Bioconvergence is a growing area within the evolving bioeconomy that seeks out synergistic opportunities at the intersection of engineering and the life sciences (Greenbaum 2023). One example is th...

Since at least the advent of Jack Kevorkian’s “suicide machine” the major argument against adopting physician-assisted suicide laws has been that they will lead us down a slippery slope to state-sa...

Shavelson et al. (2023) identify an important problem in their Target article: a significant number of terminally ill patients with impaired motor function are wrongfully excluded from receiving ai...

Cho and Martinez-Martin (2023) provide a compelling critique of the profound influence that data sourcing for artificial intelligence (AI) has on the healthcare sector. They emphasize the need for...

Digital simulacra present an entrancing vision of a research-rich future shorn of the messiness that comes from dealing with real live patients as part of the research enterprise—and in that sheari...

An attempt to reduce disability discrimination can do more harm than the ostensible discrimination itself. Such is the case with Shavelson et al.’s (2023) argument for equal access to medical aid i...

Bioethical concerns about the potential for abuse in medical aid in dying (MAID) have focused primarily on the risk of coercion (Battin et al. 2007; Foley and Hendin 2002). Accordingly, the require...

In their forthcoming article, Shavelson and colleagues (2023) identify a key ethical concern associated with medical aid-in-dying (MAiD) laws in the eleven US jurisdictions where the practice is le...

Cho and Martinez-Martin’s (2023) “Epistemic rights and responsibilities of digital simulacra for biomedicine” presents a comprehensive overview of big data and AI in clinical medicine and research....

Cho and Martinez-Martin (2023) discuss the ethical challenges associated with the use of digital simulacra (also known as digital twins) in biomedicine, specifically focusing on the issue of episte...

We are grateful to everyone who took the time to offer such insightful comments with regard to the protection–inclusion dilemma in research oversight. Nearly all respondents agreed that this dilemm...

Artificial Intelligence and Machine Learning (AI/ML) models introduce unique considerations when determining their epistemic value. Fortunately, existing work on the epistemic features of AI/ML can...

Mildred Cho and Nicole Martinez-Martin (2023) distinguish between two of the ways in which humans can be represented in medical contexts. One is technical: a digital model of aspects of a person’s...

Cho and Martinez-Martin (2023) provide a thoughtful analysis of the epistemological and ethical implications of digital twin (DT) technology in biomedical research. However, they overlook the profo...

Why would we prohibit people with disabilities from receiving the assistance needed to achieve similar goals as people without disabilities? On its face, this would seem to be a discriminatory appr...

Shavelson et al. (2023) raise the familiar question of parity or fairness in the assisted dying1 debate: if we legally permit the practice for one person, should we not permit everyone similarly si...

In their article, Cho and Martinez-Martin (2023) argue that developers and users of digital simulacra for modelling health and disease should involve a continued focus on causality of health states...

Digital twins for health care have the potential to significantly impact the provision of medical services. In addition to possible use in care, this technology could serve as a conduit by which no...

If you’ve ever had a time where your smartwatch buzzed to say you’ve completed your daily steps while you were actually just brushing your hair, you’ll know our data aren’t perfect. Every day, we c...

Shavelson et al., argues that California’s End of Life Option Act (ELOA) violates the Americans with Disabilities Act (ADA), because the ELOA requires the patient to “self-administer” their prescri...

As Shavelson et al. (2023) demonstrate with their example of Imani, the lines drawn between permissible and impermissible aid in dying can seem arbitrary, discriminatory, and inconsistent with the...

The construction of digital simulacra in healthcare and medical research purportedly strives to virtually recreate some aspect of reality, whether that be a piece of human tissue, an entire organ,...

While eleven U.S. jurisdictions have authorized medical aid in dying (MAID), it remains inaccessible to terminally ill patients who have physical disabilities that make them unable to complete self...

The legalization of physician-assisted suicide (PAS) in various U.S. states draws into question the interpretation of the cardinal virtues of medicine, including beneficence, non-maleficence, auton...

Cho and Martinez-Martin provide a wide-ranging analysis of what they label “digital simulacra”—which are in essence data-driven AI-based simulation models such as digital twins or models used for i...

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the greater (...) weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

In 2015, in preparation for implementation of the California End of Life Option Act, the UCLA Workgroup dedicated scores of hours to exploring the ethical underpinnings of aid-in-dying and the guid...

Shavelson and colleagues (2023) describe how medical aid-in-dying laws in the United States prohibit assistance in administering aid-in-dying medication. This prohibition distinguishes aid in dying...

Pragmatic clinical trials (PCTs) seek to show the effectiveness of treatments in routine, clinical practice (MacPherson 2004). However, a number of ethical challenges come to the fore when collater...

Stephanie Morain and Emily Largent’s (2023) target article “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care” identified a number of important c...

In their paper, “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Stephanie Morain and Emily Largent (2023) argue that investigators, and poss...

Ms. Johnson’s case highlights a number of the ethical challenges that can arise when treating anorexia nervosa, including uncertainty about a patient’s decisional capacity, the limitations of treat...

We read with great interest Garland, Morain and Sugarman’s manuscript on the obligations of clinicians to participate in pragmatic clinical trials (PCTs) (Garland, Morain and Sugarman 2023). We bel...

Pragmatic clinical trials (PCTs) serve an important function in the modern research landscape: studying interventions in an environment that reflects real-world conditions, rather than the relative...

Clinical ethics consultants often focus on eliciting and accommodating patient values. We encourage people to identify and share their wishes with their health care providers and families so we can...

Garland, Morain, and Sugarman's (2023) proposal is ethically attractive. But (assuming that ethics and medical law should have a close relationship with one another) it is legally seismic. It requi...

The target articles in this issue advance our understanding of bioethical considerations in pragmatic trials (Garland, Morain, and Sugarman 2023; Morain and Largent 2023). Both articles appreciate...

The concept of practical, or pragmatic, clinical trials was introduced in the early 2000s, in parallel with the growing availability and use of electronic health data. Researchers and policymakers...

Working through Esme Johnson’s case brings to light many of the elements that make for a rich and impactful clinical ethics consultation. The health and well-being of a young person, whether a fami...

Garland and colleagues provide many compelling reasons for why clinicians ought to participate in pragmatic clinical trials (Garland et al. 2023), also known as effectiveness trials (Thorpe et al....

The ethics consultant should consider addressing the following questions to help the involved parties decide how best to proceed: Were the implications of a no-dialysis decision understood?Is it kn...

More than 50 years ago, in a front-page article in the New York Times, the truth about what happened to hundreds of black men in a government-conducted research study was revealed to the American p...

Both Morain and Largent (2023) and Garland, Morain, and Sugarman (2023) recognize the ethical challenges inherent in clinician participation in embedded research. Focusing on the question of integr...

Well-designed pragmatic clinical trials (PCTs) are critical for improving healthcare delivery and patient outcomes (Haff and Choudhry 2018), and the article written by Garland et al. (2023) advance...

We whole-heartedly support Andrew Garland, Stephanie Morain, and Jeremy Sugarman’s claim that clinicians have a duty to participate in pragmatic clinical trials (Garland, Morain, and Sugarman 2023)...

In the early days of ethics consultation, two pioneer consultants noted that one of their important functions was to gather missing information and correct misinformation relevant to the facts of t...

As ethics consultants on a busy consult service in a large urban setting, we would approach this case by gathering more information and context. This involves clarifying the clinical facts, underst...

In the described case, the consult requester, nurse Gloria, wants help with the question: “is it ethically justifiable to compel tube feeding over the objection of a young adult with anorexia nervo...

In this issue, Morain and Largent (2023) raise a pressing issue arising in the context of embedded research—the nature and extent of investigator duties to patient-participants when the line betwee...

In “Think Pragmatically: Investigators’ Obligations to Patient-Subjects When Research is Embedded in Care,” Morain and Largent 2023 persuasively argue that the prevailing ways of conceptualizing in...

In their thoughtful and well-supported target article, Andrew Garland, Stephanie Morain, Jeremy Sugarman (2023) argue that clinicians have a duty to participate in pragmatic clinical trials. This d...

Morain and Largent’s (2023) thorough and thoughtful article concludes that the partial-entrustment model of medical researchers’ ancillary-care obligations (Richardson and Belsky 2004; Belsky and R...

In this target article by Morain and Largent (2023), the authors focus on an investigator’s duty to patient-subjects specifically regarding incidental or collateral findings within the context of e...

Garland, Morain, and Sugarman (2023) can be congratulated for their comprehensive and sharp analysis of physicians’ ethical duties with respect to pragmatic clinical trials (PCTs). PCTs embed resea...

In this issue of the American Journal of Bioethics, manuscripts focus on the obligations of clinicians and researchers in pragmatic clinical trials (Garland, Morain, and Sugarman 2023; Morain and L...

Embedded pragmatic clinical trials (PCTs), like other types of randomized comparative-effectiveness research (CER) studies, are sometimes conducted without informed consent. Indeed, authors of both...

In In their article Morain and Largent suggest looking “beyond the investigator-participant dyad” to understand the ethical obligations in embedded research using Electronic Health Record (EHR) dat...

Sean Morrison, the Senior Associate Editor of the Journal of Palliative Medicine, recently depicted advance directives (ADs) and advance care planning (ACP) as “clear, simple, and wrong” (Morrison...

It was the spring of 2020 when the email came to our inboxes—a memo from our Institutional Review Board informing us that we were approved to begin conducting our pragmatic clinical trial with a wa...

In their recent article, Dive, Holmes, and Newson (2023) argue that genetic information should be reported in accordance with the aims of reproductive genetic carrier screening (RGCS). Referring to...

ELSI efforts long have been troubled by critiques that they privilege scientific frameworks and grant scientists the power to set ethical agendas. As the first director of the Human Genome Project’...

The power of the scientific enterprise presents multiple avenues for harnessing and increasingly controlling biological phenomena and instituting interventions in different areas of biomedicine (Af...

We, in the rare disease community are grateful to Halley et al. (2023) for highlighting some of the long-overlooked barriers to care. As the parent of a non-ambulatory, teenage boy living with Duch...

In their target article, Conley et al. (2023) appropriately highlight the ongoing conceptual and practical opacity of public engagement (PE) in the translation of human gene editing (HGE) (Conley e...

Halley and colleagues highlight important aspects of advocacy and justice in rare disease and provide recommendations for stakeholders to encourage progress toward equity and justice. In the rare d...

In today’s world, Artificial Intelligence plays a central role in many decision-making processes. However, its use can lead to structural and epistemic injustices—especially in the context of healt...

This paper analyses the activities of five organizations shaping the debate over the global governance of genome editing in order to assess current approaches to public engagement (PE). We compare the recommendations of each group with its own practices. All recommend broad engagement with the general public, but their practices vary from expert-driven models dominated by scientists, experts, and civil society groups to citizen deliberation-driven models that feature bidirectional consultation with local citizens, as well as hybrid models that combine elements (...) of both approaches. Only one group practices PE that seeks community perspectives to advance equity. In most cases, PE does little more than record already well-known views held by the most vocal groups, and thus is unlikely to produce more just or equitable processes or policy outcomes. Our exploration of the strengths, weaknesses, and possibilities of current forms of PE suggests a need to rethink both “public” and “engagement.”. (shrink)

I gave remarks at the Third International Summit on Human Genome Editing in London, UK on the first day for the section titled, “Sickle Cell Disease: A Case Study Affecting Millions.” It did not es...

Despite what many critics see as an inability to deliver much in the way of therapeutic value (Hunter and Drazen 2019), genetics remains a bottomless source of fascination, trepidation, and reflect...

Genomic screening at population scale generates many ethical considerations. One is the normative role that people’s preferences should play in determining access to genomic information in screening contexts, particularly information that falls beyond the scope of screening. We expect both that people will express a preference to receive such results and that there will be interest from the professional community in providing them. In this paper, we consider this issue in relation to the just and equitable design of population screening (...) programs like reproductive genetic carrier screening (RGCS). Drawing on a pluralistic public health ethics perspective, we claim that generating and reporting information about genetic variants beyond the scope of the screening program usually lacks clinical, and perhaps personal, utility. There are both pragmatic and ethical reasons to restrict information provision to that which fits the stated purpose of the program. (shrink)

From its inception, genomics has been a speculative endeavor, fixated on a far-off horizon that would deliver on the promise of targeted diagnostics and individualized therapeutics (Fortun 2008). M...

Recent national calls for ethical, legal, and social implications (ELSI) research to “assess and address how ethical, historical, social, economic, legal, regulatory, socio-cultural, and contextual...

Newborn screening (NBS) began in the 1960s by testing all newborns for a single condition—phenylketonuria, or PKU—which, when identified and treated early, significantly reduces morbidity. Over the...

I take up the call for a more nuanced engagement with race in bioethics by using Creary’s analytic of bounded justice and argue that it helps illuminate processes of racialization, or racial formation, specifically Blackness, as a dialectical processes of both invisibility and hyper-visibility. This dialectical view of race provides a lens through which the ethical, legal, and social implications (ELSI) of genetics and genomics field can reflect on fraught issues such as inclusion in genomic and biomedical research. Countering or (...) interrupting racialization in precision medicine can involve asking how marginalized groups are made invisible or hyper-visible in various aspects of the research process. Incorporating these kinds of questions into biomedical research inclusion efforts could lead to potentially powerful engagements with marginalized groups and could provide the opportunity for stakeholders to engage with the ways that racialization can happen in real-time and might undermine good intentions. (shrink)

Conley and colleagues (2023) conduct a fascinating analysis of how influential organizations in the global governance of human genome editing debate conceptualize and perform public engagement. Whi...

When considering the question, “Is it just for a [genetic] screening program to give people all the information they want?” it is first necessary to understand how the information is being presente...

The target article “Bounded Justice, Inclusion, and the Hyper/Invisibility of Race in Precision Medicine” is a welcome addition to the corpus on inclusion in genomics and precision medicine (Ferrym...

Dive et al. argue to limit the scope, scale, and quantity of results in genomic screening programs at the population level. Their analysis offers two interrelated reasons for this recommendation: f...

In their article, “Rare Disease, Advocacy and Justice: Intersecting Disparities in Research and Clinical Care,” Halley et al. (2023) use three case examples to describe challenges patients with rar...

Given some of the various possible impacts of clinical germline editing, we can expect robust disagreement about how best to regulate it. One can point to examples of the promise of editing: “rough...

Rare genetic diseases collectively impact millions of individuals in the United States. These patients and their families share many challenges including delayed diagnosis, lack of knowledgeable providers, and limited economic incentives to develop new therapies for small patient groups. As such, rare disease patients and families often must rely on advocacy, including both self-advocacy to access clinical care and public advocacy to advance research. However, these demands raise serious concerns for equity, as both care and research for a given disease (...) can depend on the education, financial resources, and social capital available to the patients in a given community. In this article, we utilize three case examples to illustrate ethical challenges at the intersection of rare diseases, advocacy and justice, including how reliance on advocacy in rare disease may drive unintended consequences for equity. We conclude with a discussion of opportunities for diverse stakeholders to begin to address these challenges. (shrink)

The timing of this special issue of AJOB probing whether public engagement (PE)1 might help achieve equity in genomics is no coincidence. While many issues discussed by the authors are not entirely...

In 2013, the U.S. National Institutes of Health funded four large interdisciplinary research projects exploring the “implications, challenges and opportunities associated with the possible use of g...

Public deliberation has increasingly become the gold standard for citizens’ participation in the governance of science and technology, with a growing body of research suggesting that deliberative p...

I agree with Dive et al. (2023) “that generating and reporting information about genetic variants beyond the scope of the screening program usually lacks clinical, and perhaps personal, utility” an...

Stories of rare disease advocacy can elicit strong but ambivalent responses. It’s moving to read about the heroic efforts of parents “becoming drug developers to find a cure for their children’s ra...

Research and clinical trial development for rare diseases pose unique bioethical challenges. Much of the literature on rare diseases focuses on patient advocacy and drug development to manage or cu...

Conley and colleagues (2023) explore how calls for broad public engagement (PE) in the case of heritable human genome editing are being put into action, reviewing the activities of five different i...

In this commentary for Conley et al. (2023), we seek to bridge the gap that, unfortunately, still often exists between debates in Science & Technology Studies (STS) and Bioethics. We believe that t...

Halley et al. (2023) highlight important equity challenges emerging out of existing health policy’s reliance on self- and family advocacy. As advocacy capacity varies dramatically across groups, pu...

The authors of the ELSIcon special issue have advanced the conversation on ethics and genetics. Nevertheless, we have some concerns. Here, we respond specifically to Conley et al. (2023). We choose...

In the era of precision medicine and expanding health information technologies, large representative datasets are considered necessary for addressing health inequities. Partially in response to gro...

Bonginkosi Shozi and Donrich Thaldar’s (2023) contribution is relevant to epistemic justice, which involves efforts to develop an inclusive and global bioethics that takes seriously perspectives fr...

Conley et al. (2023) analyze the attempts at public engagement (PE) by five governance groups. These projects were conducted by organizations that endorse both the goals and values of PE. The autho...

In “The Promise and Reality of Public Engagement in the Governance of Human Genome Editing Research,” Conley et al. raise (2023) important critiques of several public engagement practices in the re...

In a recent public engagement study on heritable human genome editing (HHGE) conducted among South Africans, participants approved of using HHGE for serious health conditions—viewing it as a means of bringing about valuable social goods—and proposed that the government should actively invest resources to ensure everyone has equal access to the technology for these purposes. This position was animated by the view that future generations have a claim to these social goods, and this entitlement justified making HHGE available in the (...) present. This claim can be ethically justified in the Ubuntu ethic (deriving from South Africa) as it (a) emphasizes the interests of the community, and (b) espouses a metaphysical conception of the community that transcends the present generation and includes past and future generations. On this basis, a compelling claim can be made on behalf of prospective persons in favor of equal access to HHGE. (shrink)

The target article “Bounded Justice, Inclusion and the Hyper/Invisibility of Race in Precision Medicine” (Ferryman 2023) raises critical questions about the development of genuinely inclusive, fair...

In their article, Friesen et al. (2023) discuss two challenging roles the IRBs are playing: protecting research participants from research-related risks and promoting inclusion of diverse populatio...

Among the terms that has become a stock phrase in articles about ECMO, whether academic or news stories, is “bridge to nowhere” (Abrams et.al. 2014; Bailey 2019). It is used to describe the tragic...

Childress and colleagues conclude that arguments from distributive justice do not justify discontinuing ECMO over a capacitated patient’s objections (Childress et al. 2023). However, this conclusio...

We are grateful to Friesen and colleagues for drawing attention to the tension between the protection of populations that may experience vulnerability with their inclusion in research (Friesen et a...

Some patients who are dependent on extracorporeal membrane oxygenation (ECMO) are alert and retain capacity to participate in decision-making, including decisions regarding whether to continue life...

Childress and colleagues (2023) review several arguments that would support the unilateral withdrawal of ECMO (extracorporeal membrane oxygenation) against the wishes of a capacitated patient (Mr....

Friesen et al. (2023) describe barriers to research in patient populations that have been historically labeled as vulnerable and, as a result, are under-represented in research due to the Instituti...

Childress et al. (2023) have provided a cogent overview of the ethical considerations involved in withdrawing extracorporeal membrane oxygenation (ECMO) over a capacitated patient’s objection. Alth...

Pregnant people are often listed among groups that have been excluded from research on the basis of perceived vulnerability, to the detriment of the entire class. Lack of research among pregnant pe...

Childress and coauthors present a case considering ECMO withdrawal over the objection of the conscious patient who is no longer a candidate for transplantation or other definitive therapeutic inter...

Childress et al. (2023) present the case of a patient with capacity who requests to stay on extracorporeal membrane oxygenation (ECMO) indefinitely and highlight the ethical challenges associated w...

Given the primary mandate for institutional review boards (IRBs) to protect potential participants from harm, the egregious history of research abuses, and the fact that there is no mention of incl...

Childress et al. (2023) argue in favor of “ECMO-DT,” the provision of ECMO indefinitely as “destination therapy” in the ICU for patients who are dependent on the technology to sustain their lives....

Childress et al. (2023) describe a disagreement between the competent patient and the physician recommending withdrawal of life-sustaining therapy (WLST). While the scenario is specific to ECMO, th...

Friesen et al. (2023) article explores tensions within institutional review boards (IRBs) when they aim both to protect participants from harm and to include under-represented populations in clinic...

I fundamentally agree with Childress et al. (2023) in the scenario they have constructed with Mr. J. None of the arguments they critically assess are ethically persuasive enough to justify removing...

The ethics of long-term Extracorporeal Membrane Oxygenation (ECMO) use, especially when organ recovery appears highly unlikely and the patient does not qualify for organ transplantation, are compli...

I agree fully that a “clearer picture of how vulnerability might manifest and how it can be accommodated, ideally without resorting to mere exclusion from research, is needed” (Friesen et al. 2023,...

In their target article, Friesen et al. (2023) offer recommendations primarily aimed at IRBs for reaching a better balance in the ongoing challenge of the protection-inclusion dilemma. The authors...

In the pediatric heart-failure population, severity of illness often forces therapeutic decisions to be made under time-pressure, such that mechanical circulatory support (MCS) can be offered as a...

In their analysis Childress et al. (2023) suggest that withdrawal of extracorporeal membrane oxygenation (ECMO) over a patient’s dissent is not justified by existing ethical arguments. The alternat...

Extracorporeal membrane oxygenation (ECMO) is currently reserved predominantly for bridging patients to a different destination therapy, but the use of ECMO as a destination therapy itself (ECMO-DT...

Childress et al. (2023) critically examine claims used to support unilateral withdrawal of life-sustaining ECMO over the objections of capacitated patients. The authors raise important concerns abo...

Unfortunately, there is broad confusion regarding the justification for healthcare professionals unilaterally limiting or withdrawing life-prolonging interventions. Many mistakenly believe that suc...

In their target article, Childress et al. (2023) contemplate the ethical considerations associated with determining if and when life-sustaining interventions (in this case, ECMO) can be unilaterall...

There is a well-known American legal maxim, hard cases make bad law. If we agree that Mr. J’s case is hard, what lessons follow from the application of current ECMO guidelines and what kind of supp...

IRBs often face dueling values in research: their historically grounded mission to protect research participants from harm conflicts with more recent attention to the importance of including underr...

In articulating the protection-inclusion dilemma, Friesen et al. (2023) identify an important issue facing institutional review boards (IRBs) and elucidate historical factors contributing to its de...

Life-saving healthcare technology evolves over time, raising new ethical questions. What was once experimental becomes standard care, and what was once unthinkable becomes the next frontier. Ethici...

Adolescence, defined in the US as 11–21 years of age, is a critical period for prevention, as it marks the onset of risk behaviors. Minor (<18 years) self-consent and inclusion in biomedical resear...

In “IRBs and The Protection Inclusion Dilemma: Finding a Balance,” Friesen et al. (2023) argue that IRBs ought to attend more, and better, to the need for the inclusion of under-researched populati...

In this issue of American Journal of Bioethics, Childress et al. address one of the most challenging modern clinical ethical dilemmas: the awake, competent patient dependent on extracorporeal membr...

First, the authors should be congratulated for bringing our attention to this important issue. They have made important observations about what may be holding us back in efforts to make progress in...

In “IRBs and the Protection-Inclusion Dilemma: Finding a Balance,” Dr. Phoebe Friesen and her collaborators (2023) provide a compelling framework that helps Institutional Review Boards (IRBs) think...

The COVID-19 pandemic’s disproportionate harm to racialized communities and increased public attention to the deaths of Black people at the hands of police (Elijah McClain, Breonna Taylor, George F...

ECMO is a short-term measure providing temporary life support until resolution of the primary insult or transplantation. Thanks to technological advances in life support, its use has increased enor...

In their target article, Childress et al provide a detailed analysis of dilemmas arising from disagreement between an ICU team and a competent patient (Mr J) about dis/continuation of extra-corpore...

Sedlakova and Trachsel (2023) discuss the ethical concerns associated with employing what they term conversational artificial intelligence as therapist substitutes. Given their apprehensions, they...

Psychotherapy is provided by professionals, trained, supervised and certified by other professionals, all the way back to Freud and similar founding fathers. Even though methods and styles vary, pa...

In their scoping review of the literature on artificial womb technology (AWT), De Bie et al. report that “complete ectogenesis has been hailed as an alternative to abortion,” (De Bie et al. 2023, 7...

The paper by De Bie et al. (2023) provides an overview of various ethical arguments related to artificial womb technology (AWT). We believe some important feminist concerns about this technology ne...

Successful deployment of “artificial womb technology (AWT)” is anticipated within a decade or so. In the case of “partial” ectogestation, in vivo gestation precedes fetal transfer to an artificial...

Recent discussion on artificial womb technology (AWT) has given rise to a proliferation of terms to denote the subject of AWT. De Bie et al. opt for “fetal neonate” or “fetonate’ as “the best way t...

In their article, Sedlakova and Trachsel (2023) propose a holistic, ethical, and epistemic analysis of conversational artificial intelligence (CAI) in psychotherapeutic settings. They mainly descri...

We applaud Sedlakova and Trachsel’s work and their description of conversational artificial intelligence (CAI) as possessing a hybrid nature with features of both a tool and an agent (Sedlakova and...

In their paper, “Conversational Artificial Intelligence in Psychotherapy: A New Therapeutic Tool or Agent?” Sedlakova and Trachsel (2023) claim that therapeutic insights and therapeutic changes are...

De Bie et al. (2023) introduces a framework to conceptualize ethical issues based on four different domains, but the problem lies in the domains being falsely bounded. Apart from the step from doma...

De Bie et al. (2023) call attention at the conclusion of their essay to the “novel questions” generated by complete ectogenesis. The question I explore is how complete ectogenesis from conception t...

De Bie et al. (2023) found that most feminist literature praises Artificial Womb Technologies (AWT) for its potential to increase equality among the sexes. This literature frames gestation as a poi...

In their article, De Bie et al. (2023) provide a scoping review of the ethical and socio-legal issues arising from research into, and the potential, maybe even likely deployment of, artificial womb...

Sedlakova and Traschel (2023) propose limiting the scope and capabilities of psychotherapy-delivering conversational artificial intelligence (CAI), as (1) they deceive some users into thinking they...

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a conversation with (...) a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

De Bie et al. argued that the decision “to transfer the fetus to AWT falls under maternal autonomy” while “once the fetonate is being supported by AWT, decision making would become a shared parenta...

In their careful analysis of conversational artificial intelligence (CAI) in psychotherapy, Sedlakova and Trachsel (2023) propose a framework for the ethical evaluation of such technologies that lo...

As strong as the ethical overview of artificial womb technology (AWT) by De Bie and colleagues is (De Bie et al. 2023), it does not adequately address ethical considerations that may arise within C...

With the public release of the large language model-driven ChatGPT in November 2022, the potential for Conversational Artificial Intelligence (CAI) has once again catapulted into the spotlight. CAI...

Sedlakova and Trachsel (hereafter referred to as “the authors”) argue that conversational artificial intelligence (CAI) in psychotherapy presents an ethical challenge as a tool with aspects of agen...

De Bie et al. (2023) hold out their paper as an effort “to identify the broad range of ethical concerns and considerations regarding AWT” and to organize them “into a comprehensive framework to org...

De Bie et al. provide a novel framework for assessing ethical considerations in artificial womb technology (AWT) based on four phases of human prenatal development (DeBie 2023). As the authors note...

Sedlakova and Trachsel (2023) identify a major benefit of conversational artificial intelligence (CAI) in psychotherapy as its ability to expand access to mental healthcare for vulnerable populatio...

The review by De Bie et al. (2023) provides an overview of the current ethical literature on artificial womb technology (AWT). Two characteristics stand out, and provide the basis for our commentar...

According to Russell and Norvig’s (2009) classification, Artificial Intelligence (AI) is the field that aims at building systems which either think rationally, act rationally, think like humans, or...

Five years ago, remarkable animal experiments on artificial womb technology (AWT) at Children’s Hospital of Philadelphia (CHOP) got us thinking about the ethical for premature babies. We recognized...

De Bie et al. (2023) provide a thorough review of the existing literature concerning Artificial Womb Technology (AWT) using the PRISMA-ScR method. The summary of the scoping review they conducted a...

Sedlakova and Trachsel (2023) advocate for a holistic approach to assessing ethical application of conversational artificial intelligence (CAI) in mental health therapy. They first describe CAI as...

Sedlakova and Trachsel (2023) argue that on the one hand, conversational artificial intelligence (CAI) does not fulfill the necessary conditions for full attribution of agency, such as having consc...

In 2017, Partridge et al. published remarkable experimental results concerning the use of a new artificial womb technology (AWT) with lambs, developed at Children’s Hospital of Philadelphia, called...

Sedlakova and Trachsel (2023) consider conversational artificial intelligence (CAI) as a new way of providing psychotherapy to patients. This is an important topic, and Sedlakova and Trachsel have...

In their article, “Non-invasive prenatal testing for ‘non-medical’ traits: ensuring consistency in ethical decision-making,” Hilary Bowman-Smart and colleagues (2023) claim merely to lay out the gr...

De Bie et al. (2023) provide a helpful framework for understanding many of the ethical considerations regarding artificial womb technology (AWT), particularly in relation to existing reproductive t...

De Bie et al. posit thatthe best way to describe the person who would receive current AWT is as a “fetal neonate” or fetonate. Neonatal pertains to the fact that the subject is removed from the wom...

Good listening is an essential element in the provision of quality healthcare (Attree 2001). Good listening also supports accurate diagnosis, patient adherence to medical recommendations, and stron...

In their comprehensive review article, De Bie et al., using some references, discreetly point out that pregnant women’s decision in Domain III to undergo fetal extraction via C-section should conti...

It is an understatement to say we live in an exciting time considering the increasingly widespread applications of artificial intelligence (AI). This observation is brought to the fore by Sedlakova...

Sedlakova and Traschel argue that conversational artificial intelligence (CAI) is more than a mere tool, but not quite an agent, as it “simulates having a therapeutic conversation [but] does not re...

The introduction of chatGPT illustrates the rapid developments within Conversational Artificial Intelligence (CAI) technologies (Gordijn and Have 2023). Ethical reflection and analysis of CAI are c...

De Bie et al. (2023) propose an organizing framework for different stages of human gestational development from conception to the viable premature. They also identify ethical considerations and con...

When used in psychotherapy, Sedlakova and Trachsel (2023) hypothesize that conversational artificial intelligence (CAI) ought to be considered as a new and hybrid artifact somewhere on a spectrum b...

I thank Jane Sedlakova and Manuel Trachsel for their work on situating conversational artificial intelligence’s (CAI) potential role in psychotherapy. In their article, Sedlakova and Trachsel argue...

What happens when a patient-interfacing conversational artificial intelligence system (CAI)—AI that combines natural language understanding, processing, and machine-learning models to autonomously...

Kolbe and de Melo-Martin (2023) describe fatal problems in current definitions and measurement of moral distress and injury (MD/I) in medical professionals, which impede development of genuine atte...

Shen-yi Liao and Vanessa Cabonell’s “Materialized Oppression in Medical Tools and Technologies,” joins the long list of groundbreaking papers whose importance is obscured by an innocuous title. Som...

Biomedical practice can encode and perpetuate oppressive ideologies. This encoding and perpetuation, scholars like Liao and Carbonell (2023) convincingly argue, can occur not only via social practi...

In “Moral Distress: What are we measuring?” Kolbe and de Melo-Martin (2023) rightly note that varied understanding of moral distress, paired with shortcomings in existing empirical tools to accurat...

Our team at the Centre for Clinical Ethics has long been engaged in internal discussion about the purpose and value of ethics debriefs and their purported role in reducing moral distress (Morley an...

Liao and Carbonell discuss the role of (supposed) racial differences and racism in two medical devices: pulse oximeters and spirometers. They show that what might seem like cases of mere bias, are...

ChatGPT is an artificial intelligence (AI) chatbot that processes and generates natural language text, offering human-like responses to a wide range of questions and prompts. Five days after its re...

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

Liao and Carbonell’s (2023) article, “Materialized Oppression in Medical Tools and Technologies” directs our attention, not to new cutting edge medical technologies, but to the pulse oximeter and t...

Liao and Carbonell argue that medical devices are often not merely biased, but rather materialize oppression through the perpetuation of oppression into the present and future (Liao and Carbonell 2...

Liao and Carbonell point out that much of the danger embedded in “materialized oppression” derives from the fact that the essence of that marginalized oppression may not be overt. It can often rece...

Medical devices with built-in bias can both result from, and contribute to, harmful systemic racial oppression—a point that Liao and Carbonell (2023) argue convincingly in the target article of thi...

Kolbe and de Melo-Martin (2023) raise important concerns about the limited usefulness of measures of moral distress. They propose that moral distress is best measured in terms of “illegitimate inst...

Liao and Carbonell explore how oppressive medical technologies constitute materiality insofar as they reflect past oppression, embody oppression in the present day, and carry oppression into the fu...

Kolbe and de Melo-Martin (2023) provide a much needed reflection on the methods by which we measure moral distress. Their analysis, however, gives off the impression that the measures of moral dist...

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, (...) and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Whilst Kolbe and de Melo-Martin (2023) appropriately identify a range of concerns about the validity of existing instruments to measure moral distress, one additional limitation that the authors di...

Often a physician’s first introduction to a patient is not a physical encounter but a review of their chart. A glaring “violence risk” flag in an Electronic Medical Record (EMR) is often noticeable...

While Jameton’s (1984) definition of moral distress has been embraced by researchers and scholars for recognizing the many constraints that nurses experience on their moral agency, it has also been...

All research tools have limitations. Not all tools will be suited to every purpose. Understanding the limitations and accurately interpreting the output from any tool is essential to conducting mea...

In the target article by Kolbe and de Melo-Martin (2023), the authors discussed several shortcomings of major instruments of moral distress, including the Moral Distress Scale (MDS) (Corley et al....

Moral distress is indeed distressing for those who experience it and whose sense of integrity can be shaken by exposure to events or situations that test their core values and ethical belief system...