Practical wisdom enables moral decision-making and action by aligning one’s apprehension of proximate goods with a distal, socially embedded interpretation of a more ultimate Good. A focus on purpose within the overall process mutually informs human moral psychology and moral AI development in their examinations of practical wisdom. AI practical wisdom could ground an AI system’s apprehension of reality in a sociotechnical moral process committed to orienting AI development and action in light of a pluralistic, diverse interpretation of that Good. (...) Defining AI purpose in terms of the human struggle to determine the moral “ought” (versus the way reality is) can overcome practical and normative limitations of principle-based approaches to AI ethics without requiring idiosyncratic moral reasoning or a premature commitment to a single ethical theory, which could hinder navigating the moral implications of future unknowns. Dividing practical wisdom into proximate, mediating, and distal processes enables each division to incorporate the moral dimensions of the situation, individual AI system, and sociotechnical community, respectively. Drawing upon externalist (4E) and ecological cognitive psychology theories to extend Xavier Zubiri’s sentient intelligence, proximate apprehension of what an object affords the perceiver includes affordances for practical and moral purposes. Those apprehensions are structured by moral and other social-cognitive schemas that mediate moral constructs, the apprehended situation, and individual commitments and other motivating identifications in a process Ignacio Ellacuria calls historical reality. Distally, Josiah Royce’s community of interpretation characterizes one way of organizing a sociotechnical process to synthesize diverse interpretations of the Good, orient AI moral practice, and align AI development with human and AI moral purpose. (shrink)

Michael Lamb’s recent book A Commonwealth of Hope presents an opportunity for bioethicists to engage in critical self-evaluation in order to consider anew why and how to engage difficult bioethical problems and questions with those who maintain diverse moral and metaphysical perspectives. Drawing on an account of the virtue of hope from Augustine of Hippo, Lamb develops a political theory in which hope provides common ground for political cooperation between diverse citizens of a commonwealth. The purpose of this introduction is (...) to sketch out a framework by which to assess and evaluate whether bioethics demonstrates hope. This article provides a summary description of Lamb’s presentation of Augustine’s virtue of hope and his concept of politics. Then it considers implications of Lamb’s politics of hope for bioethics, identifying three features of hopeful bioethics, with which bioethicists can engage in self-reflection and evaluation. (shrink)

There has been increasing awareness of the medical and moral challenges in the care of unrepresented patients: those who cannot make their own medical decisions, do not have any surrogate decision maker, and have not indicated their treatment preferences. Most discussions have focused on procedural questions such as who should make decisions for these patients. An issue that has not gotten enough attention is the ethical standard that should govern medical decision making. I explore the question of which ethical standard (...) provides better justification for end-of-life decisions for unrepresented patients. Two options are considered: the conventional and less demanding best interest standard, and the novel and more demanding medical futility standard. I explain the similarities and differences between these two standards, examine arguments for and against each one, and suggest that the medical futility standard is ethically superior and should replace the established best interest standard. (shrink)

Health science students frequently experience ethical dilemmas on clinical placements, yet ethics education rarely prepares students with the ethical leadership skills required. The Leadership in Ethical Practice (LEP) program is an ethics education resource designed to enhance health science students’ knowledge and skills in ethical leadership to prepare them for clinical placements and future professional practice. This qualitative study aimed: to explore the nature of students’ ethical leadership goals; determine whether a specific, measurable, achievable, relevant, and time-bound (SMART) format was (...) an effective tool for students to create ethical leadership goals; and identify any changes in students’ pre- and post-self-ratings of ethical leadership knowledge following the LEP program. Eighty-two diagnostic radiography students from the University of Sydney participated in the study. Inductive and deductive qualitative content analysis (Elo & Kyngas, 2008) were used to explore students’ goals. Descriptive statistics were used to investigate students’ pre- and post-self-ratings. Four themes emerged from students’ goals: initiative, competence, and courage in ethical reasoning; communicating ethical stories through listening, questioning, and connecting; reflecting and growing as an ethical leader; and safe practice and person-centred outcomes. SMART goal format elements were evident in 61% of students’ goals. Students' ethical leadership self-ratings showed positive changes after participating in the LEP program. Findings indicated students planned to further develop ethical leadership skills during clinical placements and future professional practice. This study demonstrated the ethics education approaches used within the LEP could assist health science students to apply ethical leadership in future clinical practice. (shrink)

In their article, Crutchfield and Redinger (2024) outline the conditions that they have identified as situations in which it is ethically permissible to use chemical restraints, defined as medicati...

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement (...) with our commentators and respond to their critical evaluations. (shrink)

In this paper I critically examine the implications of the uncodifiability thesis for principlism as a pluralistic and non-absolute generalist ethical theory. In this regard, I begin with a brief overview of W.D. Ross’s ethical theory and his focus on general but defeasible prima facie principles before turning to 2) the revival of principlism in contemporary bioethics through the influential work of Tom Beauchamp and James Childress; 3) the widespread adoption of specification as a response to the indeterminacy of abstract (...) general principles and the limitations of balancing and deductive approaches; 4) the challenges raised to fully specified principlism by the uncodifiability thesis and 5) finally offer a defense of the uncodifiability thesis against various critiques that have been raised. (shrink)

“Outsiders” addressing ethical issues in medicine—Strangers at the Bedside —became “bioethicists.” Bioethicists providing research ethics consultation have been described as “stranger...

Medical professionals often deny patients who inject opioids a second or third heart valve replacement, even if such a surgery is medically indicated. However, such a position is not well defended. As this paper demonstrates, the ethical literature on the topic too often fails to develop and apply an ethical lens to analyse the issue of multiple valve replacements. This paper addresses this lacuna by analysing the case of Mr Walsh, a composite case which protects the identity of any one (...) patient, through the principlist approach of Beauchamp and Childress. It argues that the hospital should offer Mr Walsh, a second valve replacement because the procedure is: medically indicated, autonomously requested, non-maleficent, beneficent and does not violate a formal account of justice. The paper concludes with clinical ethical guidelines for valve surgery for patients with opioid use disorder. (shrink)

Clinicians may increasingly find themselves practicing, by choice or necessity, in resource-poor or extreme environments. This often requires altering typical patterns of practice with a different set of medical and ethical considerations than are usually faced by clinicians practicing in hospitals in the United States and Europe. Practitioners may be required to alter their usual scope of practice or their standard ways of medically treating patients. Limited resources will also often place clinicians in the position of having to make decisions (...) about fairly allocating healthcare, which will alter the physician–patient relationship. This does not absolve physicians and other healthcare practitioners of providing the best quality of care that can be given under the circumstances. In addition, the lack of a well-developed healthcare infrastructure and limited resources will require working with established providers to determine the needs of the community, and what types of healthcare are feasible given these limitations. The essays in this issue of HEC Forum encourage readers to reflect on the unique ethical challenges faced in the extreme or austere environment. (shrink)

Power tends to corrupt and absolute power corrupts absolutely. To be clear, I do not think that blood transfusions necessarily...