“At-own-risk discharges” or “self-discharges” evidences an irretrievable breakdown in the patient–clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician’s duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and competent to (...) invoke an at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care’s use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient’s decision-making capacity and raises questions as to the patient’s decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient’s welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient’s specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis. (shrink)

“At-own-risk discharges” or “self-discharges” evidences an irretrievable breakdown in the patient–clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician’s duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and competent to (...) invoke an at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care’s use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient’s decision-making capacity and raises questions as to the patient’s decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient’s welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient’s specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis. (shrink)

Advances in genetic diagnostics lead to more patients being diagnosed with hereditary conditions. These findings are often relevant to patients’ relatives. For example, the success of targeted cancer prevention is dependent on effective disclosure to relatives at risk. Without clear information, individuals cannot take advantage of predictive testing and preventive measures. Against this background, we argue that healthcare professionals have a duty to make actionable genetic information available to their patients’ at-risk relatives. We do not try to settle (...) the difficult question of how this duty should be balanced against other duties, such as the duty of confidentiality and a possible duty not to know one’s genetic predisposition. Instead, we argue for the importance of recognising a general responsibility towards at-risk relatives, to be discharged as well as possible within the limits set by conflicting duties and practical considerations. According to a traditional and still dominant perspective, it is the patient’s duty to inform his or her relatives, while healthcare professionals are only obliged to support their patients in discharging this duty. We argue that this perspective is a mistake and an anomaly. Healthcare professionals do not have a duty to ensure that their patients promote the health of third parties. It is often effective and desirable to engage patients in disseminating information to their relatives. However, healthcare professionals should not thereby deflect their own moral responsibility. (shrink)

What meaning does epidemiological evidence have for the individual? In evidence-based medicine, epidemiological evidence measures the patient’s risk of the outcome or the change in risk due to an intervention. The patient’s risk is commonly understood as an individual probability. The problem of understanding epidemiological evidence and risk thus becomes the challenge of interpreting individual patient probabilities. I argue that the patient’s risk is interpreted ontically, as a propensity. After exploring formidable problems with this interpretation (...) in the medical context, I propose an epistemic reinterpretation of individual patient probabilities as credences. On this view, epidemiological evidence informs medical uncertainty. (shrink)

This paper is designed to do three things. First, it discusses some of the key trends in business ethics in the academic and corporate communities. Initiatives like the Arthur Andersen Business Ethics Program are noted. Secondly, the paper examines certain basic misconceptions about the field and concludes that the adage that good ethics is good business is still true. Finally, the paper highlights fourteen business attitudes or practices that may put a firm at ethical risk. For example, the paper (...) discusses the risk of using ethics as simply a public relations initiative.Man's life is not a state of unalloyed happiness. The earth is no paradise. Although this is not the fault of social institutions, people are wont to hold them responsible for it. The foundation of any and every civilization, including our own, is private ownership of the means of production. Whoever wishes to criticize modern civilization, therefore, begins with private property. It is blamed for everything that does not please the critic, especially those evils that have their origin in the fact that private property has been hampered and restrained in various respects so that its full social potentialities cannot be realized.1. (shrink)

Mrs. Smith's eyes filled with tears as she said, “I feel like I've done something wrong. Are they punishing me because I've been refusing therapy and won't go to a nursing home?” She acknowledged that she hadn't always listened to her doctors but said that she knew better now and wanted to go home and see if she could make it work. Many staff members at our rehabilitation hospital had explained their safety concerns to her, and some had enlisted her (...) adult daughter, with whom she lived, to convince her too. The rehabilitation team had called on the ethics consultation service, of which I am a part, to help figure out whether Mrs. Smith had the capacity to make an informed refusal of discharge recommendations. (shrink)

The clinical trial is the major investigational tool of clinical medicine. Two recent reports highlight the fact that the most often quoted mechanisms for the protection of research subjects, viz., research ethics board review and eligibility criteria, are insufficient to achieve this end. In this paper, we argue that the prime mechanism for the protection of persons in clinical trials should be the clinical judgement of the physician-investigator. The clinical investigator has a duty to protect subjects from both harm and (...) undue risk. It is argued that the clinical investigator has a duty to screen for, and exclude, potential research subjects who may be unduly vulnerable to the risks of a particular clinical trial. In order to fulfill this obligation, the investigator should personally screen each potential research subject at the time of accrual. In larger trials in which this is not feasible, this task could be delegated to another appropriately qualified health care professional, with the principal investigator retaining personal responsibility. To reinforce and make explicit this legal and moral duty, we propose that the investigator sign a statement, appended to each subject's consent form, to attest that this duty has been responsibly discharged. (shrink)

This article shows how the ethical framing of the contemporary issue of modern slavery has evolved in UK construction, a sector in which there is a high risk of labor exploitation. It also examines how these framing dynamics have inhibited the emergence of a common framework of action to deal with the issue. We draw on both framing theory and the literature on the discursive construction of moral legitimacy. Our longitudinal analysis reveals that actors seeking to shape the debate (...) bring their own moral schemes to justify and construct the legitimacy of their frames. Actors cluster their views around five evolving frames: human rights issue (later shifting to hidden crime), moral issue, management issue (later shifting to human moral obligation), social justice issue, and decent work issue—which promote particular normative evaluations of what the issue is, who is responsible, and recommendations for action. Our study contributes to a dynamic and political understanding of the meaning making of modern slavery. We identify the antecedents and conditions that have forestalled the emergence of new patterns of action to tackle modern slavery in the UK construction sector thereby evidencing the effects of the interplay of morally competing frames on field-level change. (shrink)

The discharge of older people from hospital at night is a topical and emotive issue that has recently gained media attention in New Zealand and the United Kingdom, including calls to prevent it occurring. With growing pressures on hospital capacity and ageing populations, normative aspects of hospital discharge are increasingly relevant. This paper therefore addresses the question: Should older people (say, over eighty years old) ever be discharged home from hospital during the night? Or given safety concerns, should regulation against (...) the night-time discharge of older people be put in place? Employing a principlist lens to bioethics, this paper considers key principles or values involved, including discharge safety concerns, personal preference and consent, the risk of remaining in hospital, and broader considerations around discharge policy. These points act as a possible framework for further research and discussion of normative aspects of hospital discharge. Overall, this paper argues that while discharge safety concerns must be properly acknowledged and addressed, it can still sometimes be appropriate for an older person to leave hospital at night. The option of night-time discharge should therefore remain open to people of all ages. (shrink)

The author encourages the Church to conceptualize children-at-risk as whole, complex humans, who actively participate in their own development and experience multi-directional influences within the contexts of families, communities, cultures, and histories. This view of children requires an expanded understanding of the whole gospel moving past children-at-risk as subjects of evangelism and advocacy. Children are seen as vulnerable agents of God, participants in their own development, and co-participants with the Church in the missio Dei. Using a hermeneutic of (...) inclusion, a model of integral mission ‘to, for, and with’ children-at-risk is offered. (shrink)

Dignity of risk is a simple concept that is surprisingly hard to enact, honor, and prioritize in health care. The term was coined 50 years ago by Robert Perske in an article entitled "The Dignity of Risk and the Mentally Retarded". And as I have written in "Discharge Decisions and the Dignity of Risk", "the concept involves respect for persons, self-determination, and attempts to minimize paternalism or parentalism". Most simply, the dignity of risk embraces respecting or (...) honoring an individual's choices or decisions even in the face of potential harms.The central tension between safety/protection and autonomy/self-determination is at the core of the concept, but it also involves appraisals... (shrink)

The current COVID-19 pandemic has raised many questions and dilemmas for modern day ethicists and healthcare providers. Are physicians, nurses and other healthcare workers morally obligated to put themselves in harm’s way and treat patients during a pandemic, occurring a great risk to themselves, their families and potentially to other patients? The issue was relevant during the 1918 influenza epidemic and more recently severe acute respiratory syndrome epidemic in 2003. Since the risk to the healthcare workers was great, (...) there was tension between the ethical duty and responsibility to treat and the risk to one’s own life. This tension was further noted during the 2014 Ebola outbreak in West Africa that left hundreds of healthcare workers dead. The AMA Code of Ethics states that physicians are to ‘provide urgent medical care during disasters…even in the face of greater than usual risk to physicians’ own safety, health or life.’1 Classic Jewish sources have dealt with this question as well. There is an obligation ‘to not stand by idly when your friends life is in danger’; however, the question arises as to whether there are limits to this obligation? Is one required to risk one’s own life to save another’s? There is a consensus that one is not required but the question open to debate is whether it is praiseworthy to do so. However, regarding healthcare workers, there is agreement for ethical, professional and societal reasons that they are required to put themselves in harm’s way to care for their patients. (shrink)

Risk is the probability that within a certain time some expected negative event will take place. In medicine risk can be related to a decision or to some intrinsic factors which are associated with the probability of the occurrence of a disease. Decisions can be necessary in the individual life with respect to the question of visiting a physician or performing a certain diagnostic or therapeutic procedure. The introduction of new pharmaceutical or technical products into medical use are (...) another set of decisions which can generate certain risks. Intrinsic or inherent risk factors are a set of variables or signs and symptoms which indicate the presence of a certain probability that some disease or event, e.g., arteriosclerosis or sudden infant death syndrome, may occur. Risk is always related to judgement. In a decision process cost, effectiveness and profit can be used to estimate the magnitude of the risk to be taken. In a similar way the problems in connection with an inherent risk are primarily related to the recognition of the magnitude of risk and to the possibility of prophylactic measures.In our own area of research, the sudden infant death syndrome (SIDS) is an event where only risk factors can be observed. We point at two facts in this context: Highly complex patterns of symptoms like behaviour can better be classified by intuitive Gestalt perception. A medical procedure like induction of labour can itself become a risk factor. (shrink)

Hybrid techniques and perceptual technologies that merge the physical and the virtual dimensions of reality are generating a conceptual and experiential working space to reconfigure relationships between the perceiver and the perceived. We are entering a new perceptual paradigm where form, content, and context are merging, generating radical new types of spatial construction. Through the development of hybrid spatial technologies we can now hack the individual’s sense of space and relationship to the world (transforming the subject/object relationship). How can we (...) develop and use emerging spatial technologies to reconfigure spatial perception? Can we adapt and transform the dominant perceptive regimen, which is still based on the Cartesian split (subject-object separation)? We continue to see ourselves as separated from the environment and still need to digest the new changes brought about by hybrid techniques and methodologies that are shaping these new dimensions of space. How adaptable is our perception? The ability to alter our understanding of space provides us with a new form of spatial (self) control; sub-merging identities. What are the biological risks? What are the limits of stretching the perceptive range of the body? This article will examine these questions as an opportunity to humanise technology and create a ‘Human Centric Hybrid Literacy’. We will examine which technologies, techniques and navigation methodologies are being used by artists, technologists and designers to enable this new era of spatial augmentation and perceptual adaptation. Some examples include macroscopic navigation, 360 degree vision, new types of perspective (including third and fourth person perspectives) and reverse engineering. The role that hybrid space plays in the construction and transformation of perception through the practice of context engineering will be examined. Context engineering (Smith, 2013) is understood as an ‘intermediality’ practice for the engagement and augmentation of perception; giving us control over our senses, allowing us to adjust them in real time. Context engineering creates a new economy where we focus less on transforming content (as the primary activity), and more on how we can make our own perception the ‘content’. (shrink)

Rawls famously argues that the parties in the original position would agree upon the two principles of justice. Among other things, these principles guarantee equal political liberty—that is, democracy—as a requirement of justice. We argue on the contrary that the parties have reason to reject this requirement. As we show, by Rawls’ own lights, the parties would be greatly concerned to mitigate existential risk. But it is doubtful whether democracy always minimizes such risk. Indeed, no one currently knows (...) which political systems would. Consequently, the parties—and we ourselves—have reason to reject democracy as a requirement of justice in favor of political experimentalism, a general approach to political justice which rules in at least some non-democratic political systems which might minimize existential risk. (shrink)

Background: It is not known how neonatologists address the affective and cognitive loads on parents deciding whether to resuscitate infants born extremely preterm. This study explores expert neonatologists' views on these decision-making processes and their own roles in counseling parents. Methods: Semistructured interviews asked internationally recognized experts to share their perspectives on perinatal consultations. Their responses were subjected to thematic analysis. Results: Eighteen of 22 invited experts participated. Approximately equal numbers reported employing a physician-driven approach, a parent-driven approach, and a (...) combined approach during these consultations. Those who followed a physician-driven approach typically focused on conveying standard information about adverse outcomes. Those who followed a parent-driven approach typically focused on addressing parents' information requests, guiding their decision making, and providing affective support. Nearly all experts, in each group, endorsed addressing the child's quality of life, in terms of functionality, when discussing long-term outcomes. Although many believed that families adjusted to life with a disabled child, few discussed the topic during prenatal consultations. Most, in each group, reported trying to alleviate future “decisional regret” for parents whose premature infants subsequently became disabled. None spoke to parents about possible decisional regret after deciding to forgo resuscitation. Conclusions: Expert neonatologists are deeply concerned that parents understand the decision facing them. However, they differ on what information they offer and how they balance parents' need for cognitive and affective support. They expressed more concern about parents' decisional regret should their child survive resuscitation, but have severe disability, than about decisional regret after foregoing resuscitation. (shrink)

The idea of considering the living as an element of risk-taking was first inspired by my interest in existentialist approaches in different fields – literature, philosophy, the performing arts, etc. – as well as in the experimental approach Roy Ascott proposes between the arts and technology. Ascott (2003b: 150) advances an interpretation of change that is of particular interest to me: ‘the act of changing becomes a vital part of the total aesthetic experience of the participant’. In his article (...) ‘Biophotonic flux: Bridging virtual and vegetal realities’, Ascott (2003a) speaks of a digital paradigm whose ‘systems and processes become increasingly ubiquitous and invisible, [while provoking] many artists [to] seek new horizons – in the biological sciences, nanotechnology, and the study of consciousness, leading to the emergence of a “moistmedia” (incorporating digitally dry and biologically wet systems)’. From the outset, Ascott (2003b: 123) positions his concept of moistmedia within a dynamic of experimentation, stating ‘I use the word experimental to mean making an action the outcome of which is not foreseen’. I consider these ideas as being fundamental for my own research and for this article, in which I propose a re-evaluation of the relationship between the moving body and technology; more specifically, I suggest focusing on recent perspectives in the performing arts which inscribe new manifestations and dynamics of cross-pollination between the somatic and technology. Thus, my latest research-creation projects led me to the conception and experimentation of a new aesthetic paradigm, which takes the form of a proposition of collective physical and mediated bodies. My interest in conducting creative research involving technology concerns the fact it reveals previously unknown aspects of the body. This article therefore reflects on the experience and conception of the performative body in the link it entertains with technology; an evolutive relationship from which emerges a complexification of self. To do so, I will highlight sensorial and perceptual phenomena and strategies related to the transformation of the body through its contact with technology – lived as a physicality – and subjective experience. This article also introduces the idea of how a culture of flux – reality in flux and constant transformation – is responsible for the emergence of new performative models, and how the dynamics of a loss of bearings and personal risk are essential with respect to this emergence. (shrink)

When doing research among vulnerable populations, researchers are obliged to protect their subjects from harm. We will argue that traditional ethical guidelines are not sufficient to do this, since they mainly focus on direct harms that can occur: for example, issues around informed consent, fair recruitment and risk/harm analysis. However, research also entails indirect harms that remain largely unnoticed by research ethical committees and the research community. Indirect harms do not occur during data collection, but in the analysis of (...) the data, and how the data is presented to the scientific and wider societal community. Highly stigmatized research subjects, like substance‐dependent parents, are especially at risk of encountering indirect harm, because the prejudice against them is so persistent. In this paper we discuss two forms of indirect harm. First, researchers have to be aware how their results will be preceived by society. Even when subjects are presented in an objective way, further, out of porportion stigmatization can occur. Researchers sometimes try to counteract this by whitewashing their results, at the risk of downplaying their respondents’ problems. The second risk researchers face is that their own normative judgements influence how they question such parents, report results and interpret statements. Researchers’ own normative judgements may influence the way they present their subjects. This article reviews a broad range of research that exhibits such indirect harms, discussing how and why indirect harms occur and formulating corresponding recommendations on how to prevent them. (shrink)

The article discusses the work of the Orthodox Christian churches with children and especially children-at-risk. This work is new for these churches and is not yet theologically grounded or systematically organized. Observing the various activities of Orthodox Christians with children-at-risk, questions are raised, such as: is this missionary work, or is it ministry, or is it a task fulfilled by individuals and not by the Church at large? These questions are explored, yet readers are left to make their (...) own conclusions. What becomes evident is the necessity for the Orthodox churches to cooperate with other Christian churches and organizations that are engaged in work with children, and particularly those at-risk, so that all learn from each other and continue their ministry with children in more innovative and successful ways, for the glory of God and the salvation of people, especially the ‘little ones’. (shrink)

BackgroundThe outbreak of COVID-19 has been a major interrupting event, challenging how societies and individuals deal with risk. An essential determinant of the virus’ spread is a series of individual decisions, such as wearing face masks in public space. Those decisions depend on trade-offs between costs and risks, and beliefs are key to explain these.MethodsWe elicit beliefs about the COVID-19 pandemic during lockdown in France by means of surveys asking French citizens about their belief of the infection fatality ratio (...) for COVID-19, own risk to catch the disease, risk as perceived by others, and expected prevalence rate. Those self-assessments were measured twice during lockdown: about 2 weeks after lockdown started and about 2 weeks before lockdown ended. We also measured the quality of these beliefs with respect to available evidence at the time of the surveys, allowing us to assess the calibration of beliefs based on risk-related socio-demographics. Finally, comparing own risk to expected prevalence rates in the two successive surveys provides a dynamic view of comparative optimism with respect to the disease.ResultsThe risk perceptions are rather high in absolute terms and they increased between the two surveys. We found no evidence for an impact of personal experience with COVID-19 on beliefs and lower risk perceptions of the IFR when someone in the respondent’s family has been diagnosed with a disease. Answers to survey 1 confirmed this pattern with a clear indication that respondents were optimistic about their chances to catch COVID-19. However, in survey 2, respondents revealed comparative pessimism.ConclusionThe results show that respondents overestimated the probabilities to catch or die from COVID-19, which is not unusual and does not necessarily reflect a strong deviation from rational behavior. While a rational model explains why the own risk to catch COVID-19 rose between the two surveys, it does not explain why the subjective assessment of the IFR remained stable. The comparative pessimism in survey 2 was likely due to a concomitant increase in the respondents’ perceived chances to catch the disease and a decreased expected prevalence rate. (shrink)

Luigi Giussani, a high school religion teacher throughout the 1950s and 1960s, grounded his teachings in the vast body of experience to be found in Christianity's two-thousand-year history. He told his students, “I'm not here to make you adopt the ideas I will give you as your own, but to teach you a method for judging the things I will say.” Throughout his life, education was one of Giussani's primary intellectual interests. He believed that effective education required an adequate background (...) in the Christian tradition, presented within a lived experience that underscored the capacity of the faith to answer universal questions. What he proposed was a process that allowed one to sift through tradition, critically examining it and comparing it against the ultimate criteria for judgment: the desires of the heart. In Giussani's view, the primary concern was to “educate the human heart as God made it.” In The Risk of Education he states that fear leads students to associate this process of criticism with negativity or doubt. Yet, without an education in criticism, students cannot develop conviction. At a time when young people are abandoning the church and questioning the value of faith, Giussani's method of judging and verifying Christianity as an experience seems a necessary intervention. In The Risk of Education he argues that, ultimately, education and the Christian message reveal themselves through human freedom. (shrink)

Clinicians and administrators have a professional obligation to contribute to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution’s sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework for learning healthcare systems does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we analyse (...) the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider’s legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: the self-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers’ interests and interests of a health system; and the mediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers’ interests and the regulatory model for weighing opposite interests in LHSs. (shrink)

We argue that two long-term goals of AI research stand in tension with one another. The first involves creating AI that is safe, where this is understood as solving the problem of value alignment. The second involves creating artificial general intelligence, meaning AI that operates at or beyond human capacity across all or many intellectual domains. Our argument focuses on the human capacity to make what we call “existential choices”, choices that transform who we are as persons, including transforming what (...) we most deeply value or desire. It is a capacity for a kind of value misalignment, in that the values held prior to making such choices can be significantly different from (misaligned with) the values held after making them. Because of the connection to existentialist philosophers who highlight these choices, we call the resulting form of risk “existentialist risk.” It is, roughly, the risk that results from AI taking an active role in authoring its own values rather than passively going along with the values given to it. On our view, human-like intelligence requires a human-like capacity for value misalignment, which is in tension with the possibility of guaranteeing value alignment between AI and humans. (shrink)

: This essay distinguishes between two kinds of group harms: harms to individuals in virtue of their membership in groups and harms to "structured" groups that have a continuing existence, an organization, and interests of their own. Genetic research creates risks of causing both kinds of group harms, and engagement with the groups at risk can help to mitigate those harms. The two kinds of group harms call for different kinds of group engagement.

Adolescent sexuality is one of the most important reproductive health issues that confronts healthcare professionals with moral dilemmas and legal issues. In this study, we aim to justify the at-risk adolescents’ regulations on access to key reproductive health services (KRHSs) based on principles of Islamic biomedical ethics and jurisprudence. Despite the illegitimacy and prohibition of sexuality for both girls and boys in Islamic communities, in this study, using 5 principles or universal rules of purpose; certainty, no-harm; necessity; and custom, (...) we argue that first, applying these principles in the context of the no-harm principle can provide the best interests of at-risk adolescents; second, it is permissible to provide KRHSs to these adolescents with their own assent, as long as necessary, only with the intention of preventing or reducing harm. In this framework, while preventing harm, it tries to provide the best interests of at-risk adolescent. Thus, the principle of no-harm requires that the government, by designating the responsibility to healthcare professionals, protects at-risk adolescents from harm, and obliges these professionals to choose and implement the option that best suits adolescents’ interests. (shrink)

This essay concentrates on the term ‘children-at-risk’ taken on its own. However much risk and need are intertwined in practice, they are distinguishable as concepts. ‘Children-at-risk’ is not a virtual synonym of ‘children in need’. It is theologically suggestive and worth exploring because faith is always seeking understanding. All children are at risk in some way. Risks take various forms, each calling for an appropriate response. All risks are components of the ultimate risk of being (...) human, of falling short of the glory of God, of failing to be, to become and to persist in being, truly human, as measured in the fullness of Christ. Thus all risks have theological significance, unless God is denied totally, or restricted and stifled in a religious cave. God, Father, Son and Holy Spirit share the risk of being human mysteriously, really and unreservedly. This understanding of risk comes to us from our lived experience and from the revelation of God in Christ, as witnessed in the Scriptures. Action for children-at-risk and in need is obedience to the core of the Gospel in Jesus Christ. Engaged concern for children-at-risk brings us into practical difficulties, which are also theological. (shrink)

We have a responsibility to obey COVID-19 rules, in order to minimize risk. Yet it is still seen as rude to challenge people who do not respect those rules, when in fact the opposite is true; it is rude to increase risk to others. In this paper I analyse the relationship between risk, responsibility, and rudeness by analysing the evolution of the main governmental slogans and rules and explore the complex relationship between simplicity, safety, and perceived fairness (...) of these rules, and how these features in turn influence the extent to which we act responsibly. I begin by exploring the relationship between rudeness and risk in our interactions about coronavirus, before going on to analyse the importance of clear rules in minimizing tension between us, illustrating the argument with various slogans including “stay at home,” “stay alert,” and the now infamous “rule of six,” which is actually at least three different rules. Ultimately, we are faced with a paradox: people annoyed about complex/unfair rules are less likely to obey them, even if that means rules will apply for longer and even though it was noncompliance with earlier simpler rules that means new rules are necessary. And if rules make less or no sense it is harder to try to get people to follow them in your own capacity as a citizen; it is hard to police rules that are seen as arbitrary or unfair. (shrink)

ABSTRACTThe profession of arms is distinct from other professions for many reasons. One reason which is not so obvious is that, unlike members of other professions, soldiers may go their entire careers preparing for a day that never arrives. All things considered, we should think this to be a very good thing. For soldiers, however, this can feel somewhat odd, since there is a natural desire to want to feel useful and to see one’s role and purpose find realization. Accordingly, (...) the common soldier is forced to adopt a rather paradoxical mindset, one of longing for peace, and therefore for uselessness, while at the same time longing to be useful, which would entail that there be a war. This latter desire to be useful and to vindicate one’s identity as a soldier can sometimes take on an unhealthy life of its own. The pull of wanting too strongly to live up to a warrior identity, I argue, can sometimes skew a soldier’s ability to assess risk rationally. This article will therefore investigate how a soldier’s c... (shrink)

Some of the most difficult consultations for an ethics consultant to resolve are those in which the patient is ready to leave the acute-care setting, but the patient or family refuses the plan, or the plan is impeded by deficiencies in the healthcare system. Either way, the patient is “stuck” in the hospital and the ethics consultant is called to help get the patient “unstuck.” These encounters, which we call “complex discharges,” are beset with tensions between the interests of the (...) institution and the interests of the patient as well as tensions within the ethics consultant whose commitments are shaped both by the values of the organization and the values of their own profession. The clinical ethics literature on this topic is limited and provides little guidance. What is needed is guidance for consultants operating at the bedside and for those participating at a higher organizational level. To fill this gap, we offer guidance for facilitating a fair process designed to resolve the conflict without resorting to coercive legal measures. We reflect on three cases to argue that the approach of the consultant is generally one of mediation in these types of disputes. For patients who lack decision making capacity and lack a surrogate decision maker, we recommend the creation of a complex discharge committee within the organization so that ethics consultants can properly discharge their duties to assist patients who are unable to advocate for themselves through a fair and transparent process. (shrink)

A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally (...) grounded in a decision maker’s own desires, beliefs and actions. The presence of both doctor and patient raises the question of whose risk attitude matters for the choice at hand and what to do when these diverge. Must doctors make risky choices when treating risk-seeking patients? Ought they to be risk averse in general when choosing on behalf of others? In this paper, I will argue that healthcare professionals ought to adopt a deferential approach, whereby it is the risk attitude of the patient that matters in medical decision making. I will show how familiar arguments for widely held anti-paternalistic views about medicine can be straightforwardly extended to include not only patients’ evaluations of possible health states, but also their attitudes to risk. However, I will also show that this deferential view needs further refinement: patients’ higher-order attitudes towards their risk attitudes must be considered in order to avoid some counterexamples and to accommodate different views about what sort of attitudes risk attitudes actually are. (shrink)

Where artificial agents are not liable to be ascribed true moral agency and responsibility in their own right, we can understand them as acting as proxies for human agents, as making decisions on their behalf. What I call the ‘Moral Proxy Problem’ arises because it is often not clear for whom a specific artificial agent is acting as a moral proxy. In particular, we need to decide whether artificial agents should be acting as proxies for low-level agents — e.g. individual (...) users of the artificial agents — or whether they should be moral proxies for high-level agents — e.g. designers, distributors or regulators, that is, those who can potentially control the choice behaviour of many artificial agents at once. Who we think an artificial agent is a moral proxy for determines from which agential perspective the choice problems artificial agents will be faced with should be framed: should we frame them like the individual choice scenarios previously faced by individual human agents? Or should we, rather, consider the expected aggregate effects of the many choices made by all the artificial agents of a particular type all at once? This paper looks at how artificial agents should be designed to make risky choices, and argues that the question of risky choice by artificial agents shows the moral proxy problem to be both practically relevant and difficult. (shrink)

An anthropogenic global catastrophic risk is a human-induced risk that threatens sustained and wide-scale loss of life and damage to civilisation across the globe. In order to understand how new research on governance mechanisms for emerging technologies might assuage such risks, it is important to ask how perceptions, beliefs, and attitudes towards the governance of global catastrophic risk within the research community shape the conduct of potentially risky research. The aim of this study is to deepen our (...) understanding of emerging technology research culture as it relates to global catastrophic risks, and to shed new light on how new research governance mechanisms might be developed. We analyse in-depth interviews with leading AI and biotech researchers both from universities and the private sector. We develop new insights in terms of four salient themes. First, ‘engineering mindset’, which highlights the premium placed by many interviewees on pursuing interesting research about the physical world for its own sake. Second, ‘self-government’, which looks at how self-regulation of technological development currently occurs. Third, ‘pure incentives’, focussing on how career and other incentives shapes research. Fourth, ‘norms and persuasion’, which examines the role of moral considerations in guiding the research choices of scientists. We end by considering the implications of these findings for future research on governance of anthropogenic global catastrophic risk. (shrink)

The main aim of the paper is to present the results of research concerning psychological and socio-cultural risk factors for development of negative anti-health attitude toward one’s body in young Polish women. The study comprised 120 women, of 20 to 25 years of age, with similar socio-demographic status who so far in the course of their lives have not disclosed mental or somatic disturbances. The theoretical theses for the research model were the contemporary cognitive concepts, as well as socio-cultural (...) concepts. The following have been used in the study: thematic drawings, the Contour Drawing Rating Scale developed by - developed by Thompson & Gray, the Eating Disorder Inventory created by D. Garner, The Sociocultural Attitudes Towards Appearance Questionnaire 3, and questionnaire for behaviour towards the body. The results confirmed the existence of negative attitude toward one’s own body, as well as development of inclinations for compensation-generating behaviour. A group of risk factors has been identified, which may lead to the development of the above attitudes and behaviours toward one’s body in healthy women, who at the same time do not accept the image of their real bodies. (shrink)

This investigation focused on relationships among sexual assault, self-blame, and sexual revictimization. Among a female undergraduate sample of adolescent sexual assault victims, those endorsing greater self-blame following sexual assault were at increased risk for sexual revictimization during a 4.2-month follow-up period. Moreover, to the extent that sexual assault victims perceived nonconsensual sex is permitted by law, they were more likely to blame themselves for their own assaults. Discussion focuses on situating victim-based risk factors within sociocultural context.

When it comes to assessing the deontic status of acts and policies in the context of risk and uncertainty, moral theories are often at a loss. In this paper we hope to show that employing a multi-dimensional consequentialist framework provides ethical guidance for decision-making in complex situations. The paper starts by briefly rehearsing consequentialist responses to the issue of risk, as well as their shortcomings. We then go on to present our own proposal based on three dimensions: wellbeing, (...) fairness and probability. In the last section we apply our approach to a comparison of different climate policy options, including stratospheric solar-radiation management. (shrink)

While sexual and gender minorities are at increased risk for poor health outcomes, there is limited data regarding patient-provider interactions. In this study, we explored the perspectives of LGBTQ patients and their encounters with physicians in order to improve our understanding of patient-physician experiences. Using purposive selection of self-identified LGBTQ patients, we performed fourteen in-depth semi-structured interviews on topics of sexual orientation and gender identity, as well as their perceived role in the patient-provider relationship. Coding using a modified grounded (...) theory approach was performed to generate themes. We identified three major themes that demonstrate the complexity of LGBTQ patient experiences. The first, Lacking trust, identifies mistrust and loss of the physician-patient relationship resulting from physicians’ poor or judgmental communication, or from physicians making assumptions about gender, using incorrect pronouns, and not recognizing heterogeneity within the transgender community. A second theme, Being vulnerable, describes the challenges and fears related to comfort of patients with disclosing their sexual orientation and/or gender identity. A final theme, Navigating discrimination, outlines racial or ethnic discrimination which creates an additional burden on top of illness and stigmatized identity. Our results reveal the complex needs of individuals with multiple stigmatized identities when developing relationships with providers. By using an intersectional perspective that appreciates the plurality of patients’ identities, providers can help to improve their relationships with LGBTQ patients. Incorporating intersectional training for medical students and residents could greatly benefit both LGBTQ patients and their physicians. (shrink)

Though the duties of care owed toward innocents in war and in civil life are at the bottom univocally determined by the same ethical principles, Bazargan-Forward argues that those very principles will yield in these two contexts different “in-practice” duties. Furthermore, the duty of care we owe toward our own innocents is less stringent than the duty of care we owe toward foreign innocents in war. This is because risks associated with civil life but not war (a) often increase the (...) expected welfare of the individuals upon whom the risk is imposed, (b) are often imposed with consent, and (c) are often imposed reciprocally. The conclusion—that we have a pro tanto reason for adopting a more stringent standard of risk imposition toward foreign innocents in war—has implications for not only what standards of risk we should adopt in war, but also how we should weigh domestic versus foreign civilian lives. (shrink)

A central point of debate over environmental policies concerns how future costs and benefits should be assessed. The most commonly used method for assessing the value of future costs and benefits is economic discounting. One often-cited justification for discounting is uncertainty. More specifically, it is risk aversion coupled with the expectation that future prospects are more risky. In this paper I argue that there are at least two reasons for disputing the use of risk aversion as a justification (...) for discounting when dealing with longterm decisions, one technical and one ethical. Firstly, I argue that technically, it implies an inconsistency between theory and practice. And secondly, I argue that discounting for uncertainty relies on a form of individualism which, while reasonable in standard microeconomic theory where an agent chooses how to spread her own consumption over her own lifetime, is inappropriate in the context of intergenerational social decisions. (shrink)

We argue that we should provide extra payment not only for extra time worked but also for the extra risks healthcare workers (and those working in healthcare settings) incur while caring for COVID‐19 patients—and more generally when caring for patients poses them at significantly higher risks than normal. We argue that the extra payment is warranted regardless of whether healthcare workers have a professional obligation to provide such risky healthcare. Payment for risk would meet four essential ethical requirements. First, (...) assuming healthcare workers do not have a professional obligation to take on themselves the risks, payments in the form of incentives would preserve autonomy in deciding what risks to take on oneself. Second, even assuming that healthcare workers do have a professional obligation to take on themselves the risks, payments for risk would create fair working conditions by avoiding exploitation. Third, payments for risk would make it more likely that public healthcare systems can discharge their institutional responsibility to provide healthcare in circumstances where healthcare workers may otherwise (perhaps legitimately) opt out. Fourth, payments for risk would guarantee an efficient healthcare system in pandemic situations. Finally, we address two likely objections that some might raise against our proposal, particularly with regard to incentives, namely that such payments or incentives can themselves be coercive and that they represent a form of undue inducement. (shrink)

The term ’risk’ is used in a wide range of situations, but there is no real consensus of what it means. ‘Risk ‘is often stipulatively defined as “a probability for the occurrence of a negative event” or something similar. This formulation is however not very informative, and it fails to capture many of our intuitions about the concept or risk. One way of trying to find a common definition of a term within a group is to use (...) a Socratic Dialogue (SD). This method is fairly new, and it is rather different from the original Socratic dialogues (at least if we are to judge from how they are described by Plato). The best explanation for the name ought to be that it is inspired by the original Socratic dialogues. The SD in its modern form was originally developed as a tool for enabling laymen to perform rather advanced concept analyses under the supervision of a professional philosopher. The formal goal of the method is to find a common way of perceiving of a particular term, or at least to find out exactly how the members of the group differ in their understandings of the term, and why. The largest gain from the process has in practice turned out to be a higher awareness among the participants of different ways of understanding the term, and the ideas and intuitions behind it. This has turned out to be very useful in educational settings, but the method has also been used with great success both in research, and in e.g. business, public administration and nongovernmental organisations. In the present case, a Socratic dialogue on the concept of risk was performed within the framework of a Ph D-course about risk and uncertainty at the Swedish University of Agriculture in Alnarp, Sweden. The participants on the course where all quite familiar with practical issues relating to risks. Both from the course work, and from their own research. (shrink)

Neoclassical economists use expected utility theory to explain, predict, and prescribe choices under risk, that is, choices where the decision-maker knows---or at least deems suitable to act as if she knew---the relevant probabilities. Expected utility theory has been subject to both empirical and conceptual criticism. This chapter reviews expected utility theory and the main criticism it has faced. It ends with a brief discussion of subjective expected utility theory, which is the theory neoclassical economists use to explain, predict, and (...) prescribe choices under uncertainty, that is, choices where the decision-maker cannot act on the basis of objective probabilities but must instead consult her own subjective probabilities. (shrink)

This article approaches Ovid’s story of Echo and Narcissus in the Metamorphoses through some of Maurice Merleau-Ponty’s writings on expression and speech. Echo’s speech as portrayed by Ovid clearly illustrates how Merleau-Ponty describes speech in Phenomenology of Perception as a “paradoxical operation” through which we use words with already given sense and in that very process both stabilize and alter established meaning. Instead of reducing Echo to a moment of the identity and fate of Narcissus, I bring out Echo’s own (...) voice and the expression of her subjectivity through creative repetition. The short dialogue between Echo and Narcissus makes manifest that Echo’s words cannot be reduced to a simple repetition of a clear and distinct original. Rather, her speech emerges in relation to an original that is only made present as an original of a repetition in that very repetition. Echo’s voice is disruption of the words she repeats and each repetition is also its own origin. Echo’s own voice is only made present when we listen to it as something other than a simple repetition of the voice of Narcissus. The fragments she returns through her echo, lose their fragmented character through modifying and altering their already given meaning. What Echo lacks is not primarily a voice of her own but rather an unbound origin which by itself remains mute and thereby runs the risk of not expressing anything at all. Echo is repetition but it is precisely as repetition that she is also originating speech. (shrink)

Teachers are often placed in a space of tensionbetween responding to students as persons andresponding to students through theirinstitutionally-defined roles. Particularlywith respect to eros, which has becomeincreasingly the subject of strictinstitutional legislation and regulation,teachers have little recourse to a language ofresponsibility outside an institutional frame. By studying the significance of communicativeambiguity for responsibility, this paperexplores what is ethically at stake forteachers in erotic forms of communication. Specifically, it is Levinas's own ambiguousunderstanding of the ethical significance oferos, and what we have (...) to learn from it, thatoffers a way of reading the place of eros inresponsibility. I conclude my discussion withsome thoughts on what a renewed understandingof responsibility might mean at the personaland institutional levels. (shrink)

To address the burden of maternal morbidity and mortality in low‐ and middle‐income countries (LMICs), research with pregnant women in these settings is increasingly common. Pregnant women in LMIC‐context may experience vulnerability related to giving consent to participate in a clinical trial. To recognize possible layers of vulnerability this study aims to identify factors that influence the decision process towards clinical trial participation of pregnant women in an urban middle‐income setting. This qualitative research used participant observation, in‐depth interviews, and focus (...) group discussion with medical staff and pregnant women eligible for trial participation, at a regional hospital in Accra, Ghana. Besides lack of familiarity with modern scientific concepts, specific factors influencing the decision‐making process were identified. These include a wide power difference between health provider and patient, and a different perception of risk through externalization of responsibility of risk management within a religious context as well as a context shaped by authority. Also, therapeutic misconception was observed. The combination of these factors ensued women to rely on the opinion of the medical professional, rather than being guided by their own motivation to participation. Although being a (pregnant) woman per se should not render the label of being vulnerable, this study shows there are factors that influence the decision process of pregnant woman towards trial participation in a LMIC context that can result in vulnerability. The identification of context‐specific factors that can create vulnerability facilitates adaptation of the design and conduct of research in a culturally competent manner. (shrink)

During times of emergency like the pandemic itself, governments are often seen as exercising “exceptional power”. Given the state of growing urgency in responding to the pandemic, there is a worry that governments may resort to exercising their exceptional power arbitrarily—either willingly, unintentionally or perhaps even negligently. When power is exercised by states or even by non-state actors arbitrarily over a person or group, that is, at their own will in the absence of appropriate institutional checks and balances, republican theorists (...) argue that we are confronted with a threat to our freedom as non- domination. In this chapter, I explore whether, and in what ways, worries about domination could surface in the context of government’s enforcement of risk- containment measures in response to the pandemic. While imposition of these measures is deemed necessary and important for reducing risks in response to the pandemic, their imposition is prima facie problematic if it constitutes or entails wrongful exercise of arbitrary power, thereby risking domination of citizens. I motivate this claim by examining India’s initial response to the Covid-19 pandemic, particularly focussing on the public health emergency legislature (or lack thereof) authorising the implementation of emergency risk-containment measures. (shrink)

We reflect, using a vignette, on conceptual tensions and the value judgements that lie behind difficult decisions about whether or not the older person with dementia should return home or move into long-term care following hospital admission. The paper seeks, first, to expose some of the difficulties arising from the assessment of residence capacity, particularly around the nature of evaluative judgements and conceptual tensions inherent in the legal approach to capacity. Secondly, we consider the assessment of best interests around place (...) of residence, which demonstrates significant conceptual tensions. In addition, ‘best interests’ raise issues around the perception of risk and the perceptions of the family and crucially involve the notions of autonomy and trust. Finally, we not only gesture at some practical considerations based on insights from values-based medicine, but also make the suggestion that we require tighter functional assessments of residence capacity coupled with broader judgements about best interests. (shrink)

BackgroundThe cognitive outcomes induced by subthalamic nucleus deep brain stimulation (STN-DBS) remain unclear, especially in PD patients with mild cognitive impairment (MCI). This study explored the cognitive effects of STN-DBS in PD patients with MCI.MethodsThis was a retrospective cohort study that included 126 PD patients who underwent STN-DBS; all patients completed cognitive and motor assessments before and at least 6 months after surgery. Cognitive changes were mainly evaluated by the Montreal cognitive assessment (MoCA) scale and the seven specific MoCA domains, (...) including visuospatial/executive function, naming, attention, language, abstract, delayed recall, and orientation. Motor improvement was evaluated by the UPDRS-III. Cognitive changes and motor improvements were compared between PD-MCI and normal cognitive (NC) patients. Logistic regression analyses were performed to explore predictors of post-operative cognitive change.ResultsAt the time of surgery, 61.90% of the included PD patients had MCI. Compared with the PD-MCI group, the PD-NC group had a significantly higher proportion of cases with post-operative cognitive decline during follow-up of up to 36 months (mean 17.34 ± 10.61 months), mainly including in global cognitive function, visuospatial/executive function and attention. Covariate-adjusted binary logistic regression analyses showed that pre-operative global cognitive status was an independent variable for post-operative cognitive decline. We also found that pre-operative cognitive specific function could predict its own decline after STN-DBS, except for the naming and orientation domains.ConclusionPD-MCI patients are at a lower risk of cognitive decline after STN-DBS compared with PD-NC patients. (shrink)