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...

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

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)

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)

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)

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

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)

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)

Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...) diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method: This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results: The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion: We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound. (shrink)