Research question and aimClinical Ethics Committees (CECs) aim to support healthcare professionals (HPs) and healthcare organizations to deal with the ethical issues of clinical practice. In 2020,...

Ethics in the Virtual World examines the gamer's enactment of taboo activities in the context of both traditional and contemporary philosophical approaches to morality. The book argues that it is more productive to consider what individuals are able to cope with psychologically than to determine whether a virtual act or representation is necessarily good or bad. The book raises pertinent questions about one of the most rapidly expanding leisure pursuits in western culture: should virtual enactments warrant (...) moral interest? Should there be a limit to what can be enacted or represented within these games? Or, is it all just a game? (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law (...) and medicine, truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

Much of the excitement and concern with virtual reality (VR) has to do with the impact of virtual experiences on our moral conduct in the “real world”. VR technologies offer vivid simulations that may impact prosocial dispositions and abilities or emotions related to morality. Whereas some experiences could facilitate particular moral behaviors, VR could also inculcate bad moral habits or lead to the surreptitious development of nefarious moral traits. In this chapter, I offer an overview of the ethical (...) debate about using VR to improve morality. I start by clarifying the rationale of using VR for good, drawing on moral enhancement literature, branches of the science of morality, and the specific potentials of this technology. Then, I will briefly focus on three prominent domains of socio-moral improvement: the use of VR for enhancing empathy, reducing implicit biases, and improving pro-environmental behavior. After that, I shall consider three ethical objections to the enthusiasm for using VR in order to improve human morality. Finally, I will recapitulate the main points of the chapter and provide a few concluding thoughts on future avenues of discussion on how VR can make us act (morally) better. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

Investigates the intent, method and structural unity of Thomas Aquinas's Summa Contra Gentiles. The author of this study argues that the intended audience is Christian and that the subject is Christian wisdom.

PurposeThe purpose of this viewpoint paper is to provide an overview of three papers included in a Special Issue of the Journal of Information Communication Ethics and Society, entitled Ethics in the Virtual World.Design/methodology/approachThe papers were chosen because they reflect three key themes in computing, ethics and society. These are: the explosion in the number of opportunities for accessing sensitive data in the health sector; the risks inherent in designing information systems through technical procedures that fail (...) to address the human character of the environments they are intended to serve; and the need to teach computing ethics to students of computing. All three articles draw on philosophical approaches to ethics and well as technical aspects of system use, system design and pedagogy, respectively.FindingsThe papers demonstrate the interdisciplinary nature of computing ethics and the contested political issues at stake in using and designing information systems.Originality/valueThis editorial viewpoint paper presents the hypothesis that the ethical issues once embodied in socio‐technical systems theory have a particular salience for the contemporary ethical debates concerning computing ethics. (shrink)

This essay addresses ethical aspects of the design and use of virtual reality (VR) systems, focusing on the behavioral options made available in such systems and the manner in which reality is represented or simulated in them. An assessment is made of the morality of immoral behavior in virtual reality, and of the virtual modeling of such behavior. Thereafter, the ethical aspects of misrepresentation and biased representation in VR applications are discussed.

This chapter addresses the growing problem of unwanted sexual interactions in virtual environments. It reviews the available evidence regarding the prevalence and severity of this problem. It then argues that due to the potential harms of such interactions, as well as their nonconsensual nature, there is a good prima facie argument for viewing them as serious moral wrongs. Does this prima facie argument hold up to scrutiny? After considering three major objections – the ‘it’s not real’ objection; the ‘it’s (...) just a game’ objection; and the ‘unrestricted consent’ objection – this chapter argues that it does. The chapter closes by reviewing some of the policy options available to us in addressing the problem of virtual sexual assault. (shrink)

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses’ and nursing students’ moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses’ and nursing students’ moral competence, (...) a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses’ and nursing students’ moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare. (shrink)

How do we assign values to virtual items, which include virtual objects, properties, events, subjects, worlds, environments, and experiences? In this article, I offer a framework for answering this question. After considering different value theses in the literature, I argue that whether we think these theses mutually exclusive or not turns on our view about the number of value-salient kinds virtual items belong to. Virtual monism is the view that virtual Xs belong to only one (...) value-salient kind in relation to X. Virtual pluralism is the view that they belong to more than one value-salient kind. I argue for two claims. First, virtual monism is mistaken. Minimally some virtual Xs are Xs, while others are not. Second, dualistic virtual pluralism is also mistaken because it is too coarse grained. Instead, I argue for fourfold pluralism: virtual items either represent an original's properties or reproduce essential properties and do so to lesser or greater extents. This gives us four value-salient kinds of virtual X: virtual reproductions, simulations, representations, and simulacra of X. I apply this view to various debates in the literature and conclude with a discussion of less basic hybrid kinds. (shrink)

The prospect of using genome technologies to modify the human germline has raised profound moral disagreement but also emphasizes the need for wide-ranging discussion and a well-informed policy response. The Hinxton Group brought together scientists, ethicists, policymakers, and journal editors for an international, interdisciplinary meeting on this subject. This consensus statement formulated by the group calls for support of genome editing research and the development of a scientific roadmap for safety and efficacy; recognizes the ethical challenges involved in clinical reproductive (...) applications of genome editing but, importantly, rejects the idea that human reproductive germline modification is necessarily morally unacceptable; and highlights the importance of meaningful engagement in discussions of genome editing and the development of regulation and oversight mechanisms to govern future uses of such technologies. (shrink)

This paper attempts to give an insight into emerging ethical issues due to the increased usage of the Internet in our lives. We discuss three main theoretical approaches relating to the ethics involved in the information technology era: first, the use of IT as a tool; second, the use of social constructivist methods; and third, the approach of phenomenologists. Certain aspects of ethics and IT have been discussed based on a phenomenological approach and moral development. Further, ethical issues (...) related to social networking sites are discussed. A plausible way to make the virtual world ethically responsive is collective responsibility which proposes that society has the power to influence but not control behavior in the virtual world. (shrink)

In the context of the question of the extent to which science studies is able to mount an adequate critique of contemporary developments in science and technology, and in view of the proliferating interest in ethics across the social sciences, this article has two aims. Firstly to address some of the implications for ethics of Bruno Latour's, and to a lesser extent Alfred North Whitehead’s, conceptions of reality, both of which have a bearing on the long-standing dichotomy between (...) facts and values. Drawing on Whitehead's work, it also, secondly, seeks to make a positive argument for ethics and to ask again, in the light of this discussion, where the ethical dimensions of Latour's work might be located. Towards the end of the article, I suggest that Latour's concept of exteriority obliges him to pursue a politics of reality which is the special providence of ‘moralists’, rather than a politics of virtual reality in which all entities, human and non-human, are engaged. (shrink)

This article explores four major areas of moral concern regarding virtual reality technologies. First, VR poses potential mental health risks, including Depersonalization/Derealization Disorder. Second, VR technology raises serious concerns related to personal neglect of users’ own actual bodies and real physical environments. Third, VR technologies may be used to record personal data which could be deployed in ways that threaten personal privacy and present a danger related to manipulation of users’ beliefs, emotions, and behaviors. Finally, there are other moral (...) and social risks associated with the way VR blurs the distinction between the real and illusory. These concerns regarding VR naturally raise questions about public policy. The article makes several recommendations for legal regulations of VR that together address each of the above concerns. It is argued that these regulations would not seriously threaten personal liberty but rather would protect and enhance the autonomy of VR consumers. (shrink)

Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a (...) categorization of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs. (shrink)

Review of The Ethics of Virtual and Augmented Reality: Building Worlds, written by Erick Jose Ramirez.

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Zemyarska MS. Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it? J Med Ethics 2019;45:346–50. doi: 10.1136/medethics-2018-104983. The Acknowledgements section of ….

This chapter provides a general overview and introduction to the law and ethics of virtual sexual assault. It offers a definition of the phenomenon and argues that there are six interesting types. It then asks and answers three questions: (i) should we criminalise virtual sexual assault? (ii) can you be held responsible for virtual sexual assault? and (iii) are there issues with 'consent' to virtual sexual activity that might make it difficult to prosecute or punish (...) virtual sexual assault? (shrink)

This essay discusses the moral costs and benefits of sexual technology. It starts with first-wave sexual technology, such as dating apps, messaging apps, and social networks, and then discusses second-wave sexual technology, which offers users more immersive experiences, such as virtual reality and sex robots. The paper argues that, overall, such technologies provide more benefits than they incur costs. Finally, the paper discusses the rise of a new identity—digisexuality, explaining that digisexuals are people who consider sexual technology an essential (...) part of who they are, and who might forego relationships with other people. The paper argues that the development of this new identity is a good thing, and that reasons against it are not convincing. (shrink)

Ost S. Drs Bramhall and Bawa-Garba and the rightful domain of the criminal ….

Ethics of Everyday Medicine: Explorations of Justice examines and analyses the relatively unexplored domain of ethics involved in the everyday practice of medicine. From the author's clinical experience, virtually every decision made in the day-to-day practice of medicine is fundamentally an ethical question, as virtually every decision hinge on some value judgment that goes beyond the medical facts of the matter. The first part of the book is devoted to medical decision cases in several areas of medicine. These (...) cases highlight elements of the current healthcare ecosystem, involving players other than the physician and patient. Insurers (private, commercial, and governmental), administrators, and regulators' perspectives are surfaced in point of care case analysis. Part two contributes to the development of actionable tools to develop better ethical systems for the everyday practice of medicine by providing a critical analysis of Reflective Equilibrium and ethical induction from the perspective of logic and statistics. The chapter on Justice discusses the neurophysiological representations of just and unjust behaviours. The chapter on Ethical Theories follows, describing the epistemic conundrum, principlism, reproducibility, abstraction, chaos and complexity. The following chapter approaches ethical decisions from the logic and statistic perspectives. The following chapter, The Patient as Parenthetical, the author discusses patient-centric ethics, and the rise of business- and government-cetric ethics. The final chapter, A Framework to Frame the Questions for Explore Further, proposes a working framework to deal with current ethical issues. (shrink)

International institutions such as the International Labour Organization (ILO) have been examined from various industrial relations viewpoints. This article seeks to discuss the ILO from the standpoint of moral philosophy. Traditionally, philosophy has not been concerned with industrial relations (IR) and IR writers have not engaged with ethics either. Nonetheless, all IR agents and institutions, international or otherwise, are moral agents. Being part of the United Nations (UN), the ILO follows the Universal Declaration of Human Rights (1948). In philosophical (...) terms, the ILO carries connotations of the German moral philosopher Kant's (1724-1084) concept of universalism. Ethical universalism is also the core of American psychologist and philosopher Laurence Kohlberg's developmental model that allows an assessment of moral values and ethical behaviours. To ascertain the ILO's morality, an empirical study (n=121) was conducted at a regional University. The study indicated that most respondents (68%) saw the ILO as a reflection of the morality of " defending everyone's right to justice and welfare, universally applied while applying well-thought principles and being ready to share and debate these openly and non-defensively with others". In line with the ILO's self-understanding, survey respondents also viewed it as a thoroughly moral agent committed to the advancement of humanity as a whole. Respondents also thought that the ILO goes beyond the confinements of the standard industrial relations framework, actively engaging with the universality of all people. The overall conclusion is that the way the ILO is perceived to act along the scale of Kohlberg's text matches the ILO's actual existence and work. For the first time, the ILO's moral status has been tested using Kohlberg's scale of morality. This provides a significant contribution to our understanding of the morality of a very important universal institution that has virtually all countries as members. (shrink)

Once upon a time, they managed to bring Neverland into the bedrooms; they were seen as the heroes of a new era. However, as heroes always tend to walk a fine line between good and evil, it does not come as a surprise that a decade later the perception has dramatically changed; the fairy tale turned into a nightmare. Are Internet Service Providers (ISPs) no more than data-guzzling monsters that need to be tamed? In November, the European Commission published a (...) “Comprehensive approach on personal data protection in the European Union” which seems to nod approval. The approach seeks to strengthen the individual’s rights regarding the use of data by ISPs. The Commission notes that children deserve specific protection in this context due to the fact that their awareness of risks and consequences is usually underdeveloped. Both a general principle of transparent processing and specific obligations for data controllers regarding the type of information to be provided and the modalities for providing it had to be taken into account. Not only legal but also self-regulatory initiatives should contribute to a better enforcement of data protection rules. This approach is both applauded and heavily criticized by the European Data Protection Supervisor. In particular, he argues that children’s particular interests have not been sufficiently addressed presenting a long list of suggestions for improvement including specific provisions against behavioral advertising, the exclusion of some data categories, an age threshold or special requirements on the issue of informed consent and a reinforcement of data controllers’ accountability. Is there really a need for a new magic formula? This paper reviews the current options for addressing the challenges of the use of personal data of minors by ISPs. (shrink)

Among the many applications of artificial intelligence (AI), virtual assistants are one of the tools most likely to grow in the future. The development of these systems may play an increasingly important role in many facets of our lives. Therefore, given their potential importance and present and future weight, it is worthwhile to analyze what kind of challenges they entail. In this chapter, we will provide an overview of the ethical aspects of artificial virtual assistants. First, we provide (...) a conceptual clarification of the term ‘virtual assistant’, including different types of interfaces and recommender systems. Second, we address three ethical issues related to the deployment of these systems: their effects on human agency and autonomy and the subsequent cognitive dependence they would generate; the human obsolescence that may cause a generalized extension of the dependence problem; and the invasions of privacy that virtual assistants may cause. Finally, we outline the debates about the use of virtual assistants to improve human moral decisions and some areas in which these systems can be applied. (shrink)

In order to promote social distancing during the recent COVID-19 pandemic, physicians and healthcare systems have made efforts to replace in-person with virtual clinic visits when feasible. While these efforts have been well received and seem compatible with sound clinical practice, they do not perfectly replicate the experience of a face-to-face exchange between doctor and patient. This essay attempts to describe features of the virtual visit that distinguish it from its face-to-face analog and considers the phenomenological work of (...) Emmanuel Levinas in arguing that these differences may limit the force of the ethical summons a provider would otherwise experience before the face of a patient. The diminishment of this signal therapeutic experience may engender vocational as well as clinical consequences, which should be weighed against the practical benefits of the virtual visit as we consider whether our enthusiasm for this mode of practice should continue. (shrink)

Douglas T. Going above and beneath the call ….

Savulescu J. Is current practice around late termination of pregnancy eugenic and discriminatory? Maternal interests and abortion. J Med Ethics 2001;27:165–71. Lachlan de Crespigny contributed in a major way to the conceptualisation, design, administration of surveys, ….

The promise of virtual reality is that it may eventually lead us to a "third state of consciousness" transcending the objective reality of our embodied beings and opening up to us a world of expanded realization. However, the recurring themes of our hero myths, both religious and secular, remind us of the importance of remaining grounded in the real world of embodied people and phenomenal perception. Advances in neuroscience even suggest that unconscious processing of perceptual stimuli may guide our (...) behaviors. Thus, the journey from the phenomenal to the noumenal is a round-trip ticket. We take with us the strength of our moral convictions to serve us on our journey and bring back the spiritual expansion that always comes of travel. (shrink)

Numerous articles in the popular press together with an examination of websites associated with the medical, legal, engineering, financial, and other professions leave no doubt that the role of professions has been impacted by the Internet. While offering the promise of the democratization of expertise – expertise made available to the public at convenient times and locations and at an affordable cost – the Internet is also driving a reexamination of the concept of professional identity and related claims of expertise (...) and standards of integrity. This paper begins with a presentation of case studies illustrating the ease by which impostors infiltrate the ranks of professionals. Reports of individuals masquerading as professionals via the Internet often reveal that these imposters cause harm to the unwary victims who rely on assertions of professional expertise. Such reports motivated the authors to examine the origins and evolution of the traditional roles of professions and professionals in today’s society, as well as question how, or whether, the standards for professional practice have been adapted to the challenges posed by technology, i.e., do statements of professional ethics provide a ‘guiding light’ for practitioners and their clients in the cyber age? The authors challenge the professions to consider the notion that technology forces a confrontation between the guild-like aspects of a profession that have served, on the one hand, to protect a profession from encroachment and, on the other hand, have purportedly protected the public. (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, (...) the American Society for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

The trolley problem is one of the liveliest research frameworks in experimental ethics. In the last decade, social neuroscience and experimental moral psychology have gone beyond the studies with mere text-based hypothetical moral dilemmas. In this article, I present the rationale behind testing the actual behaviour in more realistic scenarios through Virtual Reality and summarize the body of evidence raised by the experiments with virtual trolley scenarios. Then, I approach the argument of Ramirez and LaBarge (2020), who (...) claim that the virtual simulation of the Footbridge version of the trolley dilemma is an unethical research practice, and I raise some objections to it. Finally, I provide some reflections about the means and ends of trolley-like scenarios and other sacrificial dilemmas in experimental ethics. (shrink)

Human beings have been spending a lot of time in front of a screen for many years. Through the computer and other electronic devices, we interact with our friends and colleagues, we maintain contact with our relatives, we carry out part of our work, we study and we carry out leisure activities. Despite the many advantages that all this has brought to our lives, ethical and social problems have also arisen. Although these electronic devices have become increasingly immersive and interactive, (...) virtual reality seems to present a qualitative leap. In this chapter we will analyse how big this jump is, we will review the ethical problems that may appear, we will ask ourselves if they are really new and we will study how and to what extent we can face them. (shrink)