Applied Ethics

By issuing an advance treatment directive, an autonomous person can formally express what kinds of treatment she wishes and does not wish to receive in case she becomes ill or injured and unable to autonomously decide about her treatment. While many jurisdictions and medical associations endorse them, advance treatment directives have also been criticized. According to an important criticism, when a person irreversibly loses her autonomy what she formerly autonomously desired ceases to be of importance in deciding about her treatment. (...) The medical ethical debate regarding different possible ways of solving the problem on which the criticism is based has grown exceedingly intricate. Instead of assessing the developments made in the debate so far, I present a thought experiment—built around a suicide case—which suggests that the problem is not as intractable as it has generally been deemed to be. (shrink)

BackgroundThe increased use of information technology in every day health care creates vast amounts of stored health data that can be used for research. The secondary research use of routinely collected data raises questions about appropriate consent mechanisms for such use. One option is meta consent where individuals state their own consent preferences in relation to future use of their data, e.g. whether they want the data to be accessible to researchers under conditions of specific consent, broad consent, blanket consent (...) or not at all.This study investigates whether meta consent preferences can be successfully elicited by a smartphone application in the adult Danish population.MethodsA smartphone app was developed for the elicitation of meta consent preferences. An invitation to use the app was distributed to a stratified, representative sample of the Danish adult population. The meta consent choices, the use of the app, user experience data, and demographic data were logged and analysed statistically using IBM SPSS version 20.ResultsOf 1000 potential respondents 221 used the app. One hundred eighty-eight of the respondents were female and 103 male. The age range was 19 to 79 years with an average of 51 years. Most users indicate 1) that they find the choices they are asked to make easy to understand, 2) that the application is easy to use, and 3) that this kind of choice should be offered to people.ConclusionsIt is possible to collect meta consent preferences in the general, adult population using a smartphone app. (shrink)

E-commerce sites have been doing profitable business since their induction in high-speed and secured networks. Moreover, they continue to influence consumers through various methods. One of the most effective methods is the e-commerce review rating system, in which consumers provide review ratings for the products used. However, almost all e-commerce review rating systems are unable to provide cumulative review ratings. Furthermore, review ratings are influenced by positive and negative malicious feedback ratings, collectively called false reviews. In this paper, we proposed (...) an e-commerce review system framework developed using the cumulative sum method to detect and remove malicious review ratings. (shrink)

Controversies about time discounting loom large in decisions about climate change. Prominently, a particularly controversial debate about time discounting in climate change decision-making has been conducted within climate economics, between the authors of Stern et al. and their critics :977–981, 2006; Weitzman in J Econ Lit XLV:703–724, 2007; Nordhaus in J Econ Lit XLV:686–702, 2007). The article examines the role of values in this debate. Firstly, it is shown that time discounting is a case in which values are key because (...) it is at heart an ethical problem. Secondly, it is argued that time discounting in climate economics is a case of economists making frequent and routine references to ethical values and indeed conduct ethical debates with each other. Thirdly, it is argued that there is evidence for deep and pervasive entanglement between facts and values in the prevalent methodologies for time discounting. Finally, it is argued that this means that economists have given up the ‘value-free ideal’ concerning time discounting, and discussed how the current methodology of time discounting in economics can be improved. (shrink)

Phishing is a fraudulent form of email that solicits personal or financial information from the recipient, such as a password, username, or social security or bank account number. The scammer may use the illicitly obtained information to steal the victim’s money or identity or sell the information to another party. The direct costs of phishing on consumers are exceptionally high and have risen substantially over the past 12 years. Phishing experiments that simulate real world conditions can provide cybersecurity experts with (...) valuable knowledge they can use to develop effective countermeasures and prevent people from being duped by phishing emails. Although these experiments contravene widely accepted informed consent requirements and involve deception, we argue that they can be conducted ethically if risks are minimized, confidentiality and privacy are protected, potential participants have an opportunity to opt out of the research before it begins, and human subjects are debriefed after their participation ends. (shrink)

This paper applies a virtue epistemology approach to using the Internet, as to improve our information-seeking behaviours. Virtue epistemology focusses on the cognitive character of agents and is less concerned with the nature of truth and epistemic justification as compared to traditional analytic epistemology. Due to this focus on cognitive character and agency, it is a fruitful but underexplored approach to using the Internet in an epistemically desirable way. Thus, the central question in this paper is: How to use the (...) Internet in an epistemically virtuous way? Using the work of Jason Baehr, it starts by outlining nine intellectual or epistemic virtues: curiosity, intellectual autonomy, intellectual humility, attentiveness, intellectual carefulness, intellectual thoroughness, open-mindedness, intellectual courage, and intellectual tenacity. It then explores how we should deploy these virtues and avoid the corresponding vices when interacting with the Internet, particularly search engines. Whilst an epistemically virtuous use of the Internet will not guarantee that one will acquire true beliefs, understanding, or even knowledge, it will strongly improve one’s information-seeking behaviours. The paper ends with arguing that teaching and assessing online intellectual virtues should be part of school and university curricula, perhaps embedded in critical thinking courses, or even better, as individual units. (shrink)

Recently, ethicists have posited that consideration of epigenetic mechanisms presents novel challenges to concepts of justice and equality of opportunity, such as elevating the importance of environments in bioethics and providing a counterpoint to gross genetic determinism. We argue that new findings in epigenetic sciences, including those regarding intergenerational health effects, do not necessitate reconceptualization of theories of justice or the environment. To the contrary, such claims reflect a flawed understanding of epigenetics and its relation to genetics that may unintentionally (...) undermine appeals to social justice. We provide a brief summary of epigenetic sciences, focusing on phenomena central to the current ethical discourse. We identify three fallacious modes of reasoning arising from the emergent literature on the ethical and policy implications of epigenetics, including mischaracterization, undue extrapolation, and exceptionalism. We end by discussing how these issues may work against mobilizing health equity policies and present a more modest claim regarding the value of new epigenetic knowledge to health justice by setting this discourse within the context of known themes in biomedical ethics and health policy. (shrink)

Peer review is the most important aspect of reputable journals. Without it, we would be unsure about whether the material published was as valid and reliable as is possible. However, with the advent of the Internet, scientific literature has now become subject to a relatively new phenomenon: fake peer reviews. Some dishonest researchers have been manipulating the peer review process to publish what are often inferior papers. There are even papers that explain how to do it. This paper discusses one (...) of those methods and how editors can defeat it by using a special review ID. This method is easy to understand and can be added to current peer review systems easily. (shrink)

Concerns have been voiced about the ethical implications of patenting practices in the field of biotechnology. Some of these have also been incorporated into regulation, such as the European Commission Directive 98/44 on the legal protection of biotechnological inventions. However, the incorporation of ethically based restrictions into patent legislation has not had the effect of satisfying all concerns. In this article, we will systematically compare the richness of ethical concerns surrounding biotech patenting, with the limited scope of ethical concerns actually (...) addressed in the patent system. As sources of our analyses we will use literature and document studies and a survey with important stakeholders and experts related to Norwegian patenting in the aquacultural biotechnology sector. We will structure the analyses with an ethical matrix, developed for this purpose. Showing the misalignment of the discussions within and outside the patent system, we suggest that an important reason for the ethical controversy still surrounding patenting is that ethical questions keep being framed in a narrow way within the system. Until a richer set of ethical considerations is addressed head-on within the patent system, the patent system will continue to evoke academic and interest group criticism, potentially contributing to a legitimacy crisis of the whole system. (shrink)

Though accountable care organizations are increasingly important to American healthcare, ethical inquiry into ACOs remains in its nascent stages. Several articles have raised the concern that ACOs have an incentive to avoid enrolling high-cost patients and, thereby, have an incentive to deny care to those who need it the most. This concern is borne out by the reports of consultants working with newly formed ACOs. This paper argues that, contra initial appearances, there is no financial incentive for ACOs to avoid (...) enrolling high-cost patients. (shrink)

Along with the rapid growth of editorial systems and publishers, the number of research articles is increasing, which creates a need for an effective dissemination strategy. Researchers commonly use editorial systems in a candid manner. However, when researchers concurrently submit the same contribution in more than one editorial system, it is considered unethical. In this paper, we propose a novel approach called DeMSum for detecting such duplicate submissions. DeMSum verifies a manuscript by processing the MS attributes that are accessed through (...) the editorial system. To the best of our knowledge, DeMSum is the first system to address the double submission issue, thus enabling the use of diverse editorial systems for MS review. We implemented a prototype, and our evaluation of the prototype produced excellent results. (shrink)

In the philosophy of technology after the empirical turn, little attention has been paid to language and its relation to technology. In this programmatic and explorative paper, it is proposed to use the later Wittgenstein, not only to pay more attention to language use in philosophy of technology, but also to rethink technology itself—at least technology in its aspect of tool, technology-in-use. This is done by outlining a working account of Wittgenstein’s view of language and by then applying that account (...) to technology—turning around Wittgenstein’s metaphor of the toolbox. Using Wittgenstein’s concepts of language games and form of life and coining the term ‘technology games’, the paper proposes and argues for a use-oriented, holistic, transcendental, social, and historical approach to technology which is empirically but also normatively sensitive, and which takes into account implicit knowledge and know-how. It gives examples of interaction with social robots to support the relevance of this project for understanding and evaluating today’s technologies, makes comparisons with authors in philosophy of technology such as Winner and Ihde, and sketches the contours of a phenomenology and hermeneutics of technology use that may help us to understand but also to gain a more critical relation to specific uses of concrete technologies in everyday contexts. Ultimately, given the holism argued for, it also promises a more critical relation to the games and forms of life technologies are embedded in—to the ways we do things. (shrink)

BackgroundThe informed-consent process should be one of meaningful information exchange between researchers and study participants. One of the responsibilities of research ethics committees is to oversee appropriate informed consent. The committee must consider various matters before deciding whether the process is appropriate, including the adequacy and completeness of the written information provided to study participants, and the process of obtaining informed consent.This study aimed to identify, quantitatively and qualitatively, consent-related issues in different types of malaria proposals submitted to the Faculty (...) of Tropical Medicine, Ethics Committee.MethodsThis study reviewed proposal documentation submitted to two panels of the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University, from 2011 to 2015. The documentation included proposals, notifications to researchers of review outcomes and ethical issues of concern to committee members. Each element of the informed-consent process was identified and analyzed by study classification, design, and specimen use, including whether the study involved a vulnerable population. Summative content analysis was used to analyze patterns of common issues raised in reviews.ResultsOf the 112 proposals reviewed, 63 required an informed consent process. All researchers proposed communicating with their study participants; however, about two-thirds needed to improve their explanations of study procedures to participants. About 40% of the proposals attracted comments on informed-consent process elements--risk and discomfort, vulnerable status, and compensation. Studies that planned to collect or use new/linked specimens raised more issues around informed consent than studies using linked data/records. Studies that involved vulnerable populations raised more issues than those that did not. The committee usually asked researchers to clarify, elaborate, revise, or paraphrase the consent process elements that were considered to involve inadequate information exchange between researcher and study participant.ConclusionsThis study aimed to describe lessons for malaria researchers about common informed-consent process issues in different types of malaria proposals. The information and analysis of informed-consent elements should assist the preparation of malaria-research proposals. (shrink)

An appeal to philosophers who believe in social contract theory to revise their thinking in fundamental ways. In particular, it calls upon them to take corporations -- especially transnational corporations -- more seriously in their speculations on the "just state" than they have up till now. Why? Because transnational corporations today exercise de facto sovereignty--a sovereignty that always influences, sometomes equals, and often overpowers the sovereignty of nation states. (Excerpted from Paul Durbin's detailed analysis of book in 2006.).

Readers of reports on ethical failures by four-star general officers must wonder, “Don’t they have staffs to ensure that the general follows ethics rules?” The Department of Defense publishes robust ethics guidance in several documents; however, a staff’s best efforts to implement this guidance may fail to make an impression on a senior leader who is susceptible to the “Bathsheba syndrome,” an allusion to the biblical account where the prophet Nathan rebuked King David for his moral failings. This paper proposes (...) a methodology to enable senior headquarters staffs to play the role of Nathan in supporting ethical behaviors by high-level officers. It examines the mechanisms that embed ethical behavior within members of those staffs in carrying out their three principal roles of advising, scheduling, and transporting the four-star officer. The authors offer a framework based on an ethical infrastructure of organizational climate that focuses the staff’s daily efforts to mitigate risk across seven ethical “danger areas” that threaten ethical failures by senior officers. (shrink)

Investigating an actual case that occurred in a New York state hospital where an Orthodox Jewish patient’s legal proxy demands that the clinicians and hospital administrators should provide aggressive treatment with all available technological resources for the seemingly brain-dead patient with a medically futile condition. The authors argue that a health care policy or regulation should be developed to limit patient’s access to technology in critical care. Otherwise, we will be allowing society to issue a carte blanche to religious autonomy (...) by technology abuse. It is argued that religious autonomy should be restricted when its demand exhibits apparent logical absurdity and/or goes against the common survival of the entire population. (shrink)

Background: Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. Main text: We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. (...) Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. Conclusion: We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

It seems certain that one day we will allow the genetic technology which will enhance our offspring. A highly effective new tool, called CRISPR, which allows for carving out genes, is already being used to edit the genomes of animals. In July 2017, the FDA legalized that germline drugs for therapeutic purposes could be sold in the market. It is a high time, now, that we need engage in discussions about the ethics of germline intervention. To contribute to the discussion (...) by showing our thought and to educate the public, we write this paper. (shrink)

Rawls’s notion of civil disobedience, which still dominates the literature on this subject, comprises at least these three characteristics: it involves breaking the law, is non-violent and public. But implicit in this notion is a certain tension: it shows pessisimism about the proper functioning of the public sphere as earlier normal appeals have failed, but it also displays a certain optimism about its proper functioning as it assumes that civil disobedience may be effective. In my paper I argue that Rawls (...) cannot explain how civil disobedience may be effective as a public appeal for social justice because he does not fully understand what it means for civil disobedience to be public in relation to the public sphere. His analysis would require an additional notion of publicity which, as I argue, is the notion of hermeneutical publicity. From a Bourdieusian perspective I then make a case for the claim that public spheres always suffer from hermeneutic invisibility. This may explain why non-violent appeals for social justice fail as dialogical practices. Finally I suggest how we nevertheless could understand that civil disobedience can be effective as a dialogical practice. (shrink)

The Global Burden of Disease project quantifies the impact of different health conditions by combining information about morbidity and premature mortality within a single metric, the Disability Adjusted Life Year. One important goal for the GBD project has been to inform decisions about global health priorities. A number of recent studies have used GBD data to argue that global health funding fails to align with the GBD. We argue that these studies’ shared assumption that global health resources should ‘align’ with (...) the burden of disease is unfounded and has troubling implications. First, since the allocation of resources involves difficult trade-offs between different, potentially competing goals, any ‘misalignment’ of allocation and disease burdens need not necessarily indicate that the allocation of funds fails to meet recipient countries’ needs or interests. Second, using alignment as a baseline implicitly makes controversial assumptions about how harms of different magnitudes affecting different numbers of individuals should be aggregated. We discuss two alternative ways in which GBD data could help inform decisions about resource allocation, neither of which gives more than a limited role to GBD data. (shrink)

Technological innovation in general, and nanotechnology development in particular, happens often disconnected from people and places where these technologies eventually play out. Over the last decade, a diversity of approaches have been proposed and developed to engage people in the innovation process of nanotechnology much earlier than in their conventional role as consumers. Such “upstream” engagements are conducted at stages when nanotechnology products and services are still amenable to reframing and modification. These engagement efforts have enhanced technological literacy among stakeholders (...) and the general public. Yet, there is still potential for other types of impacts by leveraging links between nanotechnology and people’s everyday experiences. The present study explores a novel approach for participatory nanotechnology assessment and design, called Collaborative On-site Technology Exploration. The approach allows nanoscale scientists and engineers to explore nanotechnologies where they matter to people and places. We conducted a series of COTEs in the Gateway district in Phoenix addressing community challenges of renewable energy supply, water contamination, and public health issues. COTEs are proposed as a step toward bringing together nanoscale scientists and engineers and community stakeholders in need for solutions to urban challenges. (shrink)

Most books and articles still treat leadership and ethics as related though separate phenomena. This edited volume is an exception to that rule, and explicitly treats leadership and ethics as a single domain. Clearly, ethics is an aspect of leadership, and not a distinct approach that exists alongside other approaches to leadership. This holds especially true for the for the military, as it is one of the few organizations that can legitimately use violence. Military leaders have to deal with personnel (...) who have either used or experienced violence. This intertwinement of leadership and violence separates military leadership from leadership in other professions. Even in a time that leadership is increasingly questioned, it is still good leadership that keeps soldiers from crossing the thin line between legitimate force and excessive violence. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

Bovine tuberculosis is an important animal health policy issue in England, which impacts farmers, the public, cattle and badgers. The government has licensed farmers to cull badgers, which are a wildlife reservoir for bovine TB. The policy is controversial, particularly because the Independent Scientific Group recommended against culling based on the Randomised Badger Culling Trial. This paper assesses impacts of bovine TB policy options on cattle and badgers. Policy options assessed are: do nothing, badger culling, and badger vaccination. Impacts are (...) illustrated by Animal Welfare Impact Assessment, which includes species description, and AWIA analysis stages. Over 4 years, 85,000 badgers will be culled to prevent the slaughter of ~17,750 cattle over 9 years. Hence, about five badgers are culled for every cow which avoids slaughter. The AWIA analyses the impact of badger vaccination on cows and badgers based on a set of stated assumptions. The AWIA estimates badger vaccination to reduce the number of cows slaughtered by 11,600, i.e. a 12.5% reduction. Additional to the harm of killing, culling has greater welfare impacts on badgers compared to non-culling options. Actors in animal health and welfare policy were asked in interviews about the concept of AWIA. Policy actors supported the idea of AWIA to provide objective data to feed into policy making. The paper concludes with the proposal that AWIA is a necessary stage of just policy making where sentient animals are impacted by government policy. (shrink)

This study examines the use of disparaging and offensive trademarks and mascots by sports teams. Specifically, this study considers whether the continued use of Native American symbols and mascots in sports comports with the Christians-Nordenstreng conceptualization of social responsibility, which considers the three principles of human dignity, truth-telling, and nonmaleficence. To do this, the article considers the history and arguments both for and against the use of these symbols in sports communication. This article concludes with a discussion of how the (...) use of these trademarks does not fulfill the three principles of social responsibility and what that means for the symbols’ continued use. (shrink)

In a paper recently published in this journal, Navin and Largent argue in favour of a type of policy to regulate non-medical exemptions from childhood vaccination which they call ‘Inconvenience’. This policy makes it burdensome for parents to obtain an exemption to child vaccination, for example, by requiring parents to attend immunization education sessions and to complete an application form to receive a waiver. Navin and Largent argue that this policy is preferable to ‘Eliminationism’, i.e. to policies that do not (...) allow non-medical exemptions, because Inconvenience has been shown to maintain exemption rates low while not harming parents by forcing them to do something that goes against their beliefs. We argue that it is at least doubtful that Inconvenience is ethically preferable to Eliminationism: while the latter disregards the value of liberty, Inconvenience disregards the value of fairness in the distribution of the burdens entailed by the preservation of a public good like herd immunity. We propose a variant of Inconvenience, which we call ‘Contribution’, which we think is preferable to the versions of Inconvenience discussed by Navin and Largent in that it successfully strikes a balance between the values of parents’ liberty, fairness and expected utility. (shrink)

BackgroundMedical schools have a major impact on future doctors’ ethics and their attitudes towards cooperation with the pharmaceutical industry. From childhood, medical students who are related to a physician are exposed to the characteristics of a medical career and learn its professional ethics not only in school but also in the family setting. The present paper sought to answer the research question: ‘How does growing up with a physician influence medical students' perceptions of conflicts of interest in their relationships with (...) industry?’MethodsAn anonymous questionnaire was completed by 451 medical students from four Philadelphia medical schools and 554 medical students from Warsaw Medical University during 2013. Medical schools in these two cities were chosen because they are both university cities with similar population sizes. Students who had and who did not have a family member working as a physician were compared using chi-square analysis. Data were analysed for each country separately.ResultsFor both the US and Poland, there were statistically significant differences between medical students with a physician as a family member and other students with respect to views regarding relationship with the pharmaceutical industry. In both groups, this difference occurred for three important dimensions: students’ relationship with the pharmaceutical industry; students’ views on physicians’ rights to cooperate with the pharmaceutical industry; trust in the pharmaceutical industry. In the US, students related to a doctor were characterized by more restrictive opinions on all three dimensions than other students. However, the contrary was observed in Poland: students with a physician in the family had less strict views than their colleagues.ConclusionsIn Poland, a former communist country, physicians transmit a more liberal approach towards collaboration with the pharmaceutical industry to their student relatives than those in the US. (shrink)

Tom Regan argues that human beings and some non-human animals have moral rights because they are “subjects of lives,” that is, roughly, conscious, sentient beings with an experiential welfare. A prominent critic, Carl Cohen, objects: he argues that only moral agents have rights and so animals, since they are not moral agents, lack rights. An objection to Cohen’s argument is that his theory of rights seems to imply that human beings who are not moral agents have no moral rights, but (...) since these human beings have rights, his theory of rights is false, and so he fails to show that animals lack rights. Cohen responds that this objection fails because human beings who are not moral agents nevertheless are the “kind” of beings who are moral agents and so have rights, but animals are not that “kind” of being and so lack rights. Regan argues that Cohen’s “kind” arguments fail: they fail to explain why human beings who are not moral agents have rights and they fail to show that animals lack rights. Since Cohen’s “kind” arguments are influential, I review and critique Regan’s objections . I offer suggestions for stronger responses to arguments like Cohen’s. (shrink)

The notion of respect for autonomy dominates bioethical discussion, though what qualifies precisely as autonomous action is notoriously elusive. In recent decades, the notion of autonomy in medical contexts has often been defined in opposition to the notion of autonomy favoured by theoretical philosophers. Where many contemporary theoretical accounts of autonomy place emphasis on a condition of “authenticity”, the special relation a desire must have to the self, bioethicists often regard such a focus as irrelevant to the concerns of medical (...) ethics, and too stringent for use in practical contexts. I argue, however, that the very condition of authenticity that forms a focus in theoretical philosophy is also essential to autonomy and competence in medical ethics. After tracing the contours of contemporary authenticity-based theories of autonomy, I consider and respond to objections against the incorporation of a notion of authenticity into accounts of autonomy designed for use in medical contexts. By looking at the typical problems that arise when making judgments concerning autonomy or competence in a medical setting, I reveal the need for a condition of authenticity—as a means of protecting choices, particularly high-stakes choices, from being restricted or overridden on the basis of intersubjective disagreement. I then turn to the treatment of false and contestable beliefs, arguing that it is only through reference to authenticity that we can make important distinctions in this domain. Finally, I consider a potential problem with my proposed approach; its ability to deal with anorexic and depressive desires. (shrink)