities on 9-11-01. This essay (1) surveys the methods and models used to assess effects of low-dose ionizing radiation from above-ground nuclear weapons tests and (2) explains some (...) of the epistemological and logical problems (with these methods and models) that have caused scientists to decide against health screening of the most likely test victims. It also (3) argues that, once the faulty presuppositions and question-begging frames about testing and screening are recognized, there are compelling arguments in favor of nuclear-test nations'' screening fallout victims, at least among their citizens. Finally, it (4) suggests that logically and epistemically flawed fallout studies/recommendations against screening are more like to occur when scientists adopt a Laudan-style comparativist rationality, rather than when they adopt a metascience more like that of Kuhn and others. (shrink)

Abstract:An integrated and principled neuroethics offers ethical guidelines able to transcend conventional and medical reliance on normality standards. Elsewhere we have proposed four principles for wise guidance on human transformations. Principles like these are already urgently needed, as bio- and cyberenhancements are rapidly emerging. Context matters. Neither “treatments” nor “enhancements” are objectively identifiable apart from performance expectations, social contexts, and civic orders. Lessons learned from disability studies about enablement and inclusion suggest a fresh way to categorize modifications to the body (...) and its performance. The term “enhancement” should be broken apart to permit recognition of enablements and augmentations, and kinds of radical augmentation for specialized performance. Augmentations affecting the self, self-worth, and self-identity of persons require heightened ethical scrutiny. Reversibility becomes the core problem, not the easy answer, as augmented persons may not cooperate with either decommissioning or displacement into unaccommodating societies. We conclude by indicating how our four principles of self-creativity, nonobsolescence, empowerment, and citizenship establish a neuroethics beyond normal that is better prepared for a future in which humans and their societies are going so far beyond normal. (shrink)

Where feminist critiques of bioscience have uncovered a whole set of operations that range round the Foucauldian notions of biopower and normativity, and have explored genetic discourse in particular to question the stability of self-identity, feminist bioethics has lagged behind. Despite an engagement with the technologies of postmodernity, including those associated with genetic research (and especially in its relation to reproduction), there has been, with relatively few exceptions, a reluctance to explore the implications of postmodernist theory. The difficulty is that (...) bioscience itself is now throwing up a problematic that destabilizes the central agent of ethical theory - the modernist sovereign subject. Using the field of genetics and the mapping of the human genome as a focal point, this paper suggests that bioethics should move on from conventional analytic strategies and, like feminist science studies, embrace uncertainty and complexity. The task is to fashion a new form of ethical response grounded in the notions of embodied connection and fluidity. (shrink)

This study examines elderly residential life in long-term care settings, focusing on the ways residents interact with their physical and social environments. It further proposes that the residential environment is an important player for everyday ethics in long-term care settings, and is also an important factor in enhancing the quality of life for residents. By employing the theories of place identity and environmental meanings and listening to the voices of the elderly collected through an ethnographic field study in elderly homes (...) of life care, the study reveals the residents’ experiences of going through declining health and moving through the stages of care. Two major themes were identified. The first theme of liminal life portrays the elders’ fears as they move through the stages of care. This theme includes four sub-themes: the loss of home and the loss of autonomy; impending loss and its constant reminders; the social classification of “us” and “them”; the irreversibility of moving. The second theme of relational life describes the keys to successful transitions as experienced and told by the residents. The second theme includes three sub-themes: shifting identity and the acceptance of old age; human interdependence and building trust; an accompanied death. Study implications are further discussed, including specific suggestions for social programs and revisions to the physical environments. A more fundamental question about place-based staged care is also raised so as to serve as a point of departure for reflections and discussions amongst health professionals, planners and designers, and other decision-makers. (shrink)

As is often the case in clinical ethics, the discourse in COVID-19 has focused primarily on difficult and controversial decision-making junctures such as how to decide who gets access to intensive care resources if demand outstrips supply. However, the lived experience of COVID-19 raises less controversial but arguably more profound moral questions around what it means to look after each other through the course of the pandemic and how this translates in care for the dying. This piece explores the interface (...) between the pandemic, ethics, and the role of palliative care. We argue that the ethical discourse should be broader, and that the principles that underly the discipline of palliative care provide a solid ethical foundation for the care of all patients through the coronavirus pandemic. (shrink)

Principlism, the bioethical theory championed by Tom Beauchamp and James Childress, is centered on the four moral principles of beneficence, non-maleficence, respect for autonomy, and justice. Two key processes related to these principles are specification—adding specific content to general principles—and balancing—determining the relative weight of conflicting principles. I argue that both of these processes necessarily involve an appeal to human goods and evils, and therefore require a theory of the good. A significant problem with principlism is that it lacks a (...) theory of the good and consequently does not have an adequate solution to the problems of specification and balancing. My conclusion is that principlism must adopt some account of human well-being in order to be a satisfactory bioethical framework. (shrink)

The physician-researcher conflict of interest has thus far eluded satisfactory solution. Most attempts to deal with it focus on improving informed consent. But those attempts are not successful and may even make things worse. Research subjects are already voluntarily undertaking the risks of research — we should not ask them to go it alone — to undergo medical “treatment” without medical “care.” The only effective solution is that in much clinical research, each research subject should have a doctor independent from (...) the research study. (shrink)

The physician-researcher conflict of interest, a long-standing and widely recognized ethical challenge of clinical research, has thus far eluded satisfactory solution. The conflict is fairly straightforward. Medical research and medical therapy are distinct pursuits; the former is aimed at producing generalizable knowledge for the benefit of future patients, whereas the latter is aimed at addressing the individualized medical needs of a particular patient. When the physician-researcher combines these pursuits, he or she serves two masters and cannot — no matter how (...) well-intentioned — avoid the risk of compromising the duties owed in one of the professional roles assumed. Because of the necessary rigidity of a research protocol, the more demanding of the two masters is frequently the research.The problem of the physician-researcher conflict has been evident since the first attempts to regulate human research in the United States. Otto E. Guttentag, a physician at the University of California School of Medicine in San Francisco, addressed the conflict in a 1953Sciencemagazine article. (shrink)

The articles in this issue cover a wide range of topics, including the moral status of human embryos and human-animal chimeras and hybrids, the determination of death, theories of human cognition, and policies on the identity of mitochondrial donors. Despite this variety, there are two underlying questions that tie the articles together: what is a human being? And, what is the basis of moral status? First, I discuss these two questions and why they are important for bioethics. Then I provide (...) summaries of the six articles in this issue and explain how each of them is connected to the questions of human nature and moral status. (shrink)

This special issue commemorates the 40th anniversary of Tom Beauchamp and James Childress’s Principles of Biomedical Ethics with a collection of original essays addressing some of the major themes in the book. It opens with intellectual autobiographies by Beauchamp and Childress themselves. Subsequent articles explore the topics of common morality, specification and balancing of moral principles, virtue, moral status, autonomy, and lists of bioethical principles. The issue closes with a reply by Beauchamp and Childress to the other authors.

Our current Anthropocene epoch is marked by a rampant proliferation of challenging environmental issues. Over the years, researchers have come to recognize these issues as quintessential wicked pro...

Many ethical issues are posed by public health interventions. Although abstract theorizing about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation's children and reduce dental inequalities through a combination of targeted and universal interventions. With (...) Scotland's level of dental caries among the worst in Europe, Childsmile represents one of the largest programmes of work aimed at combating oral health inequalities in the UK. The areas of ethical interest include several contrasting themes: reducing health inequalities and improving health; universal and targeted interventions; political values and evidence base; prevention and treatment; and underlying all of these, justice and utility. (shrink)

Nursing as a profession seems to avoid considering the problem of racism. There is, however, a need to address this topic and to evaluate its implications for nursing practice. This article attempts to establish a rationale for nursing to address racism and introduce it into academic discourse. The results of a small-scale study by the author are analysed and the implications for ethical-moral reasoning in nursing practice are discussed in relation to professional codes of conduct developed by nurses’ professional organizations (...) in the UK and elsewhere. (shrink)

A new world has probably emerged through the progression of technology which has led to significant debates on social, cultural, legal, and ethical issues, especially in the biomedical field in this century. Application of physician-patient relationship, principles of pluralism, autonomy, democracy, human dignity, and human rights is being challenged within the medicine and health-care system of today. Development of technology-based remedies has fostered greater degrees of medicalization. Hence, the automatic application of such technologies risks distorting the nature of medicine. To (...) be sure, there is a cultural shift that is affecting the society that is increasingly unable to adapt to traditional legal systems. This cultural shift, perhaps, demands new ethics. This entry aims to evaluate the gap between traditional deontological nature of medicine and the emerging new ethics and assess why bioethical reflection is needed. (shrink)

Background Chronic pain is a pervasive and invisible condition which affects people in a myriad of ways including but not limited to their quality of life, autonomy, mental and physical health, social mobility, and productivity. There are many ethical implications of neuroscience research on chronic pain, given its potential to reduce suffering and improve the lived experience of people in pain. While a growing body of research studies the etiology, neurophysiology, and management of chronic pain, it is unknown to what (...) degree neuroscience research in this area engages with relevant ethics concepts. Aim To explore the presence of ethics concepts in empirical chronic pain neuroscience literature to advance knowledge regarding the ethics of chronic pain management. Methods We conducted a hybrid bibliometric analysis and scoping review of chronic pain neuroscience articles published between 1999 and 2021 to identify the presence of ethics concepts. We selected articles from the top, middle, and bottom 20 neuroscience journals ranked by Impact Factor. We conducted a database search of Web of Science and a hand-search using PubMed, Google Scholar, and the reference lists of included articles. Findings Our database search yielded 2779 results from which 46 articles met inclusion criteria. An additional 13 articles were hand-retrieved using PubMed and Google Scholar in accordance with the inclusion criteria, totaling 59 articles. We identified four main ethics themes in our analysis: 1) Quality of Life (n = 46), 2) Autonomy (n = 5), 3) Transparency (n = 4), and 4) Beneficence and Non-Maleficence (n = 4). Conclusion Most neuroscience papers do not include a discussion of ethics related to chronic pain conditions. Those that do tend to merely state rather than define or contextualize a particular ethics concept. Given the potential ethical implications of neuroscience research for people living with chronic pain, we argue that to maximize its public health benefit, neuroscience researchers should consider the ethical relevance of their work within their scientific publications. This may generate further ethical reflection within the field, to improve pain management. (shrink)

As robots are deployed in a widening range of situations, it is necessary to develop a clearer position about whether or not they can be trusted to make good moral decisions. In this paper, we take a realistic look at recent attempts to program and to train robots to develop some form of moral competence. Examples of implemented robot behaviours that have been described as 'ethical', or 'minimally ethical' are considered, although they are found to only operate in quite constrained (...) and limited application domains. There is a general recognition that current robots cannot be described as full moral agents, but it is less clear whether will always be the case. Concerns are raised about the insufficiently justified use of terms such as 'moral' and 'ethical' to describe the behaviours of robots that are often more related to safety considerations than to moral ones. Given the current state of the art, two possible responses are identified. The first involves continued efforts to develop robots that are capable of ethical behaviour. The second is to argue against, and to attempt to avoid, placing robots in situations that demand moral competence and an understanding of the surrounding social situation. There is something to be gained from both responses, but it is argued here that the second is the more responsible choice. (shrink)

Academic medical centers and drug manufacturers have traditionally occupied very distinct positions with regard to public trust. As collaborations among medical researchers and pharmaceutical companies expand, however, worries about the aggressive pursuit of profit that has tarnished the reputation of the pharmaceutical industry may be transferred to medical institutions and clinical investigators, suggesting to some that biomedical research is more about increasing profit than promoting public health. Consequently, when medical institutions forge research collaborations with industry they should be mindful of (...) the potential for these relationships to erode public confidence in the integrity of clinical research.Recent events have heightened concerns about the financing of clinical research. These include the widely publicized deaths of several research volunteers, scandals at the nation's largest funder of biomedical research, and evidence of fabricated research findings in prominent medical journals. These unfortunate events have prompted many to re-examine strategies for managing industry relationships and the financial conflicts of interest they may create. (shrink)

This article addresses an important, overlooked regulatory challenge during global health emergencies. It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively capturing (...) these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines—which draw upon practical examples of guidelines ‘in action’—that assist in determining how to act in a particular situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples—which incorporate important lessons learned—illustrate how such guidelines can be interpreted at a practical level. (shrink)

In 1974, the United States Congress asked a question prompting a national conversation about ethics: which ethical principles should govern research involving human participants? To embark on an answer, Congress passed the National Research Act, and charged this task to the newly established National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Commission’s mandate was modest however, the results were anything but. The outcome was The Belmont Report: a trio of principles - respect for persons, (...) beneficence, and justice - serving as an ethical compass for scientists, researchers, and institutional review boards (IRBs). Almost 50 years later, the utility, legacy, and ingenuity of The Belmont Report continues to be both admired and challenged. Critics argue that Belmont is not fit for the 21st century, while supporters praise Belmont for its enduring wisdom. The goal of this paper is to equip IRB practitioners with the tools necessary to maximally interpret The Belmont Report and meaningfully engage in ethical analysis that reconsiders outmoded legacy thinking and fixed decision-making. Through historical and contextual reflection, this paper describes how IRB practitioners can contemporize review of ethical human research using their moral imagination – a skill found at the intersection of creativity, deliberation, and empathy. (shrink)

Norms have been widely enacted in human and agent societies to regulate individuals’ actions. However, although legislators may have ethics in mind when establishing norms, moral values are only sometimes explicitly considered. This paper advances the state of the art by providing a method for selecting the norms to enact within a society that best aligns with the moral values of such a society. Our approach to aligning norms and values is grounded in the ethics literature. Specifically, from the literature’s (...) study of the relations between norms, actions, and values, we formally define how actions and values relate through the so-called value judgment function and how norms and values relate through the so-called norm promotion function. We show that both functions provide the means to compute value alignment for a set of norms. Moreover, we detail how to cast our decision-making problem as an optimisation problem: finding the norms that maximise value alignment. We also show how to solve our problem using off-the-shelf optimisation tools. Finally, we illustrate our approach with a specific case study on the European Value Study. (shrink)

La comunicación de la verdad ética pasa históricamente por modelos, pero sus propuestas se discuten cuando no favorecen la belleza ética en la persona.El estudio refleja un análisis a modelos éticos en la cultura, para proponer la importancia de enfocar la educación ética valorando los paradigmas de una ética integradora y practica en un currículo global.Se infiere por el relativismo, una dialéctica que permanece sobre las certezas éticas; sobre lo justo, lo bueno, lo verdadero; sobre lo legal y lo ético; (...) para continuar divulgándose un discurso ético no de tipo vinculante, sin despertar pasión por la verdad. (shrink)

In this essay, I develop a moderate hierarchical position about the moral status of animals that is based on two factors: on the level of mental development of a being who is affected and on the significance of the interests that are affected. I argue that this view accommodates two different sets of moral intuitions. On one hand, it explains why, in general, humans have the special moral standing that is typically attributed to us. On the other hand, it also (...) allows us to accommodate much of our intuition about how animals ought to be treated. In addition, this view is supported also by plausible general theoretical considerations. Subsequently, I explore some implications of this view for some real-life examples of our interactions with animals, especially, for the practice of raising them for food using industrial methods. I argue that this practice is morally wrong and that the correct approach is to adopt a (nearly) plant-based lifestyle. (shrink)

This paper discusses the Indirect Duties View implying that, when our actions have no negative effects on humans, we can treat animals any way we wish. I offer several criticisms of this view. Subsequently, I explore some implications of rejecting this view that rise in the contexts of animal research and veterinarian ethics.

In this article, I consider a number of arguments that assume that beings who have immortal souls occupy a special position in the sphere of moral concern. First, I place these arguments in their historical and cultural contexts. Next, I formulate several conditions of adequacy that all such arguments must satisfy. Subsequently, I distinguish two different general kinds of such arguments: Inclusionary arguments attempt to use the immortality of soul as a criterion for either including someone into a sphere of (...) morality while excluding others or, at least, for elevating someone's position within this sphere. Modifying arguments attempt to strengthen or weaken moral considerations that already apply to a being included into the sphere of morality. I argue that, although some modifying arguments may fulfill all conditions of adequacy, they have very little practical importance. (shrink)

The new dilemmas and responsibilities which arise in bioethics both because of the unprecedented pace of scientific development and of growing moral pluralism are more and more difficult to grapple with. At the ‘global’ level, the call for the universal nature at least of some fundamental moral values and principles is often being contended as a testament of arrogance, if not directly as a new kind of subtler imperialism. The human rights framework itself, which provided the basis for the most (...) relevant international declarations and documents, is not exempt from the charge. However, the refusal of a top-down conception of the universal as a sort of product for exportation should not be confused with a relativistic landscape, where all the cows can be indifferently black or white. This contribution aims at outlining an approach, which reconciles universalism as enshrined in founding human rights declarations with respect for cultural diversity. In order to do so, two conceptual frameworks are discussed: the ‘tool-kit’ model and the morals/ethics difference. The example of the right to quality health care confirms the argument that striking a balance between cherishing pluralism and defending some fundamental rights and obligations does not amount to an assertion of moral imperialism. (shrink)

Gain-of-function research involves experimentation that aims or is expected to increase the transmissibility and/or virulence of pathogens. Such research, when conducted by responsible scientists, usually aims to improve understanding of disease causing agents, their interaction with human hosts, and/or their potential to cause pandemics. The ultimate objective of such research is to better inform public health and preparedness efforts and/or development of medical countermeasures. Despite these important potential benefits, GOF research can pose risks regarding biosecurity and biosafety. In 2014 the (...) administration of US President Barack Obama called for a “pause” on funding of GOF experiments involving influenza, SARS, and MERS viruses in particular. With announcement of this pause, the US Government launched a “deliberative process” regarding risks and benefits of GOFR to inform future funding decisions—and the US National Science Advisory Board for Biosecurity was tasked with making recommendations to the US Government on this matter. As part of this deliberative process the National Institutes of Health commissioned this Ethical Analysis White Paper, requesting that it provide review and summary of ethical literature on GOFR, identification and analysis of existing ethical and decision-making frameworks relevant to the evaluation of risks and benefits of GOFR, decision-making about the conduct of GOF studies, and the development of US policy regarding GOFR, and development of an ethical and decision-making framework that may be considered by NSABB when analyzing information provided by GOFR risk-benefit assessment, and when crafting its final recommendations. The ethical and decision-making framework ultimately developed is based on the idea that there are numerous ethically relevant dimensions upon which any given case of GOFR can fare better or worse : research imperative, proportionality, minimization of risks, manageability of risks, justice, good governance, evidence, and international outlook and engagement. Rather than drawing a sharp bright line between GOFR studies that are ethically acceptable and those that are ethically unacceptable, this framework is designed to indicate where any given study would fall on an ethical spectrum—where imaginable cases of GOFR might range from those that are most ethically acceptable, at one end of the spectrum, to those that are most ethically problematic or unacceptable, at the other. The aim should be that any GOFR pursued should be as far as possible towards the former end of the spectrum. (shrink)

Many patients are subject to 'do not resuscitate' orders or are 'allowed to die'. The predominant moral position within health care seems to be that this is permissible, while voluntary euthanasia is not. This paper attempts to consider the logic of that position. It is not intended as a case for or against voluntary euthanasia; those cases are made elsewhere. Instead, this is an attempt to challenge implicit assumptions. It is the experience of many nurses that issues relating to matters (...) at the end of life are far from being resolved. This paper does not try to offer any practical solutions but aims at some clarification of the language used. This, it is hoped, will enable nurses to contribute to the debate. (shrink)

Ein gelungenes Arzt-Patient-Verhältnis, das auf gegenseitigem Vertrauen und ärztlicher Verantwortung basiert, ist ein zentraler Bestandteil des Ideals der ärztlichen Profession. Aktuell wird vielfach von einem neuen „ökonomischen Paradigma“ in der Medizin gesprochen, das dieses Verhältnis vermeintlich unterminiert. Als ein wichtiges Merkmal dieses Paradigmas gilt das Verständnis vom Patienten als Kunden, der charakterisiert ist durch seine Selbstbestimmung bzw. Autonomie. Wie stellt sich die Kundenrolle nun aber bei vulnerablen Patientengruppen dar, die in ihrer Autonomie eingeschränkt sind, und was bedeutet dies wiederum für (...) das Arzt-Patient-Verhältnis? In dem vorliegenden Artikel wollen wir deshalb die Fragestellung verfolgen, ob sich ärztliche Verantwortung bzw. das Arzt-Patient-Verhältnis ändert, wenn sich der (vulnerable) Patient als Kunde begreift. Als Analysesetting dient die Palliativmedizin, da sie als Beispiel für eine besonders vulnerable Patientengruppe gelten kann. Als Basis der Argumentation werden die Ergebnisse einer qualitativen Studie herangezogen, welche die Einstellungen von Palliativpatienten zum Thema „der Patient als Kunde“ erhob sowie der Frage nachging, ob sich Palliativpatienten, speziell im Rahmen von medizinischen Entscheidungen, als selbstbestimmt begreifen. Die Studienergebnisse zeigen, dass Autonomie relational verstanden werden muss und dem Arzt eine entscheidende Rolle in der Ermöglichung von Patientenselbstbestimmung zukommt – ganz unabhängig von der Selbstattribuierung der Befragten als Kunde oder Patient. Anschließend werden diese Ergebnisse dahingehend analysiert, ob sie als Ausdruck einer Veränderung des Arzt-Patient-Verhältnisses und der ärztlichen Verantwortung gegenüber den Patienten zu werten sind. Hieraus folgernd wird nach den praktischen Implikationen für das Arzt-Patient-Verhältnis auf der Grundlage der „Ethics of Care“ gefragt sowie auf die individuelle Betreuungsnotwendigkeit, speziell von vulnerablen Patientengruppen, verwiesen. (shrink)