The global development of human embryonic stem cell science and its therapeutic applications are dependent on the nature of its engagement at national and international levels with key cultural values and beliefs concerning the moral status of the early human embryo. This article argues that the political need to reconcile the promise of new health technologies with the cultural costs of scientific advance, dependent in this case on the use of the human embryo, has been met by the evolution of (...) bioethics as a political community, transnational network, and bureaucratic device. Bioethics has become the political means for the creation of a global moral economy where the trading and exchange of values is normalized and legitimated. As a result of such trading, value compromises are produced capable of legitimizing the regulatory policies necessary for maintaining public trust in the new science. (shrink)

The governments of China, India, and the United Kingdom are unanimous in their belief that bioinformatics should supply the link between basic life sciences research and its translation into health benefits for the population and the economy. Yet at the same time, as ambitious states vying for position in the future global bioeconomy they differ considerably in the strategies adopted in pursuit of this goal. At the heart of these differences lies the interaction between epistemic change within the scientific community (...) itself and the apparatus of the state. Drawing on desk-based research and thirty-two interviews with scientists and policy makers in the three countries, this article analyzes the politics that shape this interaction. From this analysis emerges an understanding of the variable capacities of different kinds of states and political systems to work with science in harnessing the potential of new epistemic territories in global life sciences innovation. (shrink)

Empathy is commonly regarded as an essential attribute for doctors and there is a conviction that empathy must be taught to medical students. Yet it is not clear exactly what empathy is, from a philosophical or sociological point of view, or whether it can be taught. The meaning, role and relevance of empathy in medical education have tended to be unquestioningly assumed; there is a need to examine and contextualise these assumptions. This paper opens up that debate, arguing that ‘empathy’, (...) as it is commonly understood, is neither necessary nor sufficient to guarantee good medical or ethical practice. (shrink)

In recent years, there has been tension between farmers and the Dutch government regarding sustainability policy (in the efforts to reduce the harm caused by manure surplus) and how implementing this policy affects farmers (in the form of justice concerns). We interviewed Dutch farmers to uncover how they view manure policy. We identified four types of injustices: procedural, contributive, distributive, and intergenerational. We propose that a multi-tiered approach is required to overcome these kinds of ‘wicked problems’, avoid paralysis from lack (...) of action, and overcome the flaws by overestimating the effectiveness of top-down policy. (shrink)

We can currently see the formation of new nationalist and racist parties or tendencies within established parties to lean towards right-wing politics within many European countries; from the Alternative für Deutschland in Germany, the Partij voor de Vrijheid (PVV) in the Netherlands, Lega Nord or Lega in Italia, Vox in Spain, the Freiheitliche Partei Österreichs, Front National in France, the Sverigedemokraterna in Sweden, Fidesz in Hungary, and Golden Dawn in Greece, to name only a few. At the same time, there (...) has been a surge in racist, fascist, and antisemitic attacks within Europe. Since 1991, Neo-Nazi gangs have attacked migrants and members of antifascist groups, burned down housing facilities for asylum seekers (including facilities for Ukrainian refugees in 2022), disrupted social initiatives, and spread fear (BfV, 2022; cf. Speit, 2021). However, most of these activities were described as the criminal action of socially marginalized individuals, downplaying the organized structure behind these far-right activities and, thus, paving the way for more attacks. Part of this paper is to show how the epistemic tools developed by the epistemology of ignorance literature can help to understand (a) why the organized structures of far-right movements are unintelligible within the dominant frame of intelligibility in Europe and (b) how the silence about far-right movements shifts the boundaries for what can be said or done, thus, having deeply problematic repercussions for who can feel safe in Europe. This paper has a modest aim: By bringing into focus contexts of social injustice that have not received much attention in the current literature and by understanding them with the help of existing research from the debate on problematic epistemic practices and philosophy of language, the paper aims to highlight some problematic practices. (shrink)

Miranda Fricker’s account of hermeneutical injustice and remedies for this injustice are widely debated. This article adds to the existing debate by arguing that theories of recog- nition can fruitfully contribute to Fricker’s account of hermeneutical injustice and can provide a framework for structural remedy. By pairing Fricker’s theory of hermeneutical injustice with theories of recognition, I bring forward a modest claim and a more radical claim. The first concerns a shift in our vocabulary; recognition theory can give a name (...) to the seriousness of the long-term effects of hermeneutical injustice. The second claim is more radical: thinking of hermeneutical injustice as preventing what I call “self-recogni- tion” provides a structural remedy to the phenomenon of hermeneutical injustice. Because hermeneutical injustice is first and foremost a structural injustice, I contend that every virtue theory of hermeneutical justice should be complemented by structural remedies in terms of recognition. Finally, what I argue sheds light on the seriousness of cases of exclusion of and discrimination against women in academia and helps to draw our attention to new ways to combat such problems. (shrink)

One night in 2017, ‘Grace’ went on a date with actor Aziz Ansari. She later described the date as “the worst experience with a man I’ve ever had,” and accused him of sexual assault. In a statement, he responded by saying that the sexual activity was completely consensual. While Grace felt pressured, uncomfortable, and violated, he was convinced that the sexual acts were consensual. How is it possible that a man who describes himself as an ally to the feminist cause (...) engages in such unacceptable actions and seems incapable of understanding them for what they are, that is, acts of sexual violence? And how is it possible that a woman who feels uncomfortable is still incapable of resisting further advances? In this paper, I argue that such cases have to be understood within the framework of a ‘sexist ideology,’ that is, a social structure that constrains our actions and epistemic tools of interpretation. What hinders Ansari from understanding the act as sexual violence and what hinders Grace from resisting Ansari is the complex set of interconnected sexist practices which determine who owes what to whom based on different gendered roles. (shrink)

We appreciate that the theme “ethics of ethics conferences” that we introduced in 2023 (Van der Graaf et al. 2023) was echoed by the previous and current presidents of the International Association...

In this paper, I use the example of rape myths to argue that certain real-life phenomena compel us to adjust our philosophical methods such that we explicitly endorse feminist commitments and strive for democratic practices in our philosophical thinking. The concept of rape has evolved significantly over the past few decades both in law and common usage. But despite decades of work to dispel rape myths, they persist and interfere with the proper application of the concept. This paper aims to (...) account for this problem and propose a solution. First, I consider three examples that show how rape myths and other problematic schemas can distort our dominant working understanding of phenomena. All three examples are cases of grave injustices to the victims. I suggest that a revisionary project of conceptual amelioration can help counter injustices like these. In a second step, I argue that problematic schemas (such as rape myths) not only distort our working understanding or the accurate application of an existing concept, but can furthermore interfere with our philosophical analyses—even in cases of amelioration. As a solution, taking clues from theories of epistemologies of ignorance, I propose a more democratic and progressive method for engaging in conceptual amelioration. (shrink)

This article is about nursing theories, the development of nursing knowledge and the underlying, hidden epistemology. The current technical–economical rationality in society and health care calls for a specific kind of knowledge based on a traditional Western, Socratic view of science. This has an immense influence on the development of nursing knowledge. The purpose of the article was therefore to discuss the hidden epistemology of nursing knowledge and theories seen in a broad historical context and point to an alternative epistemology (...) for a future context. It is a question about which nursing theories and what nursing knowledge should be developed in order to benefit patients and relatives of the future. We suggest that future knowledge development in nursing be developed in an interchange between theory and practice and guided by philosophy like a kind of pendulum where all three elements are treated as equals. We suggest a framework for the development of nursing knowledge based on a caring‐ethical practice, a theory on life phenomena in suffering and relationship‐based nursing, and thereby, we may be able to help patients to be cured, to recover, to be alleviated or comforted when suffering. (shrink)

During the COVID-19 pandemic governments across the globe have provided unparalleled support to private sector firms. As a result, new oversight mechanisms are urgently needed, to enable society to assess and, if necessary, redress, moves by firms which have taken government aid. Many jurisdictions have seen the introduction of ‘piecemeal’ conditionality on different pots of aid. This paper argues that a better response would be to adopt a more unified approach. In particular, the paper explores the social licence framework as (...) a potential way to ‘build back better’. It is argued that the nature of the implicit social contract between society and the private sector provides the normative force underpinning demands for a social purpose for business, and that this purpose in turn can be used to specify the conditions firms must meet to legitimise their operations. The paper then considers three core elements involved in any introduction of a social licence framework, and surveys the potential benefits and challenges that might emerge in moving towards a social licence framework. (shrink)

Feminismus – das ist nicht nur für Männer, sondern auch für einige Frauen immer noch ein bedrohliches Wort, selbst oder gerade in Zeiten von #MeToo. Liegt das daran, dass viele gar nicht wissen, was Feminismus ist und worauf er hinarbeitet? Gibt es den einen Feminismus? Was hat Feminismus eigentlich mit Sexismus zu tun? Und was mit unseren Beziehungen? Die Philosophin Hilkje Hänel klärt über diese Fragen auf und plädiert für einen Feminismus, von dem alle etwas haben. Offener Frauenhass ist in (...) unserer Gesellschaft mittlerweile weitgehend geächtet. Aber auch nach über fünfzehn Jahren mit einer Frau an der Regierungsspitze sind wir noch längst nicht in der Gleichberechtigung angekommen. Im Gegenteil: Weiterhin strukturiert Sexismus geschlechtsspezifische Alltagserfahrungen, bis hinein in unsere Intimbeziehungen, wo die Grenzen zwischen Lust und sexueller Gewalt schnell verschwimmen. Die Philosophin und Schriftstellerin Hilkje Hänel deckt die Mechanismen sexueller Objektifizierung und männlichen Anspruchsdenkens auf. Sie zeigt, wie Frauen oft in die sexistischen Alltagsstrukturen verstrickt sind, an denen auch viele Männer leiden. Ihr zugängliches Buch ist das Plädoyer für einen Feminismus, von dem alle etwas haben. (shrink)

Although there is a growing acknowledgement of the potential of a more nuanced healthcare paradigm and practice, the discourses of health promotion—and with that nursing and other healthcare professionals’ practice—still tend to focus on the medical diagnosis, disease and the rationale of biomedicine. There is a need for shifting to a human practice that draws on a broader perspective related to illness. This requires a transformation of practices which can be constructed within a narrative understanding. A narrative approach appreciates the (...) importance of emotion and intersubjective relation in the telling and listening that occur in the clinical encounter. The essence of nursing lies in the creative imagination, the sensitive spirit and the intelligent understanding of the individuals’ possibilities of becoming empowered in his or her own life. This entails that the focus of the use of patients’ narratives is, ultimately, not the story itself, but the nurses’ and other healthcare professionals’ ability to support the patients in finding useful meaning in their stories. Herein, it is of particular importance to let the patients narrate about what is sparkling moments or events in the lived life. Stories with such focus can open up for patients’ hopes and dreams, which gives inspiration for finding meaningful ways to cope in life empowering personal recovery. It is, therefore, crucial to transform clinical settings into places that acknowledge the need for imagination and creativity, aiming at creating the opportunity for sensibility and vision essential to encouraging a narrative approach and thereby the ability to reflect upon and promote a healing process. (shrink)

Being a member of a minority group makes it harder to succeed in academic philosophy. Research suggests that students from underrepresented groups have a hard time in academic philosophy and often drop out instead of pursuing a career in philosophy, despite having the potential to become excellent philosophers. In this paper, I will argue that there is a specific way of thinking about traditional conceptual analysis within analytic philosophy that marginalizes underrepresented groups. This has to do with what kinds of (...) analyses we philosophers think are worthy of conducting and with who we think are worthy of pursuing such analyses. I will then show why this is particularly worrisome for the profession of philosophy as an institution geared towards the love of knowledge and argue that it should be in our interest as philosophers to find ways to prevent this marginalization of underrepresented groups. Finally, I will provide an example of how to do philosophy differently that does not exclude members of underrepresented groups and suggest ways in which the teaching of analytic philosophy can directly counter the discriminatory practices of academic philosophy. (shrink)

La province jésuite du Brésil est parcourue au début du XVIIe siècle par une série de tensions qui relèvent autant de son rapport à la société coloniale contemporaine que de ses relations avec le centre romain. À travers l'étude d'un document programmatique exceptionnel et original, dont l'auteur et la date de rédaction demeurent inconnus, les Advertências para a provincia do Brasil, on analyse l'inscription de l'entreprise missionnaire dans sa double dimension économicopolitique, avec l'engagement dans la production sucrière, et spirituelle, assurer (...) le salut du missionnaire et la conversion des Indiens. Ce projet, qui fait de l'a ldeia la structure déterminante de la présence et de l'action jésuites en terre de Brésil, révèle une vision globale de la mission, à la fois géopolitique, économique et religieuse que l'historiographie traditionnelle a occultée au profit d'une approche exclusivement spirituelle. (shrink)

Wem wird geglaubt und wem nicht? Wessen Wissen wird weitergegeben und wessen nicht? Wer hat eine Stimme und wer nicht? Theorien der epistemischen Ungerechtigkeit befassen sich mit dem breiten Feld der ungerechten oder unfairen Behandlung, die mit Fragen des Wissens, Verstehens und Kommunizierens zusammenhängen, wie z.B. die Möglichkeit, vom Wissen oder von kommunikativen Praktiken ausgeschlossen zu werden oder zum Schweigen gebracht zu werden, aber auch Kontexte, in denen die Bedeutungen mancher systematisch verzerrt oder falsch gehört und falsch dargestellt werden, in (...) denen manchen misstraut wird oder es an epistemischer Handlungsfähigkeit mangelt. In diesem Buch wird eine Übersicht über die breite Debatte epistemischer Ungerechtigkeit, epistemischer Unterdrückung und epistemischer Gewalt gegeben, in dem unterschiedliche Theorien, die sich auf der Schnittstelle von Gerechtigkeitstheorie und epistemischen Fragen befinden, systematisch und kritisch diskutiert sowie theoretische Vorgänger dieser Theorien beleuchtet werden. (shrink)

Sex. Die meisten von uns haben ihn. Mal schlecht, mal gut, manchmal phänomenal. Die wenigsten denken lange drüber nach. Oder reden offen drüber. Dabei ist gar nicht so klar, was Sex eigentlich gut macht. Und wann ist Sex schlecht? Oder nicht nur schlecht, sondern sogar moralisch problematisch? Hilkje Hänel zeigt, dass es gar nicht so einfach ist, zwischen (moralisch) problematischem Sex und gutem Sex klar zu unterscheiden und dass es dabei häufig vor allem auf den Kontext und unsere Kommunikation ankommt. (...) Auf der Basis aktueller Wissenschaft und medialer Bewegungen wie #MeToo verteidigt Hänel ihre Ansichten gegen die wichtigsten Einwände und argumentiert für mehr Respekt im Bett. (shrink)

L'Aufklärung allemande s'est réapproprié polémiquement le concept rousseauiste de perfectibilité, souvent avec d'importants déplacements. Théologie, philosophie, histoire naturelle, pédagogie, anthropologie concourent à un débat critique par lequel cette anthologie montre la pluralité des Lumières. --.

Charlotte Wolff was born in Riesenburg, West Prussia into a middle-class Jewish family. She studied philosophy and then medicine at several German universities, completing her doctorate in Berlin in 1926. Working in various institutions over the next few years, she was also interested in psychotherapy and had a small private medical and psychotherapeutic practice. In 1933 she was forced to leave Germany because of the Nazi regime, and settled for a few years in Paris. As a German refugee she (...) was unable to practice medicine, so she began her research into the correlation between hand traits and personality. In 1936 she went to London to continue her research work and lived there until her death. An active lesbian from an early age, her later research turned to sexology and her writing on lesbianism and bisexuality were influential early works in the field. This is a great opportunity to rediscover her early work, including her first autobiography. (shrink)

Whether adolescents should be allowed to make their own medical decisions has been a topic of discussion in bioethics for at least two decades now. Are adolescents sufficiently capacitated to make their own medical decisions? Is the mature-minor doctrine, an uncommon legal exception to the rule of parental decision-making authority, something we should expand or eliminate? Bioethicists have dealt with the curious liminality of adolescents—their being neither children nor adults—in a variety of ways. However, recently there has been a trend (...) to rely heavily, and often exclusively, on emerging neuroscientific and psychological data to answer these questions. Using data from magnetic resonance imaging and functional MRI studies on the adolescent brain, authors have argued both that the adolescent brain isn't sufficiently mature to broadly confer capacity on this population and that the adolescent brain is sufficiently mature to assume adolescent capacity. Scholars then accept these data as sufficient for concluding that adolescents should or should not have decision-making authority. Two critical mistakes are being made here. The first is the expectation that neuroscience or psychology is or will be able to answer all our questions about capacity. The second, and more concerning, mistake is the conflation of decision-making capacity with decision-making authority. (shrink)

Charlotte Sabourin | : Cet article se penche sur la contribution de Gabrielle Suchon à la célèbre « querelle des femmes ». J’y démontre que, quoique Suchon défende l’égalité des deux sexes en ce qui a trait à leurs capacités à la liberté, à la science et à l’autorité, elle vise ultimement à montrer que les femmes peuvent se rendre supérieures aux hommes. Je montrerai que son projet d’élévation des femmes ne peut être accompli qu’en soustrayant les femmes à (...) l’influence des hommes, les relations entre les deux sexes étant foncièrement préjudiciables aux premières. | : This paper examines Gabrielle Suchon’s contribution to the famous “querelle des femmes”. I argue that although Suchon is a proponent of the equality of the sexes with respect to their capacities for freedom, science and authority, she ultimately suggests that there is a way in which women can make themselves superior to men. I will show that her project for the elevation of women can be accomplished only by isolating women from men, given that the relationships between the sexes will always be detrimental to women. (shrink)

This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several (...) important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to “re-contextualize” patients, in order that they might be better equipped to make decisions that harmonize with their real lives. (shrink)

Oakeshott’s thesis is that political knowledge is essentially praetical: it is not given to propositional formulation and cannot be deliberately exercised, but rather is expressed in conduct and transmitted by example and practice. I argue that this is true primarily of physical skills which depend upon unconscious, automatic physiological processes. Political practice, by contrast, is largely a matter of rule-governed activity. It is an empirical fact that we do have introspcetive access to many of the rules whieh govern our political (...) conduct, and there is good evidence for the claim that we can deliberately and reflectively set ourselves to apply them. (shrink)

We are at the crux of a return of animals to the battlefield. Framed as an improvement over current limitations of biomimetic devices, couplings of microelectrical mechanical systems with insect bodies are currently being designed and created in laboratories, with funding from military agencies. Moving beyond the external attachment of computerized ‘backpacks’, MEMS are being implanted into larval stages to allow for living tissue to envelop otherwise fragile circuitry and electronics: the creation of bioelectronic interfaces. The weaponization of animals, with (...) insect cyborgs as a first step—a foundation for the remaking of more complex species—is an anthropocentric solution to an anthropocentric problem. Speciesism is the normative context in which technoscientific discourse and such approaches to nanoscience and nanotechnology are situated. This is a network of actors and relationships within and across science and society. Animals are framed as mechanical devices that can be dis/enhanced for human ends. This paper engages with the remaking of species, the blurring of boundaries between mechanism and organism, and the implications of the effective disappearance of the animal as key sociotechnological challenges. (shrink)

InThe Second Sex, Simone de Beauvoir argues that women are often complicit in reinforcing their own unfreedom. But why women become complicit remains an open question. The aim of this article is to offer a systematic analysis of complicity by focusing on the Heideggerian strands of Beauvoir's account. I begin by evaluating Susan James's interpretation of complicity qua republican freedom, which emphasizes the dependent situation of women as the primary cause of their complicity. I argue that James's analysis is compelling (...) as far as it goes, but that it implies complicity is the inevitable outcome of women's current existence and fails to adequately account for Beauvoir's claim that women actively embrace their own unfreedom. I then draw out the Heideggerian strands of Beauvoir's analysis, demonstrating how this enables us to systematize Beauvoir's account of women's oppressive situation with her claims regarding the active role women can play in reinforcing their own unfreedom. I argue that this approach preserves the strengths of the republican interpretation, but provides a better account of cases where complicity may not be inevitable and yet some women still act to reinforce rather than resist their own unfreedom. (shrink)

ABSTRACT Testimony from victims of gendered violence is often wrongly disbelieved. This paper explores a way to address this problem by developing a phenomenological approach to testimony. Guided by the concept of ‘disclosedness’, a tripartite analysis of testimony as an affective, embodied, communicative act is developed. Affect indicates how scepticism may arise through the social moods that often attune agents to victims’ testimony. The embodiment of meaning suggests testimony should not be approached as an assertion, but as a process of (...) ‘articulating an understanding’. This account is deepened in the discussion of testimony as a communicative act. It is argued that testimony must be considered as a relational whole, and thus our aim in receiving victims’ testimony should be to honour the relational conditions under which the truth of testimony can be heard. Approaching testimony as the collaborative process of enabling an understanding to be articulated can enhance our conception of gendered violence, whilst also better serving the victims of gendered violence by helping to overcome the lack of trust and excessive scepticism with which victims’ testimony is often met. (shrink)

This paper argues that close personal relationships play an important role in our judgments about what is fair. I start with an explanation of leading theories of fairness, highlighting the potential for further work on the grounds of fairness. Next, I offer an account of close personal relationships as having the ability to generate legitimate and reasonable expectations of one or other party to a judgment about fairness, or both. I show how and when close personal relationships can ground fairness.

In a criminal trial, a judge or jury needs to reason about what happened based on the available evidence, often including statistical evidence. While a probabilistic approach is suitable for analysing the statistical evidence, a judge or jury may be more inclined to use a narrative or argumentative approach when considering the case as a whole. In this paper we propose a combination of two approaches, combining Bayesian networks with scenarios. Whereas a Bayesian network is a popular tool for analysing (...) parts of a case, constructing and understanding a network for an entire case is not straightforward. We propose an explanation method for understanding a Bayesian network in terms of scenarios. This method builds on a previously proposed construction method, which we slightly adapt with the use of scenario schemes for the purpose of explaining. The resulting structure is explained in terms of scenarios, scenario quality and evidential support. A probabilistic interpretation of scenario quality is provided using the concept of scenario schemes. Finally, the method is evaluated by means of a case study. (shrink)

ABSTRACT When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account (...) can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm. (shrink)

This article describes the process engaged by 17 expert scholars in the development of a set of six consensus recommendations about the normative foundations of pediatric decision-making. The process began with a robust pre-reading assignment, followed by three days of in-person symposium discussions that resulted in a publication in _Pediatrics_ entitled “Pediatric Decision-Making: Consensus Recommendations” (Salter et al. 2023). This article next compares the six recommendations to existing statements about pediatric decision-making (specifically those developed by the American Academy of (...) Pediatrics), highlighting similarities and differences. Finally, the article discusses the value of finding consensus in the field of pediatric bioethics. (shrink)

We argue against Christopher Meyers’s call for clinical ethicists to participate in deceiving patients, surrogate decision-makers, or family members. While we acknowledge that some forms of deception may be ethically appropriate in highly circumscribed situations, the type of case Meyers describes as involving justifiable deception differs in at least two important ways. First, Meyers fails to distinguish acts of deception based on the critical feature of who is being deceived—patient, surrogate, or family member—and the overarching duty to respect the autonomy (...) of relevant decision-makers to make rationally-informed decisions. Second, Meyers’s analysis relies on an assessment of harm, a value-laden concept which health care professionals and ethicists should not presumptively assess without considering how the patient, surrogate, or family might assess specific harms. (shrink)

Our aim in this article is to bring some clarity to the clinical ethics expertise debate by critiquing and replacing the taxonomy offered by the Core Competencies report. The orienting question for our taxonomy is: Can clinical ethicists offer justified, normative recommendations for active patient cases? Views that answer “no” are characterized as a “negative” view of clinical ethics expertise and are further differentiated based on (a) why they think ethicists cannot give justified normative recommendations and (b) what they think (...) ethicists can offer, if they cannot offer recommendations. Views that answer “yes” to the orienting question are characterized as a “positive” view of clinical ethics expertise. Positive views are distinguished according to four additional questions. First (P1), how are those recommendations generated? Second (P2), what is the nature of the recommendations? Third (P3), we ask, how are the recommendations justified? And finally (P4), how are the recommendations communicated? (shrink)

In the development of governmental policy for artificial intelligence that is informed by ethics, one avenue currently pursued is that of drawing on “AI Ethics Principles”. However, these AI Ethics Principles often fail to be actioned in governmental policy. This paper proposes a novel framework for the development of ‘Actionable Principles for AI’. The approach acknowledges the relevance of AI Ethics Principles and homes in on methodological elements to increase their practical implementability in policy processes. As a case study, elements (...) are extracted from the development process of the Ethics Guidelines for Trustworthy AI of the European Commission’s “High Level Expert Group on AI”. Subsequently, these elements are expanded on and evaluated in light of their ability to contribute to a prototype framework for the development of 'Actionable Principles for AI'. The paper proposes the following three propositions for the formation of such a prototype framework: preliminary landscape assessments; multi-stakeholder participation and cross-sectoral feedback; and, mechanisms to support implementation and operationalizability. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special Issue on Pediatric Decision-MakingErica K. SalterUnlike in the traditional decisional dyad in adult-based care, pediatric decision-making typically involves a triadic relationship among the patient, their parents, and the health-care providers. This complex relationship raises questions and concerns regarding each party’s expectations, obligations, and authority. For example, should a parent be allowed to withhold a poor diagnosis from an adolescent patient? Should an HLA-matched six-year-old sister (...) be permitted to serve as a bone marrow donor for her older sibling with lysosomal storage disease? Or, should parents be given decisional authority to consent to gender-affirming care for an adolescent with gender dysphoria? Cases like these are among the most ethically challenging decisions faced by parents and health-care providers because they present competing interests and values, and it’s not always clear what is in the best interests of the child.In the context of American medicine, the best interest standard has been identified as the primary ethical and legal guide for decision-making. In its most prominent form, the best interest standard requires parents and pediatric practitioners to choose the medical treatment that maximizes benefits and minimizes harms to the particular child in question. However, over the past few decades, the standard has come under significant scrutiny, with discussions and debate in the academic bioethics literature asking whether the standard is able to serve the [End Page 181] purposes it is thought to serve and whether alternative standards might be better suited to the task(s). Despite vigorous interest in these issues, the academic literature did not seem to generate any sense of identifiable consensus about how others ought to make health-care decisions on behalf of children.Thus, in June 2022, 17 scholar-experts on pediatric decision-making standards gathered in St. Louis, MO, for a three-day symposium of discussion and consensus-building. The participating authors represented different disciplinary perspectives and different viewpoints in the debate about guidance principles that underlie pediatrics. Despite apparent disagreement about such standards in the literature, the group was able to generate a set of six consensus-based recommendations (see Table 1) for pediatric decision-making. These recommendations, as well as their application, justification, and limitations, were published as a special article in Pediatrics in August 2023 (Salter et al. 2023), which was composed with the primary goals of accessibility, teachability, and implementability for practicing pediatric clinicians. Click for larger view View full resolutionTable 1.Six consensus recommendations for pediatric decision-makingWhile the group was able to find agreement about these six central principles of pediatric decision-making, there remained several related issues that were outside of the scope of the symposium aims. For example, should these recommendations apply to neonates, children in state custody, or adolescents, and if so, how would their application be operationalized? What specific conditions should justify state intervention on parental authority? How should parents and health-care providers think about obligations to siblings in health-care decisions? This [End Page 182] special issue of Perspectives in Biology and Medicine provides a forum for our authors and collaborators to further explore these, and other, important questions.The issue opens with a piece by the symposium organizers and editors of this special issue, Erica Salter, Lainie Friedman Ross, and D. Micah Hester, describing the symposium’s inspiration and design, its execution, and the implications it might have for pediatric ethics. This contribution compares the six symposium recommendations with existing statements about pediatric decision-making, in particular the statements developed by the American Academy of Pediatrics (AAP). In “How We Found Consensus on Pediatric Decision-Making and Why It Matters,” readers will find a detailed account of the process engaged to develop the six consensus-based recommendations, as well as a discussion of the value and limitations of such a process, which may serve as a model of consensus-building useful for other unsettled topics of interest in the bioethics community.The issue’s second article, “Childhood Interests: What They Are, and Why It Matters,” by Johan Bester and Jeffrey Blustein, dives into the conceptual foundation of the symposium’s first two recommendations. This... (shrink)