During the past decade, the “script” concept, indicating how technologies prescribe human actions, has acquired a central place in STS. Until now, the concept has mainly functioned in descriptive settings. This article will deploy it in a normative setting. When technologies coshape human actions, they give material answers to the ethical question of how to act. This implies that engineers are doing “ethics by other means”: they materialize morality. The article will explore the implications of this insight for engineering ethics. (...) It first augments the script concept by developing the notion of technological mediation. After this, it investigates how the concept of mediation could be made fruitful for design ethics. It discusses how the ambition to design behaviorinfluencing technologies raises moral questions itself and elaborates two methods for anticipating technological mediation in the design process: performing mediation analyses and using an augmented version of constructive technology assessment. (shrink)

Pioneering researchers claim that telepsychiatry presents the possibility of improving both the quality and quantity of patient care for populations in general as well as for those in rural and remote locations. The prevalence of, and literature on telepsychiatry has increased dramatically in the last decade, covering all aspects of research endeavors. However, little can be found on the topic of ethics in telepsychiatry. Using various clinical scenarios we may provide insight into the moral challenge in telepsychiatry—the lack of in-person (...) contact. The difficulty is to articulate what the significance of in-person contact is and further, its meaning in the therapeutic relationship between the patient and the physician. Using the personalist perspective and related philosophical approaches we may sketch an idea of the patient as person, existentially considered as a relational and bodily human being. By applying Brennan’s model for health technology assessment we may evaluate the morally troubling aspect of telepsychiatry—a lack of in-person contact—on this philosophical sketch of the person. This consideration is crucial when developing policies to guide the use of telepsychiatry in order to maintain the quality of care. (shrink)

Doctors have an ethical and legal duty to respect patient confidentiality. We consider the basis for this duty, looking particularly at the meaning and value of autonomy in health care. Enabling patients to decide how information about them is disclosed is an important element in autonomy and helps patients engage as active partners in their care.Good quality data is, however, essential for research, education, public health monitoring, and for many other activities essential to provision of health care. We discuss whether (...) it is necessary to choose between individual rights and the wider public interest and conclude that this should only rarely be necessary. The paper makes some recommendations on practical steps which could help ensure that good quality information is available for work which benefits society and the public health, while still enabling patients’ autonomy to be respected. (shrink)

Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled (...) version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors. (shrink)

Psychiatric ethics spans several overlapping domains, including the guidelines for ethical research in psychiatry, the professional ethics required in the practice of psychiatry, and a broader set of moral and ethical problems and dilemmas distinctive to, or at least magnified by, the mental health care setting. Reviewed here are selected issues arising in the last two domains, some seemingly inevitable components of mental disorder and its cultural history and others resultant from recent changes and discoveries. Even as science explains and (...) demystifies mental disorder, it is concluded, new ethical problems will continue to arise in psychiatry and certain recalcitrant problems will likely persist. (shrink)

Power is an inescapable aspect of all socialrelationships, and inherently is neither goodnor evil. Doctors need power to fulfil theirprofessional obligations to multipleconstituencies including patients, thecommunity and themselves. Patients need powerto formulate their values, articulate andachieve health needs, and fulfil theirresponsibilities. However, both parties canuse or misuse power. The ethical effectivenessof a health system is maximised by empoweringdoctors and patients to develop `adult-adult'rather than `adult-child' relationships thatrespect and enable autonomy, accountability,fidelity and humanity. Even in adult-adultrelationships, conflicts and complexitiesarise. Lack of (...) concordance between doctors andpatients can encourage paternalism but may bebest resolved through negotiated care. Afurther area of conflict involves the `doubleagency' of doctors for both patients and thecommunity. Empowerment of all players is notalways possible but is most likely where eachparty considers and acknowledges power issues. (shrink)

Proliferating media forms, from tablets to Twitter, are changing communicative practice, delimiting new experiential horizons, and thus providing phenomenological research with novel variations on the experience of self and other. Videoconferencing via Skype or FaceTime offers prominent examples of these changing forms. Despite the use of these communication technologies in both educational contexts and everyday life, educational videoconferencing has been described in the research literature as “a hidden mode of delivery, employing invisible pedagogical techniques.” In this study I address this (...) situation of simultaneous familiarity, invisibility and uncertainty by focusing particularly on the lived experience of space, the body and eye contact in videoconferencing contexts. This study suggests that the disruption of spatial coherence and power of gaze and mutual gaze are all but unavoidable features of this experience. It concludes by emphasizing the importance forms or expressions of absence, such as the diminution of eye contact, or the importance of not always being perceived as performing or “on” in videoconferencing contexts. (shrink)

The following paper addresses the experience of reality in video-calls. To this extent, it first draws from Edmund Husserl’s phenomenological reflections that connect the question of reality with that of interaction and that of intersubjective communication. These reflections set the larger theoretical framework for sketching out ten theses with regard to the specific case of video-calls. To this extent it addresses issues like the public-private divide, the specific image-form of contemporary video-calls, the mutual intersubjective relations they involve, as well as (...) their specific spatiality and temporality. (shrink)