Media appeals encouraging people to sign organ donor cards suggest that donating one's own organs after death or donating the organs of a deceased family member is an act of charity, i.e., something which it would be meritorious for people to do but not wrong to avoid. This paper argues to the contrary that posthumous organ donation is a moral duty, a duty of the type that rests at the base of recently enacted state “Good Samaritan” laws which require a (...) witness to an emergency situation to render aid to the victim when this can be done at minimal cost/risk to the potential rescuer. (shrink)

Patients belonging to ethnic, racial, and religious minorities have been all but excluded from the legal academy's on-going conversation about informed consent. This article repairs that egregious omission. It begins by observing the narrowing of ethical justifications that underlie our informed consent law, tracing the ethical literature from the ancients to modern formulations of autonomy-centered models. Next, this article reviews the vast body of empirical data available in social science literature, that demonstrates how distinct from the autonomy model the broad (...) range of values and priorities held by patients from racial, ethnic, and religious minority groups is. The conclusion that informed consent's focus on the western notion of autonomy affirmatively harms minority patients is inescapable. The article concludes by offering a fiduciary model of informed consent law that could improve the quality of health care for more than 100 million minority patients, potentially at risk under current law while also regulating the informed consent procedure and practice in a way that will bring balance and justice to all American patients and providers. (shrink)

Medical students pose as physicians during clinical training. This article presents three cases where students justify misrepresenting their status for different reasons: self-concern for career, necessity for clinical training, and belief that the truth could cause undue psychological stress in the patient. The author suggests that serious consequences of this practice should be constantly reviewed in a critical light.

This paper introduces the controversy surrounding active voluntary euthanasia and describes the legal position on euthanasia and assisted suicide in the UK. Findings from studies of the nurses' attitudes to euthanasia from the national and international literature are reviewed. There are acknowledged difficulties in carrying out research into attitudes to euthanasia and hence the review of findings from the published studies is followed by a methodological review. This methodological review examines the research design and data collection methods used in the (...) published studies, problems with understanding definitions of euthanasia and the measurement of attitudes. The paper concludes with a discussion of how research in this area may influence nursing practice. (shrink)

A number of criticisms of Utilitarianism – such as “nearest and dearest” objections, “demandingness” objections, and “altruistic” objections – arise because Utilitarianism doesn’t permit partially or wholly disregarding the utility of certain subjects. A number of authors, including Sider, Portmore and Vessel, have responded to these objections by suggesting we adopt “dual-maximizing” theories which provide a way to incorporate disregarding. And in response to “altruistic” objections in particular – objections noting that it seems permissible to make utility-decreasing sacrifices – these (...) authors have suggested adopting a dual-maximizing theory that permits disregarding one’s own utility. In this paper I’ll defend two claims. First, I’ll argue that dual-maximizing theories are a poor way to incorporate disregarding. Instead, I’ll suggest that “variable-disregarding” theories provide a more attractive way to incorporate disregarding. Second, I’ll argue that the right way to handle these “altruistic” objections isn’t to permit disregarding one’s own utility, it’s to permit disregarding the utility of those who consent. Together, these two claims entail that the best way to modify Utilitarianism to handle “altruistic” objections is to adopt a variable-disregarding view that disregards the utility of those who consent. (shrink)

For today, the medical association came to common opinion, that a doctor-scientist cannot be higher than the universal values. At a decision-making, equally with the scientific interests, which, undoubtedly, will bring to development of the theoretical and practical medicine, a doctor must take into account moral values. The doctrine of the informed consent of patient that is examined as a necessary condition of any medical interference became ethic basis of experiment with participation of human. An observance of confidentiality of the (...) results of the studies is also very important. The present development of the biomedical knowledge supposes realization of human research in a good cause, after the conducted tests on the animals and the other models. A clinical test on human must take place only then, when the risk does not exceed the benefit. Carrying out of the biomedical studies is considered as illegal, unconscionable, amoral and even criminal action. If the regulations and the norms of the law are not observed, it entails penal offence. This article provides the basic foundations of medical activities rather moral standards of medical and research activity, which in the different periods underwent the changes dictated by moral requirements of an era and society are analyzed. (shrink)

In financial disputes involving research, the parties are traditionally individual researchers and their institutions, biotech and pharmaceutical companies, and other entities engaged in the commercial development of biomedical research. Occasionally, research subjects claim that researchers have misled them or misappropriated their biological materials to derive financial gain. The best known example is the case of Moore v. Regents of the University of California, decided in 1990.With new developments in genomics, large-scale repositories of tissue and other biological specimens are increasingly important. (...) Biobanks have been established by various researchers, commercial entities, health-care institutions, and even entire countries. Individuals who contribute specimens almost always retain no commercial interest in any resulting research and language to that effect is now customarily included in informed consent documents signed at the time the specimen is given. Suppose, however, that the research subjects actually collect the specimens themselves, recruit the researcher, and provide financial support for the research. (shrink)

In this paper I argue that applied ethics is a phenomenon spontaneously emerged between the Sixties and the Seventies and resulting from interbreeding of theoretical discussion in ethics and public discourse of liberal-democratic societies. I contend that the phenomenon’s novelty is in a peculiar relationship it has helped in establishing between ethical theories and real-world issues, and besides that the true nature of applied ethics is that of deliberation, whose tool is the faculty of judgment, or casuistry, understood the Kantian (...) way. (shrink)

In this open access book, Timothy Aylsworth and Clinton Castro draw on the deep well of Kantian ethics to argue that we have moral duties, both to ourselves and to others, to protect our autonomy from the threat posed by the problematic use of technology. The problematic use of technologies like smartphones threatens our autonomy in a variety of ways, and critics have only begun to appreciate the vast scope of this problem. In the last decade, we have seen a (...) flurry of books making “self-help” arguments about how we could live happier, more fulfilling lives if we were less addicted to our phones. But none of these authors see this issue as one involving a moral duty to protect our autonomy. (shrink)

How the diversity of membership of research ethics committees is arrived at has, to date, largely been fairly arbitrary. However, a tool to help determine one's moral preference is now available and it is introduced here as, arguably, having the potential to assist with ensuring a more meaningful diversity amongst an ethics committee's membership. The tool is seen to be easily applied – but, it is argued, may be conceived on at least two false premises. Firstly, despite different theories of (...) ethics, none can be proved to give the ‘right’ answer other than in its own terms. Secondly, if there is an ethical hierarchy, as the model suggests, then ethical diversity must become redundant for the possibility of achieving ethical excellence. (shrink)

This systematic review identifies and critically evaluates instruments that have been developed to measure clinical trial informed consent comprehension in non-cognitively-impaired adults.Literature searches were carried out on Medline (Ovid), PsycInfo, CINHAL, ERIC, ScienceDirect, and Cochrane Library for English language articles published between January 1980 and September 2008. Instruments were excluded if they focused on consent onto paediatric trials, the construct under study was primarily capacity or competency, or the instrument was developed specifically for psychiatric or cognitively-impaired populations. Instruments selected for (...) review were evaluated against the following criteria: (1) method of item generation; (2) type and format of test items; (3) administration and interpretation of test results; and (4) psychometric properties.Three instruments met our defined inclusion criteria: the Deaconess Informed Consent Comprehension Test (DICCT), the Quality of Informed Consent (QuIC) questionnaire and the Brief Informed Consent Protocol (BICEP). Each instrument varied in terms of content measured. Significantly, these are the first standardized instruments developed to assess comprehension in non-cognitively-impaired adults. Yet, each instrument had its own set of limitations such as the lack of generalizability and the absence of details pertaining to how test results should be used to guide clinical decision-making.Standardized clinical trial informed consent comprehension assessments have been developed to identify gaps in research participants' understanding and ensure that respect for patient autonomy is satisfied. (shrink)

In a time marked by the development of innovative treatments in healthcare and the need for health professionals to deal with resulting ethical dilemmas in clinical practice, this study was developed to determine the influence of the bioethics teaching on the moral competence of medical and nursing students. The authors conduct a longitudinal study using the Moral Competence Test extended version before and after attending the ethics curricular unit, in three nursing schools and three medical schools of Portugal. In this (...) questionnaire the participant is confronted with three ethical dilemmas and asked to evaluate arguments for and against the attitude of the main character. For both nursing and medical students, C-score was lower after the attendance of the ethics curricular units, with a statistically significant decrease in the total score for nursing students and a decrease not statistically significant for medical students. A multivariate analysis did not find any association between this decrease and gender, course, or age. The phenomenon of moral segmentation was observed, with better performance in the worker and judge dilemma, than in the doctor dilemma. These results highlight the need to reflect on the curricular strategies that can be implemented for health professionals to better develop moral competence and decision-making, allowing for the provision of humanized health care. (shrink)

Our primary focus is on analysis of the concept of voluntariness, with a secondary focus on the implications of our analysis for the concept and the requirements of voluntary informed consent. We propose that two necessary and jointly sufficient conditions must be satisfied for an action to be voluntary: intentionality, and substantial freedom from controlling influences. We reject authenticity as a necessary condition of voluntary action, and we note that constraining situations may or may not undermine voluntariness, depending on the (...) circumstances and the psychological capacities of agents. We compare and evaluate several accounts of voluntariness and argue that our view, unlike other treatments in bioethics, is not a value-laden theory. We also discuss the empirical assessment of individuals? perceptions of the degrees of noncontrol and self-control. We propose use of a particular Decision Making Control Instrument. Empirical research using this instrument can provide data that will help establish appropriate policies and procedures for obtaining voluntary consent to research. (shrink)

Pain medication is one of the responses to the mercy argument that utilitarian ethicists use for justifying active euthanasia on the grounds of prevention of cruelty and appeal to beneficence. The researcher reinforces the significance of pain medication in meeting this challenge and considers it the most preferred response among various other responses. It is because of its realism and effectiveness. In exploring the mechanism and considerations related to pain medication, the researcher briefly touches the Catholic ethical position on the (...) issue, a position that cannot be ignored in the development of contemporary bioethics. The researcher particularly deliberates on the contemporary Islamic discourse on the issue; by furthering the debate in line with the Islamic legal maxims and general guidance from the primary sources of Islamic law and ethics. The resolution on the issue is sought by synthesizing the views and legal maxims (al-Qawaid al-Fiqhiyyah) on the issue, which in conclusion provide justification for pain medication by considerably regarding pain as necessity and pressing need. However, such resolution allows pain medication to the limit and proportion that removes the pain and prohibits overdosing the patient with medication that may directly cause the death. (shrink)

Wenn Künstliche Intelligenz (KI) Texte generieren kann, was sagt das darüber, was ein Text ist? Worin unterscheiden sich von Menschen geschriebene und mittels KI generierte Texte? Welche Erwartungen, Befürchtungen und Hoffnungen hegen Wissenschaften, wenn in ihren Diskursen KI-generierte Texte rezipiert werden und Anerkennung finden, deren Urheberschaft und Originalität nicht mehr eindeutig definierbar sind? Wie verändert sich die Arbeit mit Quellen und welche Konsequenzen ergeben sich daraus für die Kriterien wissenschaftlicher Textarbeit und das Verständnis von Wissenschaft insgesamt? Welche Chancen, Grenzen und (...) Risiken besitzen KI-Textgeneratoren aus Sicht von Technikethik und Technikfolgenabschätzung? Und welche Kriterien sind für einen ethisch bewussten Umgang mit KI-Textgeneratoren im Bildungskontext anzulegen? Diese und ähnliche Fragen verdeutlichen die Komplexität und Tragweite der Herausforderung, die der stetig wachsende und zunehmend selbstverständliche Einsatz von KI-Textgeneratoren für das zukünftige Arbeiten mit und an Texten mit sich bringt. Hierbei kristallisieren sich Problematiken heraus, die sich an ein breites Spektrum von Disziplinen wenden, deren spezifischen Diskurse in diesem Band beleuchtet werden. (shrink)

This paper argues for the superiority of natural law theory over consent -based approaches to sexual morality. I begin by criticizing the “consenting adults” sexual ethic that is dominant in contemporary Western culture. I then argue that natural law theory provides a better account of sexual morality. In particular, I will defend the “perverted faculty argument”, according to which it is immoral to use one’s bodily faculties contrary to their proper end.

Essays explore the significance of Julia Kristeva’s concept of intimate revolt for social and political philosophy. Over the last twenty years, French philosopher, psychoanalyst, and novelist Julia Kristeva has explored how global crises threaten people’s ability to revolt. In a context of widespread war, deepening poverty, environmental catastrophes, and rising fundamentalisms, she argues that a revival of inner psychic experience is necessary and empowering. “Intimate revolt” has become a central concept in Kristeva’s critical repertoire, framing and permeating her understanding of (...) power, meaning, and identity. New Forms of Revolt brings together ten essays on this aspect of Kristeva’s work, addressing contemporary social and political issues like immigration and cross-cultural encounters, colonial and postcolonial imaginations, racism and artistic representation, healthcare and social justice, the spectacle of global capitalism, and new media. Sarah K. Hansen is Assistant Professor of Philosophy at California State University, Northridge. Rebecca Tuvel is Assistant Professor of Philosophy at Rhodes College. (shrink)

Research to improve the health of pregnant and fetal patients presents ethical challenges to clinical investigators, institutional review boards, funding agencies, and data safety and monitoring boards. The Common Rule sets out requirements that such research must satisfy but no ethical framework to guide their application. We provide such an ethical framework, based on the ethical concept of the fetus as a patient. We offer criteria for innovation and for Phase I and II and then for Phase III clinical trials (...) to improve the health of pregnant patients and of fetal patients and also criteria to responsibly manage the transition from investigation to clinical practice. Basing ethical criteria for research involving pregnant women on the ethical concept of the fetus as a patient insulates the proposed ethical framework and therefore research on pregnant women from the divisive and politicized concepts and discourses of personhood, fetal rights, and unborn child. (shrink)

The purpose of this article is to re-examine an ethic of care as the main ethical approach to nursing practice in light of past and present developments in nursing ethics, and to briefly speculate whether or not it will survive within nursing in the future. Overall, it is maintained throughout that the terms ?caring?, ?nursing? and an ?ethic of care? are inextricably linked. This is because, it is argued, professionally focused nursing practices are based predominantly on a well-recognised moral commitment (...) to deliver expert care, and that a care-based ethic is the major factor in the construction and maintenance of these practices. Subsequently, the influences and developments of a caring ethic in nursing are firstly re-examined, and the discussion is supported by evidence from more recent nursing research and theoretical developments. Consideration is given to the philosophical underpinnings of both care theory and caring ethics, and the fundamental importance of caring in nursing, as an interpersonal relationship and as an appropriate ethical response, is made transparent. Finally, an outline of the future possibilities that may affect an ethic of care in nursing is offered. (shrink)

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...) present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

"Ethical Explorations: Moral Dilemmas in a Universe of Possibilities" by Brendan Shea is an open access textbook that provides a comprehensive study of ethical philosophy. Shea makes it his task to chart the sprawling landscape of moral thought from ancient times to the present, employing a straightforward, easily accessible style. -/- In the book, each chapter addresses a distinct ethical theory. Shea discusses everything from Plato's allegorical Cave to contemporary issues in bioethics. The text features relatable narratives, clear explanations of (...) core concepts, thought-provoking questions, and handy glossaries to help readers grasp the subject matter. -/- Among the topics, you'll find the principles of utilitarianism through the adventures of a princess, an exploration of duty via a story about a golem, and a look at natural law theory through an engaging science-fiction tale. Contemporary themes also make an appearance, including discussions on Marxism, Nietzsche's radical ideas, Simone de Beauvoir's intersection of feminism and existentialism, and racial theories from W.E.B. Du Bois and Martin Luther King. -/- As an open access (CC-BY) textbook, "Ethical Explorations" is freely available to everyone, making the study of moral philosophy accessible to all. It's a tool that gives its readers the means to wrestle with ethical questions in an ever-changing world. (shrink)

This volume bridges contemporary philosophical conceptions of risk and responsibility and offers an extensive examination of the topic. It shows that risk and responsibility combine in ways that give rise to new philosophical questions and problems. Philosophical interest in the relationship between risk and responsibility continues to rise, due in no small part due to environmental crises, emerging technologies, legal developments, and new medical advances. Despite such interest, scholars are just now working out how to conceive of the links between (...) risk and responsibility, the implications that risks may have to conceptions of responsibility (and vice versa), as well as how such theorizing might play out in applied cases. With contributions from leading scholars, this volume brings together new work examining the interplay between risk and responsibility, exploring its varied philosophical aspects and applications to contemporary issues in law, bioethics, technology, and environmental ethics. Risk and Responsibility in Context will be of interest to philosophers working in ethics, bioethics, philosophy of law, and philosophy of technology, as well as scholars and practitioners in law, health and science management, public policy, and environmental studies. (shrink)

Can autonomous systems replace humans in the performance of their activities? How does the answer to this question inform the design of autonomous systems? The study of technical systems and their features should be preceded by the study of the activities in which they play roles. Each activity can be described by its overall goals, governing norms and the intermediate steps which are taken to achieve the goals and to follow the norms. This paper uses the activity realist approach to (...) conceptualize autonomous systems in the context of human activities. By doing so, it first argues for epistemic and logical conditions that illustrate the limitations of autonomous systems in tasks which they can and cannot perform, and then, it discusses the ramifications of the limitations of system autonomy on the design of autonomous systems. (shrink)

The application of human right frameworks is an increasingly important part of efforts to accelerate progress in global mental health. Much of this has been driven by several influential legal and policy instruments, most notably the United Nations’ Convention on the Rights of Persons with Disabilities, as well as the World Health Organization’s QualityRights Tool Kit and Mental Health Action Plan. Despite these significant developments, however, much more needs to be done to prevent human rights violations. This chapter focuses on (...) a critical component of this broader challenge, which is the question of how best to regulate and reduce the use of coercive measures. The recent literature on coercion in psychiatry – which addresses involuntary commitment, seclusion, restraint, and forced medication – represents a useful resource that can help guide tractable solutions in global mental health. These issues are evaluated from the perspective of global health governance, and several general recommendations are made in order to improve monitoring and enforcement, provide guidance for domestic legislative reform, and strengthen health systems. (shrink)

Can artificial entities be worthy of moral considerations? Can they be artificial moral agents (AMAs), capable of telling the difference between good and evil? In this essay, I explore both questions—i.e., whether and to what extent artificial entities can have a moral status (“the machine question”) and moral agency (“the AMA question”)—in light of Kazuo Ishiguro’s 2021 novel Klara and the Sun. I do so by juxtaposing two prominent approaches to machine morality that are central to the novel: the (1) (...) view “from within,” including the standard (or “metaphysical”) perspective on moral agency, and the (2) view “from outside,” which includes behaviorism, functionalism and the social-relational perspective. Importantly, while the story illustrates both views, it exposes the epistemological vulnerability of the first in relation to the practical and social reality imposed by the second. That is, regardless of what metaphysical properties the Artificial Friend Klara can be said to have (from within), her moral status as well as agency ultimately depend on the views of others (from outside), including the others’ own epistemic beliefs about the nature of consciousness and personhood. (shrink)

In connection with research on humans, the term “vulnerability” is only appropriate to identify the special need for protection of certain sections of the population and individuals, if this term refers to the additional risk of certain groups of subjects. Authors who focus on the additional risk suffering of a subject group when defining vulnerability succeed in considering the specific worthiness of protection in a context-sensitive way. The attempt to define the risk–benefit assessment for vulnerable subject groups on a binding (...) basis faces considerable difficulties. This assessment depends both on the research situation and on the test subject. The normative aspect of this decision could be solved by referring to Rawl’s decision model of an original position. In cases where there is no benefit for the subject, arguments in the discussion of the risks and benefits that are based on a “group or overall benefit” and an “objective interest,” cannot be fully sustained. (shrink)

This article describes a method of scoping for potential ethical contentions within a resource constrained research environment where actor participation and bottom–up analysis is precluded. Instead of reverting to a top–down analytical structure, a data-led process is devised. This imitates a bottom–up analytic structure in the absence of the direct participation of actors, culminating in the construction of a map of the ethical landscape; a high-resolution ethical matrix of coded interpretations of various actors’ ethical framings of the technology. Despite its (...) limitations, which are discussed, the map can subsequently support the identification of areas where ethical contentions may be raised. Here, the method is described with reference to the construction and analysis of a map of the ethical landscape of carbon capture and storage technology. Taken as a preliminary stage of a larger study, it can support the design and initiation of more sophisticated analyses which may integrate stronger bottom–up participation and facilitate a reflective, deliberative process amongst actors. (shrink)

The doctrine (or principle) of double effect is often invoked to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. According to the principle of double effect, sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a (...) means to bringing about the same good end. Does the principle of double effect play the important explanatory role that has been claimed for it? To consider this question, one must be careful to clarify just what the principle is supposed to explain. Three misinterpretations of the principle’s force or range of application are common. 1. To ensure that Double Effect is not misunderstood as principle issuing a blanket permission on causing any unintended harm that yields a benefit, applications must require that the agent seek to minimize the harm involved. 2. Since it is widely accepted that it is wrong to aim to produce harm to someone as an end, to rule this out is not part of double effect’s distinctive content. 3. Harms that were produced regretfully and only for the sake of producing a good end may be prohibited by double effect because they were brought about as part of the agent’s means to realizing the good end. (shrink)

This article explores the implications of what it means to moralize about future technological innovations. Specifically, I have been invited to comment on three papers that attempt to think about what seems to be an impending social reality: the availability of life-like sex robots. In response, I explore what it means to moralize about future technological innovations from a secular perspective, i.e., a perspective grounded in an immanent, socio-historically contingent view. I review the arguments of Nancy Jecker, Mark Howard and (...) Robert Sparrow, and Wang Jue and respond to their arguments concerning the permissible limits of human-robot sexual interaction. I argue that we are in a poor epistemic position regarding what the actual future human response will be towards sex robots and how it affects society generally. Given this poor epistemic position, I argue that moralizing about future trends like human-robot sex is difficult because we do not have the relevant facts to work with. Furthermore, I remain skeptical as to policy recommendations based on socio-historically contingent moral viewpoints both because they do not carry in principle moral authority to say what future others may or may not do with their property and they may not even appeal to future secular others, insofar as secular morality is plural and consistently develops anew. (shrink)

In this chapter, the focus is on robotics development and its ethical implications, especially on some particular applications or interaction principles. In recent years, such developments have happened very quickly, based on the advances achieved in the last few decades in industrial robotics. The technological developments in manufacturing, with the implementation of Industry 4.0 strategies in most industrialized countries, and the dissemination of production strategies into services and health sectors, enabled robotics to develop in a variety of new directions. Policy (...) making and ethical awareness addressed these issues using socio-economic knowledge and also in an effort to solve some of the application problems raised in a range of different circumstances and sectoral environments. (shrink)

În cele ce urmează vom prezenta pe scurt zona de cercetare a eticii aplicate și locul ei în cadrul disciplinei filosofiei. Vom discuta apoi despre ce fac filosofii când fac etică aplicată. Vom trece în revistă câteva concepte importante din etica aplicată, cum ar fi deontologie, virtute, grijă sau drepturi. Apoi vom încerca să oferim un răspuns la întrebarea din titlul introducerii: de ce avem nevoie de etica aplicată? Vom povesti pe scurt despre istoria eticii aplicate în România, iar la (...) final vom rezuma capitolele incluse în volum. (shrink)

This chapter serves as an introduction to the edited collection of the same name, which includes chapters that explore digital well-being from a range of disciplinary perspectives, including philosophy, psychology, economics, health care, and education. The purpose of this introductory chapter is to provide a short primer on the different disciplinary approaches to the study of well-being. To supplement this primer, we also invited key experts from several disciplines—philosophy, psychology, public policy, and health care—to share their thoughts on what they (...) believe are the most important open questions and ethical issues for the multi-disciplinary study of digital well-being. We also introduce and discuss several themes that we believe will be fundamental to the ongoing study of digital well-being: digital gratitude, automated interventions, and sustainable co-well-being. (shrink)

Human dignity is one of the key concepts of our ethical evaluations, in politics, in biomedicine, as well as in everyday life. In moral philosophy, however, human dignity is a source of intractable trouble. It has a number of characteristic features which apparently do not fit into one coherent ethical concept. Hence, philosophers tend to ignore or circumvent the concept. There is hope for a philosophically attractive conception of human dignity, however, given that one takes three crucial turns. The negative (...) turn: to start the inquiry with violations of human dignity. The inductive turn: to consider the whole range of applications of the concept of human dignity in different areas of ethics. And finally, the historical turn: to take into account the historical bonds between human dignity and traditional conceptions of dignity. Taken together they point in the direction of an understanding of human dignity as universal nobility. (shrink)

Bioethics has increasingly become a standard part of medical school education and the training of healthcare professionals more generally. This is a promising development, as it has the potential to help future practitioners become more attentive to moral concerns and, perhaps, better moral reasoners. At the same time, there is growing recognition within bioethics that nonideal theory can play an important role in formulating normative recommendations. In this chapter we discuss what this shift toward nonideal theory means for ethical curricula (...) within healthcare education. In particular, we contend that more attention to the particularities of historical and social context needs to be incorporated into bioethics training. To make this argument, we focus on two examples: teaching units on race and medicine and those that focus on stigma and coercion in mental health. For both, we show how a pedagogical approach in which educators focus on social injustice could influence how practitioners engage in ethics in the clinic. This chapter, then, demonstrates what a commitment to nonideal theory can mean practically when it comes to bioethics education. (shrink)

This paper has two goals. The first is to argue that the field of bioethics in general and the literature on ideal vs. nonideal theory in particular has underemphasized a primary problem for normative theorizing: the role of conditioning principles. I define these as principles that implicitly or explicitly ground, limit, or otherwise determine the construction and function of other principles, and, as a result, profoundly impact concept formation, perception, judgment, and action, et al. The second is to demonstrate that (...) ableism is one such conditioning principle and that it undermines the field of bioethics and the practice of biomedicine from achieving the aim of justice as fairness. After briefly addressing the history and critiques of principlism in bioethics, I lay out and defend my account of conditioning principles. I then argue that ableism is one such principle and demonstrate it at work through an analysis of a storied debate between Eva Kittay, Peter Singer, and Jeff McMahan. In conclusion, I contend that the ethical and philosophical dangers of conditioning principles are too easily exacerbated by ideal theory frameworks, and I do so by demonstrating how they are especially liable to generate epistemic injustice, especially contributory and hermeneutical injustice. (shrink)

This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...) by outlining his moral theory (principlism) and showing why it, as it stands, has to allow for hard paternalism. Secondly, the paper focuses on the notion of rights within principlism. I will employ traditional theories of rights to make sense of rights in principlism. Unfortunately, this attempt fails. In the third part, then, I claim that rights can only be limited with reference to the rights or interests of others. This structure is the very point of rights, it is their bite. I will argue for this claim and show its implications. The most important implication is that not only principlism, but every normative theory that includes rights of individuals, has to abolish hard paternalism. (shrink)

What proper role should considerations of risk, particularly to research subjects, play when it comes to conducting research on human enhancement in the military context? We introduce the currently visible military enhancement techniques (1) and the standard discussion of risk for these (2), in particular what we refer to as the ‘Assumption’, which states that the demands for risk-avoidance are higher for enhancement than for therapy. We challenge the Assumption through the introduction of three categories of enhancements (3): therapeutic, preventive, (...) and pure enhancements. This demands a revision of the Assumption (4), alongside which we propose some further general principles bearing on how to balance risks and benefits in the context of military enhancement research. We identify a particular type of therapeutic enhancements as providing a more responsible path to human trials of the relevant interventions than pure enhancement applications. Finally, we discuss some possible objections to our line of thought (5). While acknowledging their potential insights, we ultimately find them to be unpersuasive, at least provided that our proposal is understood as fully non-coercive towards the candidates for such therapeutic enhancement trials. (shrink)

Modern health data practices come with many practical uncertainties. In this paper, I argue that data subjects’ trust in the institutions and organizations that control their data, and their ability to know their own moral obligations in relation to their data, are undermined by significant uncertainties regarding the what, how, and who of mass data collection and analysis. I conclude by considering how proposals for managing situations of high uncertainty might be applied to this problem. These emphasize increasing organizational flexibility, (...) knowledge, and capacity, and reducing hazard. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

This thesis addresses the tension in pragmatic cluster-randomized trials between their social value and the requirement to respect the autonomy of research participants. Pragmatic trials are designed to evaluate the effectiveness of treatments in real-world settings to inform clinical decision-making and promote cost-efficient care. These trials are often embedded into clinical settings and ideally include all patients who would receive the treatments under investigation as a part of routine care. Trialists increasingly adopt cluster-randomized designs—in which intact groups, such as hospitals (...) or clinics, are allocated randomly to study interventions—to simplify the inclusion of all patients. But including all-comers conflicts with the requirement to obtain written informed consent from research participants. Since informed consent is central to respecting patient autonomy, the question arises: how can the ends of autonomy and pragmatism be served simultaneously? Some philosophers argue that patients have an obligation to participate in clinical research and that this may negate consent requirements. I argue that while there may be grounds for a prima facie obligation for patients to participate in clinical research, no compelling argument has demonstrated that the obligation is enforceable. Others assert that broad application of a waiver of consent will facilitate the conduct of pragmatic cluster-randomized trials. I demonstrate that this proposal sharply conflicts with the historical origins of the waiver. I articulate a novel moral foundation for the use of a waiver of consent and show that when trials evaluate treatments delivered directly to patients, the autonomy interests at stake for participants are too substantial to permit its use. My solution draws a distinction between consent requirements in existing policy and consent as an autonomous authorization. As many pragmatic cluster-randomized trials are conducted in primary care settings with no research staff, I argue that patient autonomy can be promoted and protected using clinical-style consent, in which health providers seek verbal informed consent from patients and document it in the electronic health record. This approach has been associated with high rates of recruitment and, thus, may satisfy both requirements for social value and respect for autonomy. (shrink)

In this article, I argue that the Canadian government’s position against screening for hepatitis C virus and publicly funding HCV treatment is ethically unjustifiable. Cost of medication and likelihood of widening existing health inequality are the government’s argument for not funding HCV treatment and for also not having a screening program. I object to this position and argue in favour of a screening program and public funding of HCV treatment. I argue that these barriers are ethically unjust. Conclusively, being denied (...) screening and early treatment is to be denied the best possible outcome. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was (...) 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

Background Citizen science and models for public participation in health research share normative ideals of participation, inclusion, and public and patient engagement. Academic researchers collaborate in research with members of the public involved in an issue, maximizing all involved assets, competencies, and knowledge. In citizen science new ethical issues arise, such as who decides, who participates, who is excluded, what it means to share power equally, or whose knowledge counts. This article aims to present an ethics framework that offers a (...) lens of understanding and heuristic guidelines to deal with ethical issues in citizen science. -/- Methods We conducted seven case studies between 2015 and 2021 to attune and validate the ethics framework for the context of citizen science. The cases related to studies with older adults, people with a psychiatric vulnerability, people dependent on community care, people who are unemployed or living in poverty or both, and young adults with respiratory disease. -/- Results Ethics in citizen science reaches beyond the ethical issues in traditional biomedical and health research. It entails more than following procedures about informed consent and privacy and submitting a proposal to a Medical Research Ethics Committee. Ethics in citizen science relates to everyday ethical issues during the study, including relational and moral complexities concerning collaboration, sharing power, and democratic decision-making. Dealing with these issues requires ethics work of researchers. This entails seeing ethically salient issues and reflecting on everyday ethical issues. Ethics work consists of seven features: framing work, role work, emotion work, identity work, reason work, relationship work, and performance work. All are relevant for researchers in citizen science. -/- Conclusions Ethical issues in citizen science often relate to power differentials, partnership, and collaboration between academics and non-academics. The ethics framework prepares researchers for the work needed in citizen science to act responsibly and offers a heuristic guide to reflect on ethics. Reflection on ethics is a pathway towards ethical citizen science, especially if researchers collaboratively reflect in partnership with non-academics who are subject to the moral issue. (shrink)

To promote ethical practices, healthcare managers must understand the ethical challenges encountered by key stakeholders. To characterize ethical challenges in Veterans Administration (VA) facilities from the perspectives of managers, clinicians, patients, and ethics consultants. We conducted focus groups with patients (n = 32) and managers (n = 38); semi-structured interviews with managers (n = 31), clinicians (n = 55), and ethics committee chairpersons (n = 21). Data were analyzed using content analysis. Managers reported that the greatest ethical challenge was fairly (...) distributing resources across programs and services, whereas clinicians identified the effect of resource constraints on patient care. Ethics committee chairpersons identified end-of-life care as the greatest ethical challenge, whereas patients identified obtaining fair, respectful, and caring treatment. Perspectives on ethical challenges varied depending on the respondent's role. Understanding these differences can help managers take practical steps to address these challenges. Further, ethics committees seemingly, are not addressing the range of ethical challenges within their institutions. (shrink)