Background In this study, we examined the ethical implications of Egypt’s new clinical trial law, employing the ethical framework proposed by Emanuel et al. and comparing it to various national and supranational laws. This analysis is crucial as Egypt, considered a high-growth pharmaceutical market, has become an attractive location for clinical trials, offering insights into the ethical implementation of bioethical regulations in a large population country with a robust healthcare infrastructure and predominantly treatment-naïve patients. Methods We (...) conducted a comparative analysis of Egyptian law with regulations from Sweden and France, including the EU Clinical Trials Regulation, considering ethical human subject research criteria, and used a directed approach to qualitative content analysis to examine the laws and regulations. This study involved extensive peer scrutiny, frequent debriefing sessions, and collaboration with legal experts with relevant international legal expertise to ensure rigorous analysis and interpretation of the laws. Results On the rating of the seven different principles (social and scientific values, scientific validity, fair selection of participants, risk-benefit ratio, independent review, informed consent and respect for participants) Egypt, France, and EU regulations had comparable scores. Specific principles (Social Value, Scientific Value, and Fair selection of participants) were challenging to directly identify due to certain regulations embodying 'implicit' principles more than explicitly stated ones. Conclusion The analysis underscores Egypt's alignment with internationally recognized ethical principles, as outlined by Emanuel et al., through its comparison with French, Swedish, and EU regulations, emphasizing the critical need for Egypt to continuously refine its ethical regulations to safeguard participant protection and research integrity. Key issues identified include the necessity to clarify and standardize the concept of social value in research, alongside concerns regarding the expertise and impartiality of ethical review boards, pointing towards a broader agenda for enhancing research ethics in Egypt and beyond. (shrink)

Despite its successes, to date Artificial Intelligence (AI) is still characterized by a number of shortcomings with regards to different application domains and goals. These limitations are arguably both conceptual (e.g., related to the underlying theoretical models, such as symbolic vs.connectionist), and operational (e.g., related to robustness and ability to generalize). Biologically inspired AI, and more specifically brain-inspired AI, promises to provide further biological aspects beyond those that are already traditionally included in AI, making it possible to assess and possibly (...) overcome some of its present shortcomings. This article examines some conceptual, technical, and ethical issues raised by the development and use of brain-inspired AI. Against this background, the paper asks whether there is anything ethically unique about brain-inspired AI. The aim of the paper is to introduce a method that has a heuristic nature and that can be applied to identify and address the ethical issues arising from brain-inspired AI (and from AI more generally). The conclusion resulting from the application of this method is that, compared to traditional AI, brain-inspired AI raises new foundational ethical issues and some new practical ethical issues, and exacerbates some of the issues raised by traditional AI. (shrink)

In order to have an effective and reliable understanding of the basic moral concepts, moral propositions and moral reasoning in Daoist ethical thoughts, it is necessary to use the methods of doing philosophy and doing ethics to engage in research work, and thus draw an intellectual conclusion about Daoist ethics. The methods of Daoist ethics mainly include analysis, explanation and comparison. The method of analysis focuses on logical analysis and language analysis of moral language in (...) the classic texts of Daoist ethics. The method of interpretation focuses on effective translation and understanding of moral language with unclear meaning in Daoist ethics. The method of comparison focuses on critical dialogue between ancient Daoist ethical thoughts and contemporary ethical theories and comparison between Confucian, Buddhist and Daoist ethics. Explaining the method of doing Daoist ethics clearly will promote the dialogue and understanding between Daoist ethics and contemporary ethics. (shrink)

The general public and environmental policy makers often perceive management actions of environmental managers as “science,” when such actions are, in fact, value judgments about when to intervene in natural processes. The choice of action requires ethical as well as scientific analysis because managers must choose a normative outcome to direct their intervention. I examine a management case study involving prescribed burning of sagebrush (Artemisia tridentata) communities in south-central Montana (USA) to illustrate how to teach students to ethically (...) evaluate a management action by precisely identifying: 1) the proposed management action, 2) the deficiency of the system to be remedied by the action, 3) the stakeholders affected by the action, and 4) the category and type of values affirmed in the management action. Through such analysis, students are taught to recognize implicit and explicit value judgments associated with management actions, identify stakeholders to whom managers have legitimate ethical obligations, and practice a general method of ethical analysis applicable to many forms of environmental management. (shrink)

There’s no doubt that medical ethics should be ‘grounded’, in the sense that it aims to make a practical, normative contribution to significant ethical issues in medicine. There are a number of ways in which ethics can do that, two of which feature in this issue of the Journal of Medical Ethics. One way is by responding to significant new policy or legal developments that will have an impact on clinical practice. This issue discusses two legal developments that matter (...) to patients and healthcare professionals: the sanctions applied to Dr Bawa-Garba and the Supreme Court’s ruling on the withdrawal of artificial nutrition and hydration. A second way of grounding ethical analysis in the reality and complexity of ethical issues is by using empirical methods. There are two papers in this issue from Canada that illustrate how the subtleties of complex ethical issues can be teased out via qualitative methods. Medical tourism is an important and rapidly developing phenomenon that raises a set of interesting and tricky ethical issues.1 It has been discussed in the Journal of Medical Ethics before and its implications for end of life, dentistry and other health interventions have been explored.2 3 Reproductive tourism occurs in many countries and the complications it can create for issues such as the citizenship of resulting children have been discussed at some length in the JME.4 5 Reproductive tourism is a good example of an area where it is particularly important for ethical analysis to be grounded in the facts and reality of a situation and an empirical approach to ethics is therefore a good option for this topic. In this issue, Couture et …. (shrink)

The general public and environmental policy makers often perceive management actions of environmental managers as science, when such actions are, in fact, value judgments about when to intervene in natural processes. The choice of action requires ethical as well as scientific analysis because managers must choose a normative outcome to direct their intervention. I examine a management case study involving prescribed burning of sagebrush (Artemisia tridentata) communities in south-central Montana (USA) to illustrate how to teach students to ethically (...) evaluate a management action by precisely identifying: 1) the proposed management action, 2) the deficiency of the system to be remedied by the action, 3) the stakeholders affected by the action, and 4) the category and type of values affirmed in the management action. Through such analysis, students are taught to recognize implicit and explicit value judgments associated with management actions, identify stakeholders to whom managers have legitimate ethical obligations, and practice a general method of ethical analysis applicable to many forms of environmental management. (shrink)

As more national governments adopt policies addressing the ethical implications of artificial intelligence, a comparative analysis of policy documents on these topics can provide valuable insights into emerging concerns and areas of shared importance. This study critically examines 57 policy documents pertaining to ethical AI originating from 24 distinct countries, employing a combination of computational text mining methods and qualitative content analysis. The primary objective is to methodically identify common themes throughout these policy documents and perform (...) a comparative analysis of the ways in which various governments give priority to crucial matters. A total of nineteen topics were initially retrieved. Through an iterative coding process, six overarching themes were identified: principles, the protection of personal data, governmental roles and responsibilities, procedural guidelines, governance and monitoring mechanisms, and epistemological considerations. Furthermore, the research revealed 31 ethical dilemmas pertaining to AI that had been overlooked previously but are now emerging. These dilemmas have been referred to in different extents throughout the policy documents. This research makes a scholarly contribution to the expanding field of technology policy formulations at the national level by analyzing similarities and differences among countries. Furthermore, this analysis has practical ramifications for policymakers who are attempting to comprehend prevailing trends and potentially neglected domains that demand focus in the ever-evolving field of artificial intelligence. (shrink)

In the dialogues earlier than the Republic, Plato indicates in many ways his lack of confidence that any method of ethical analysis will lead to a discovery of the truth. The doubts which he expresses or implies have not always been given the attention which they deserve, and there has often been a reluctance to accept them as an expression of Plato's genuine conviction. There is, admittedly, some justification for this reluctance. Plato does not always seem to be (...) consistent. In his attitude towards the results attainable by the use of a method of joint inquiry, he is sometimes extremely optimistic, at other times sceptical; and it seems a not unreasonable explanation of his scepticism to ascribe it to his desire to preserve a consistent portrait of the ‘ignorant’ Socrates. Thus the hesitation and reserve with which Plato immediately qualifies his dogmatic presentation of the theory of νμνησις in the Meno is explicable as a concession to dramatic realism. His reference to the method discussed in the Phaedo as a δετερος πλος may be dismissed as ‘ironical’, as ‘the habitual playful selfdepreciation of Socrates’. The purpose of this paper is to suggest that the development of Plato's views on method in the dialogues as far as the Republic can be traced more consistently if we accept Plato's doubts, as well as his optimism, about ethical analysis, as the expression of his genuine conviction. (shrink)

Movies can serve valuable didactic purposes teaching clinical ethics to medical students. However, using film sequences as means to develop critical thinking is not a straightforward task. There is a significant gap in the literature regarding how to analyse the ethical content embedded in these clips systematically, in a way that facilitates the students’ transition from anecdotal reflections to abstract thinking. This article offers a pedagogical proposal to approach the ethical analysis of film sequences in a systematic (...) fashion. This structured stepwise method encourages students to identify the main ethical problem of a selected scene and to reflect on the theoretical principles involved, emphasizing the application of these norms and values in a contextually situated analysis. We believe this method in film studies both reinforces the students’ comprehension of the theoretical framework of an ethical topic, and casts light on its pertinence and limitations under the circumstances of the scene, thus proving a constructive tool to strengthen the bridge between the theoretical teaching of clinical ethics and clinical practice. (shrink)

This paper provides a systematic literature review, analysis and discussion of methods that are proposed to practise ethics in research and innovation. Ethical considerations concerning the impacts of R&I are increasingly important, due to the quickening pace of technological innovation and the ubiquitous use of the outcomes of R&I processes in society. For this reason, several methods for practising ethics have been developed in different fields of R&I. The paper first of all presents a systematic search of academic (...) sources that present and discuss such methods. Secondly, it provides a categorisation of these methods according to three main kinds: ex ante methods, dealing with emerging technologies, intra methods, dealing with technology design, and ex post methods, dealing with ethical analysis of existing technologies. Thirdly, it discusses the methods by considering problems in the way they deal with the uncertainty of technological change, ethical technology design, the identification, analysis and resolving of ethical impacts of technologies and stakeholder participation. The results and discussion of our literature review are valuable for gaining an overview of the state of the art and serve as an outline of a future research agenda of methods for practising ethics in R&I. (shrink)

Improvements in production methods over the last two decades have resulted in aquaculture becoming a significant contributor to food production in many countries. Increased efficiency and production levels are off-setting unsustainable capture fishing practices and contributing to food security, particularly in a number of developing countries. The challenge for the rapidly growing aquaculture industry is to develop and apply technologies that ensure sustainable production methods that will reduce environmental damage, increase productivity across the sector, and respect the diverse social and (...) cultural dimensions of fish farming that are observed globally. The aquaculture industry currently faces a number of technology trajectories, which include the option to commercially produce genetically modified (GM) fish. The use of genetic modification in aquaculture has the potential to contribute to increased food security and is claimed to be the next logical step for the industry. However, the potential use of these technologies raises a number of important ethical questions. Using an ethical framework, the Ethical Matrix, this paper explores a number of the ethical issues potentially raised by the use of GM technologies in aquaculture. Several key issues have been identified. These include aspects of distributive justice for producers; use of a precautionary approach in the management of environmental risk and food safety; and impacts on the welfare and intrinsic value of the fish. There is a need to conduct a comparative analysis of the full economic cycle of the use of GM fish in aquaculture production for developing countries. There is also a need to initiate an informed dialogue between stakeholders and strenuous efforts should be made to ensure the participation of producers and their representatives from developing nations. An additional concern is that any national licensing of the first generation of GM fish, i.e., in the USA, may initiate and frame an assessment cycle, mediated by the WTO, which could dominate the conditions under which the technology will be applied and regulated globally. Therefore, an integrated analysis of the technology development trajectories, in terms of international policy, IPR, and operational implications, as well as an analysis of a broader range of ethical concerns, is needed. (shrink)

The purpose of the research is to explicate the Buddhist principles of ethical analysis of premeditated murder as an immoral act. The author solves this problem through the method of case study of exegetical treatises of outstanding Buddhist thinkers Vasubandhu (4th-5th centuries) and Yašomitra (8th century). It is shown that the ethical analysis of premeditated murder is based on a religious anthropological concept (the Buddhist doctrine of human action producing karmic retribution). Sinful intent is interpreted as (...) an immoral mental urge that generated a verbal intention to take the life of a certain person or a certain animal. According to the canonical point of view, there are three mental roots of immoral acts - greed, hatred, ignorance. The ethnical analysis of sinful intent is aimed at determining the connection of intent with any of these three mental phenomena. In accordance with this principle, Buddhist thinkers have identified three types of premeditated murder. All of them produce a “black” (unfavorable) karmic fruit, i.e. an unfortunate form of rebirth, exacerbating physical suffering. Great attention is paid by the author to the problem of the karmic responsibility of individuals ordering murders and the executors of such orders. In the considered sources, the verbal order to kill and its physical execution are interpreted as equally immoral actions that produce collective karmic responsibility. The author of the research examines in detail a special class of premeditated murder, fraught with inevitable infernal retribution. This class includes murders of benefactors (mother, father, arhat) and Buddhist ascetics practicing asceticism. These malicious sins were interpreted as an insurmountable obstacle to achieving a soteriological goal, even in the distant transcendental future. It is shown that Buddhist exegetes have developed principles for diagnosing these sins and characterized the immoral personal characteristics of sinners (disrespect towards parents, Buddhist preachers and religious ascetics, heretical denial of spiritual values, shamelessness, arrogance, ignorant self-will, misanthropy). (shrink)

Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses a reflective (...) equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions ], we argue that the patient needs to experience some degree of suffering, which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development. (shrink)

Business Ethics: Theories, Methods, and Applications provides a new systematic approach to normative business ethics that covers the complex and various ethical challenges of modern business. It aims to train analytical thinking skills in the field of business ethics and to approach ethical issues in business in a rational and systematic way. The book develops a number of specific methods for business ethics analysis that are tailored for ethical decision-making in business and for analysing complex (...) class='Hi'>ethical topics in business. The book discusses fundamental ethical questions regarding the meaning of business and the economy for the individual person, society, the environment, and people around the world. As a result, Business Ethics: Theories, Methods, and Applications develops normative guidelines for business in the 21st century and its fundamental challenges and will be key reading for undergraduate, postgraduate, and MBA students of business ethics, business strategy, business and society, and related fields. This second edition is fully updated to recognize the changing nature of ethics and corporate responsibility in a globalized world and include online support material. (shrink)

Here we provide an overview of some of the central ethical issues related to the use of surgical robots. Subsequently we introduce an anticipatory ethical analysis of possible consequences for the use of robotic surgery. Anticipatory ethics aims at identifying ethical problems with emerging technologies while they are at the introductory stages for a wide range of stakeholders. Robotic surgery presents a range of positive possibilities, which include treating patients more safely and effectively to caring for (...) patients with telesurgery at remote locations. However, injuries and deaths caused by robotic surgical platforms (RSPs) pose roadblocks to full realization of this technology. Investment in RSPs by for-profits like hospitals requires a detailed stakeholder analysis that takes into account both institutional and patient perspectives. It will take carefully crafted policy and regulation based upon sound technical and ethical analysis to induce the widespread adoption of this surgical method. (shrink)

Nanotechnology (NT)‐enabled disease‐free life is a form of reconstruction of the human body that promises a paradigm shift toward a new form of human existence in an imaginable life. However, as human reconstruction may be within the limits of the concept of “human enhancement,” it is not clear to what extent “enhanced humans” will be ethically acceptable or desired. This study discusses the ethical implications of NT‐embedded enhanced humans and this new imaginable life. First, ethical concerns arising from (...) the existence of a grey zone of certain dilemmas regarding benefits and possible/unpredicted risks are addressed in terms of the four main principles of bioethics. Then, we focus on the ethical problems in human nano‐enhancement. Finally, we study the methods of analyzing these ethical problems within the framework of principlism to conceive a comprehensive and coherent bioethical understanding. (shrink)

Technological advancements in information systems over the past few decades have enabled firms to work with the major suppliers and customers in their supply chain in order to improve the performance of the entire channel. Tremendous benefits for all parties can be realized by sharing information and coordinating operations to reduce inventory requirements, improve quality, and increase customer satisfaction; but the companies must collaborate effectively to bring these gains to fruition. We consider two alternative methods of managing these interfirm supply (...) chain relationships in this article. The first, which we have named “dictatorial collaboration,” occurs when a dominant supply chain entity assumes control of the channel and forces the other firms to follow its edicts. We compare and contrast this method with “sustainable collaboration,” in which the parties share resources and engage in joint problem solving to improve the performance of the system as a whole. We use a virtue ethics lens to describe these methods of relationship management to suggest that sustainable collaboration is preferable to dictatorial collaboration both operationally and ethically in the long run. (shrink)

This paper examines the role of managerial self-interest in the merger market. It looks at factors influencing managers'' merger decisions by analyzing managerial expense preference factors on cross-sectional data employing non-parametric statistical methods. The same factors are examined for acquiring, acquired, and merging firms, and control groups used in each case. The results support the authors'' contention that managerial discretion is a significant motivating factor for mergers. The changes in expense preference factors indicate management decisions which provide conditions allowing management (...) to indulge in management preferred expenditures, while reducing risk to their career. The authors then provide a moral/philosophic framework of ethical analysis for examining manager''s merger decisions, using teleological and deontological theories. They conclude that merger decisions motivated or influenced by self-interest are unethical and, in the process, provide managers facing a merger decision with a framework for making an ethical decision. (shrink)

Schools of economic ethics inspired by Buchanan propose viewing ethical conflicts as prisoners’ dilemmas to facilitate solutions based on Pareto-improving institutional changes. Given that healthcare is determined by complex institutional arrangements, it has been claimed that this approach is also suitable for business ethics in healthcare. To scrutinize this claim, this research systematically searched for studies reporting PD structures in healthcare. PubMed, EconLit, and EconBiz were searched to find articles in German and English. Study type, characteristics of the game, (...) and the proposed means to overcome the dilemma were extracted and analyzed for aspects supporting or challenging the claim. Across 53 studies, 68 descriptions of various dilemmas in healthcare and public health were identified. Many authors successfully developed proposals for institutional change to overcome these dilemmas. However, many of these analyses exhibited limitations such as oversimplifications or inconsistencies. Also, the quality of evidence on both the characteristics of dilemmas and the effectiveness of proposed solutions was very poor. The subsamples of studies that explicitly cited the ethical approach were disjunct from those that applied empirical methods to analyze the dilemmas. The large number of identified PDs indicates that economic ethics is relevant to healthcare. However, there is a need for further evidence to substantiate both the descriptive and prescriptive claims of this ethical theory. It should thus be seen as a complement that needs justification, rather than a substitute superior to other ethical frameworks. (shrink)

Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. -/- Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. -/- Methods: On the basis of (...) a systematic literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles. -/- Results: We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients. -/- Conclusions: The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access. (shrink)

Introduction Hundreds of thousands of premature neonates born in low-income countries are implicitly denied treatment each year. Studies from India show that treatment is rationed even for neonates born at 32 gestational age weeks (GAW), and multiple external factors influence treatment decisions. Is withholding of life-saving treatment for children born between 28 and 32 GAW acceptable from an ethical perspective? Method A seven-step impartial ethical analysis, including outcome analysis of four accepted priority criteria: severity of disease, (...) treatment effect, cost effectiveness and evidence for neonates born at 28 and 32 GAW. Results The ethical analysis sketches out two possibilities: (a) It is not ethically permissible to limit treatment to neonates below 32 GAW when assigning high weight to health maximisation and overall health equality. Neonates below 32 GAW score high on severity of disease and efficiency and cost-effectiveness of treatment if one gives full weight to early years of a newborn life. It is in the child's best interest to be treated. (b) It can be considered ethically permissible if high weight is assigned to reducing inequality of welfare and maximising overall welfare and/or not granting full weight to early years of newborns is considered acceptable. From an equity-motivated health and welfare perspective, we would not accept (b), as it relies on accepting the lack of proper welfare policies for the poor and disabled in India. Conclusion Explicit priority processes in India for financing neonatal care are needed. If premature neonates are perceived as worth less than other patient groups, the reasons should be explored among a broad range of stakeholders. (shrink)

ABSTRACT Objective: To contrast relief efforts for the 26 December 2004 tsunami with current global HIV/aids relief efforts and analyse possible reasons for the disparity. Methods: Literature review and ethical analysis. Results: Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation’s long‐term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/aids in 2004, with UNAIDS predicting a (...) US$8 bn funding gap for HIV/aids in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response? The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/aids to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/aids pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community? Conclusion: We detected no morally relevant distinction between the tsunami and the HIV/aids pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/aids violates the fundamental principles of justice and fairness. (shrink)

Introduction: There is currently no binding, internationally accepted and successful approach to ensure global equitable access to healthcare during a pandemic. The aim of this ethical analysis is to bring into the discussion a legally regulated vaccine allocation as a possible strategy for equitable global access to vaccines. We focus our analysis on COVAX (COVID-19 Vaccines Global Access) and an existing EU regulation that, after adjustment, could promote global vaccine allocation. -/- Methods: The main documents discussing the (...) two strategies are examined with a qualitative content analysis. The ethical values reasonableness, openness and transparency, inclusiveness, responsiveness and accountability serve as categories for our ethical analysis. -/- Results: We observed that the decision-making processes in a legal solution to expand access to vaccines would be more transparent than in COVAX initiative, would be more inclusive, especially of nation states, and the values responsiveness and accountability could be easily incorporated in the development of a new regulation. -/- Discussion: A legal strategy that offers incentives to the pharmaceutical industry in return for global distribution of vaccines according to the Fair Priority Model is an innovative way to achieve global and equitable access to vaccines. However, in the long term, achieving the Sustainable Development Goals will require from all nations to work in solidarity to find durable solutions for global vaccine research and development. Interim solutions, such as our proposed legal strategy for equitable access to vaccines, and efforts to find long-term solutions must be advanced in parallel. (shrink)

BackgroundBesides balancing burdens and benefits of intensive care, ethical conflicts in the process of decision-making should also be recognised. This calls for an ethical analysis relevant to clinicians. The aim was to analyse ethically difficult situations in the process of deciding whether a patient is admitted to intensive care unit.MethodsAnalysis using the ‘Dilemma method’ and ‘wide reflective equilibrium’, on ethnographic data of 45 patient cases and 96 stakeholder interviews in six UK hospitals.Ethical analysisFour moral questions and (...) associated value conflicts were identified. Who should have the right to decide whether a patient needs to be reviewed? Conflicting perspectives on safety/security. Does the benefit to the patient of getting the decision right justify the cost to the patient of a delay in making the decision? Preventing longer-term suffering and understanding patient’s values conflicted with preventing short-term suffering and provision of security. To what extent should the intensivist gain others’ input? Professional independence versus a holistic approach to decision-making. Should the intensivist have an ongoing duty of care to patients not admitted to ICU? Short-term versus longer-term duty to protect patient safety. Safety and security were key values at stake in the ethical conflicts identified. The life-threatening nature of the situation meant that the principle of autonomy was overshadowed by the duty to protect patients from harm. The need to fairly balance obligations to the referred patient and to other patients was also recognised.ConclusionProactive decision-making including advance care planning and escalation of treatment decisions may support the inclusion of patient autonomy. However, our analysis invites binary choices, which may not sufficiently reflect reality. This calls for a complementary relational ethics analysis. (shrink)

The case method approach to introducing ethical issues is a traditional tool for applying critical thinking skills to a specific dilemma (Beauchamp & Childress, 2001). It allows for personal reflection and clarification of an individual's conceptual framework for deciding what is and is not ethical behavior. However, it also affords the student distance from the story line and may, through providing a retrospective critique, prevent sufficient challenge to the student to articulate and defend personal value assessments in addressing (...) the ethical dynamics reflected in the case. Providing teaching exercises that encourage the creation of language to form that conceptual framework and a comfort in using that language allows the student to not only identify ethical issues but also recognize and more effectively communicate the struggles with molding a personal values portrait to apply to such cases. (shrink)

Here I use aspects of Phil Graham’s discourse analytical work to examine forms of e/valuations and critically analyse the formulation of truths in the constitution of Artificial Intelligence (hereafter, AI). This paper focuses on two 2019 documents: Ethics guidelines for trustworthy AI (AI HLEG, Citation2019a) and Policy and investment recommendations for trustworthy AI (AI HLEG, Citation2019b). My aim here is to provide a timely contribution to contemporary philosophical–methodological innovations in documenting the constellation of values that are prefigured in human-centric constructions (...) of AI. The analysis is informed primarily by principles from Graham’s distinctive approach to critical discourse analysis (CDA), which I take to be the philosophical study of valuation. In that approach, political economy is taken as a composite formulation of values whereby neo-liberalism is discursively entwined and progressed through a system of principles of e/valuation. This paper presents a roadmap to demonstrate the usefulness of a philosophically grounded interdisciplinary piece of linguistic research through which evaluative semantic categories can be usefully synthesised with CDA to systematically expose the assumptions which underpin current truth claims and values – in this case, about and around the ethics of AI. (shrink)

Emotions play a significant role in human relations, decision-making, and the motivation to act on those decisions. There are ongoing attempts to use artificial intelligence (AI) to read human emotions, and to predict human behavior or actions that may follow those emotions. However, a person’s emotions cannot be easily identified, measured, and evaluated by others, including automated machines and algorithms run by AI. The ethics of emotional AI is under research and this study has examined the emotional variables as well (...) as the perception of emotional AI in two large random groups of college students in an international university in Japan, with a heavy representation of Japanese, Indonesian, Korean, Chinese, Thai, Vietnamese, and other Asian nationalities. Surveys with multiple close-ended questions and an open-ended essay question regarding emotional AI were administered for quantitative and qualitative analysis, respectively. The results demonstrate how ethically questionable results may be obtained through affective computing and by searching for correlations in a variety of factors in collected data to classify individuals into certain categories and thus aggravate bias and discrimination. Nevertheless, the qualitative study of students’ essays shows a rather optimistic view over the use of emotional AI, which helps underscore the need to increase awareness about the ethical pitfalls of AI technologies in the complex field of human emotions. (shrink)

While a significant literature has appeared discussing theoretical ethical concerns regarding COVID-19, particularly regarding resource prioritization, as well as a number of personal reflections on providing patient care during the early stages of the pandemic, systematic analysis of the actual ethical issues involving patient care during this time is limited. This single-center retrospective cohort mixed methods study of ethics consultations during the first surge of the COVID 19 pandemic in Massachusetts between March 15, 2020 through June 15, (...) 2020 aim to fill this gap. Results indicate that there was no significant difference in the median number of monthly consultation cases during the first COVID-19 surge compared to the same period the year prior and that the characteristics of the ethics consults during the COVID-19 surge and same period the year prior were also similar. Through inductive analysis, we identified four themes related to ethics consults during the first COVID-19 surge including (1) prognostic difficulty for COVID-19 positive patients, (2) challenges related to visitor restrictions, (3) end of life scenarios, and (4) family members who were also positive for COVID-19. Cases were complex and often aligned with multiple themes. These patient case-related sources of ethical issues were managed against the backdrop of intense systemic ethical issues and a near lockdown of daily life. Healthcare ethics consultants can learn from this experience to enhance training to be ready for future disasters. (shrink)

Objective The objective of this article is to provide an ethical analysis of a high-risk, advanced treatment case where the patient received transcatheter aortic valve insertion, for aortic valve stenosis. Particular emphasis will be placed upon the significance of evidence and the implications for priority setting. Method One paradigmatic case involving a TAVI patient from a large university hospital in Norway is described and analysed. The method used was ethical case analysis modified after Kymlicka by Miljeteig (...) et al. Perioperative mortality risk was estimated using the Euroscore risk-logarithm and the Society of Thoracic Surgeons’ risk model, STS. These predict the risk of operative mortality and morbidity associated with adult cardiac surgery. GRADE, the Grading of Recommendations Assessment, Development and Evaluation, was used to evaluate the evidence. Results In the case analysis, we found that it would be ethically justifiable not to recommend TAVI treatment for this patient. Although the patient had a severe condition in need of treatment, the expected improvement was marginal, the quality of evidence was low and the opportunity costs for other patients and society were higher than usually deemed appropriate. Conclusions Decision-making in the absence of high quality evidence from randomized trials is a complex process involving difficult ethical judgments. Novel high-risk devices often enter the European market with limited clinical evidence. Transparency and improved clinical evaluation are required so patient safety is not jeopardized. We argue that implementation of high risk, high cost interventions should be better regulated at a national level. Background All clinical decisions imply priority setting and therefore indirectly affect other patients and other patient groups. The use of expensive, innovative health technologies has an affect on individual patients as well as on other patient groups competing for the same resources. (shrink)

There has been increasing interest in developing practical, non-theoretical tools for analyzing ethical problems in public health, biomedicine, and other scientific disciplines so that professionals can make and justify ethical decisions in their own research or practice. Tools for ethical decisionmaking, together with case studies on ethics, are often used in graduate education programs and in continuing professional education. Students can benefit from opportunities to further develop their analytical skills, to recognize ethical issues, and to develop (...) their moral sensitivity. One practical approach for illustrating and facilitating ethical analysis uses cases with contrary facts and circumstances, an approach which complements rather than replaces theoretical approaches to moral reasoning. Cases with contrary facts and circumstances are presented in two or more alternative ways so that the facts, circumstances, or framing of one version runs counter to that of the other version (s). Cases with contrary facts, together with practical steps for identifying and analyzing ethical issues, are likely to be useful tools for illustrating and facilitating ethics analysis and stimulating the moral imagination. (shrink)

BackgroundThe Catalan Institute of Health is the largest health services public provider in Catalonia. “CIH Code of Ethics Virtual Forum”, was created within the Intranet of the CIH to facilitate participation among their employees. The current study aims to: a) Analyse the CIH workers’ assessment of their own, their colleagues’ and the organization’s observance of ethical values; b) Identify the opinions, attitudes, experiences and practices related to the ethical values from the discourse of the workers that contributed voluntarily (...) to the CEVF.MethodsMixed methods study with convergent parallel design:1.Cross sectional study by means of a self-administered, ad hoc, anonymous questionnaire to assess the observance of the ethical values of the CIH according to the participants. A total of 712 workers responded to the questionnaire. A descriptive, bivariate analysis of the results was carried out. 2.Qualitative study to determine the meaning for the workers of the ethical values put forward by the organization. Their individual opinions and experiences were explored by means of a thematic contents analysis of 225 comments posted in the CEVF. The study was conducted between May and December 2008.ResultsThe average score for observance of the CE by the respondents themselves was high, between 3.5-4/5 for the observance by their colleagues and close to 3/5 for the CIH management. These results do not change when we compare by gender, age group and professional discipline. The comments on the values are information-rich, they mirror the ethical environment of the institution and show various ethical dilemmas and suggestions.ConclusionsResults show that it is feasible for a publicly funded health care organization to develop a CE with the participation of employees and the support of the management. Results underscore the relevance of this strategy for the implementation, improvement and update of the CE as a responsibility shared by all workers. Practices consistent with ethical values are rewarded by social approval, enhance employee’s confidence and coherence in decision-making and improve public engagement and institutional policies. (shrink)

The aim of this article is to discuss quantitative content analysis as established in communication sciences as a method for research in business ethics. We argue that communication sciences and business ethics are neighboring disciplines, which allow the transfer of quantitative content analysis from communication sciences to business ethics. Technically, quantitative content analysis can be applied through human as well as software coding. Examples for both applications are provided and discussed. We make reference to the software solutions (...) ‘Leximancer’, ‘Crawdad’, and ‘Wordle’, and examine their suitability and limitations with regard to ethical questions for researching business ethics. We recommend a mixed‐method approach, combining human and software coding. Furthermore, we propose a three‐step process that discusses quantitative content analysis as a method for business ethics, including an ethical research objective, and most importantly, concluding with ethical reasoning and interpretation of the quantitative results. (shrink)

The aim of this article is to examine the usefulness of spirituality and aesthetics for generating new perspectives and understandings with regard to business ethics. Using an interpretive mixed-methods approach, data were collected through an online survey of 223 respondents and focus group interviews with 20 participants. Analysis of the quantitative and qualitative data suggests that the presence of aesthetic spirituality and religious spirituality, along with the factors of optimism, contentment, making a difference and interconnectedness, are significantly associated with (...) ethical practice in the workplace. These factors may be focused upon when considering the ethical climate of organizations. Although this research does not support universal conclusions, the relationship between ethics, spirituality and aesthetics identified in the Australian services sector might be replicated elsewhere. (shrink)

Background: Although attention to healthcare ethics in rural areas has increased, specific focus on rural palliative care is still largely under-studied and under-theorized. The purpose of this study was to gain a deeper understanding of the values informing good palliative care from rural individuals' perspectives. Methods: We conducted a qualitative ethnographic study in four rural communities in Western Canada. Each community had a population of 10, 000 or less and was located at least a three hour travelling distance by car (...) from a specialist palliative care treatment centre. Data were collected over a 2-year period and included 95 interviews, 51 days of field work and 74 hours of direct participant observation where the researchers accompanied rural healthcare providers. Data were analyzed inductively to identify the most prevalent thematic values, and then coded using NVivo. Results: This study illuminated the core values of knowing and being known, being present and available, and community and mutuality that provide the foundation for ethically good rural palliative care. These values were congruent across the study communities and across the stakeholders involved in rural palliative care. Although these were highly prized values, each came with a corresponding ethical tension. Being known often resulted in a loss of privacy. Being available and present created a high degree of expectation and potential caregiver strain. The values of community and mutuality created entitlement issues, presenting daunting challenges for coordinated change. Conclusions: The values identified in this study offer the opportunity to better understand common ethical tensions that arise in rural healthcare and key differences between rural and urban palliative care. In particular, these values shed light on problematic health system and health policy changes. When initiatives violate deeply held values and hard won rural capacity to address the needs of their dying members is undermined, there are long lasting negative consequences. The social fabric of rural life is frayed. These findings offer one way to re-conceptualize healthcare decision making through consideration of critical values to support ethically good palliative care in rural settings. (shrink)

The aim of this article is to examine the usefulness of spirituality and aesthetics for generating new perspectives and understandings with regard to business ethics. Using an interpretive mixed‐methods approach, data were collected through an online survey of 223 respondents and focus group interviews with 20 participants. Analysis of the quantitative and qualitative data suggests that the presence of aesthetic spirituality and religious spirituality, along with the factors of optimism, contentment, making a difference and interconnectedness, are significantly associated with (...) ethical practice in the workplace. These factors may be focused upon when considering the ethical climate of organizations. Although this research does not support universal conclusions, the relationship between ethics, spirituality and aesthetics identified in the Australian services sector might be replicated elsewhere. (shrink)

This book offers an easy-to-read, yet comprehensive introduction to practical issues in doctor–patient relationships in a typical low- and middle-income country setting in India, examining in detail the reasons for erosion of trust and providing guidance on potential research areas in the field. It strikes a balance between empirical work and theoretical normative analysis, while adopting mixed-method research in exploring important constructs in the doctor–patient relationship, such as trust, solidarity, advocacy, patient-centeredness, privacy, and confidentiality. Since the concept of trust (...) has direct implications for the ethical practice of medicine, the book is a valuable resource for academics and researchers in the field of medical, clinical, and applied ethics. (shrink)

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by (...) trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted. (shrink)

Since the beginning of UN peace operations, there has been discussion as to exactly how they should be carried out. Thus far, a just theory of UN peacekeeping operations has not yet been formed, in the way a Theory of Just War for waging war or a theory of police ethics for law enforcement in a peace context had been formed. The article discusses what a justified risk distribution between UN peacekeepers and local civilians should be. One of the points (...) of criticism of UN peacekeeping missions is the lack of protection of the local population in the course of an escalating situation. Familiar examples are the traumas of Rwanda (1994) and Srebrenica (1995). Discussing differences between UN peacekeeping missions, warfare, and law enforcement, it appears that peacekeepers have more in common with law enforcers than with combatants during wartime. Through the method of analogy and by applying some typically military ethics principles, the moral status of the UN peacekeepers is analyzed. Finally, a risk distribution analysis between UN peacekeepers and the local population is carried out, by offering a concise overview by philosophers of arguments for and against taking fewer risks by peacekeepers. The analysis reveals important deontological and consequentialist arguments. Taking also into consideration that transferring more risk to the peacekeeping troops alone does not mandatory lead to less exposure to risk of the vulnerable and innocent local civilians, it can be concluded that a more practical, virtuous, responsible risk calculation will be necessary at that point to find the best risk distribution. (shrink)

Procedures for the selection of subjects for participation in randomized clinical trials--usually formalized as eligibility criteria in the study protocol--have both scientific and ethical implications. In this thesis, I undertake an examination of eligibility criteria at three stages in the genesis and dissemination of medical knowledge: clinical trial protocol, interpretation by investigators, and reporting of study results.In the first chapter, ethical issues in subject selection are reviewed and the main study questions are presented. In the second chapter, the (...) results of an examination of eligibility criteria in two sets of clinical trials, one sponsored by the NSABP, the other sponsored by POG, covering a twenty-year time span are presented. The POG trials had far fewer eligibility criteria than the NSABP studies, suggesting that large numbers of criteria may not be necessary for high quality research. In the third chapter, the impact of subjective eligibility criteria on enrollment and investigator uncertainty is explored. Subjective criteria were associated with more variable enrollment decisions and greater uncertainty. Such criteria represent a threat to the validity, conduct and interpretation of trials and, therefore, should only be included when carefully justified. The fourth chapter examines the accuracy of the reporting of eligibility criteria in sets of corresponding study protocol, methods paper, journal article, and Clinical Alert. Important information is lost at each step in the dissemination of study results. Unnecessary criteria ought to be dropped at a trial's inception; all other criteria must be reported faithfully. The fifth chapter attempts to provide a comprehensive philosophical account of just selection procedures for clinical research using the political philosophy of Michael Walzer. The sixth, and last, chapter, discusses explanatory and pragmatic approaches to clinical trial design, overlapping scientific and ethical concerns related to eligibility criteria, and questions for further study. (shrink)

Policymakers use financial incentives to achieve a wide variety of public objectives, from pollution reduction to the employment of welfare recipients. Combining insights from economic theory with lessons learned from actual implementation, this article analyzes the implications of two such policies: first, subsidizing contraception, and second, offering financial incentives to individuals for sterilization or for using a long-term, semipermanent method of contraception such as the Intra-Uterine Device, Depo-Provera or Norplant. These subsidy and incentive policies achieve their goals through a myriad (...) of individuals who make their reproductive choices in response to particular costs and benefits. Such programs are ethically and politically controversial. In this paper, I address the question of whether they can be justified either economically or ethically.The first section of this article presents an economic theory to assess whether a subsidy, tax, or incentive is economically efficient, both generally and in the context of contraception. (shrink)

While bioethics as a field has concerned itself with methodological issues since the early years, there has been no systematic examination of how ethics is incorporated into research on the Ethical, Legal and Social Implications of the Human Genome Project. Yet ELSI research may bear a particular burden of investigating and substantiating its methods given public funding, an explicitly cross-disciplinary approach, and the perceived significance of adequate responsiveness to advances in genomics. We undertook a qualitative content analysis of (...) a sample of ELSI publications appearing between 2003 and 2008 with the aim of better understanding the methods, aims, and approaches to ethics that ELSI researchers employ. We found that the aims of ethics within ELSI are largely prescriptive and address multiple groups. We also found that the bioethics methods used in the ELSI literature are both diverse between publications and multiple within publications, but are usually not themselves discussed or employed as suggested by bioethics method proponents. Ethics in ELSI is also sometimes undistinguished from related inquiries. (shrink)

BackgroundThe coronavirus disease (COVID-19) treatment must be based on scientific methods such as clinical trials. Trials involving human subjects and those requiring a risk-benefit analysis may occasionally face challenges owing to the time limitations in the pandemic. MethodologyThis study analyses the WHO's International Clinical Trials Registry Platform and clinicaltrials.gov, where most COVID-19 clinical trials are registered, according to ethical criteria including study design, conflicts of interest, enrollment of healthcare workers, study locations, site-, design-, and participant-related issues. The discussion (...) is based on three aspects: the quality of the information to be produced, the relevance to significant health problems, and the creation or evaluation of interventions, policies, or practices that promote individual or public health. ResultsThere were significant differences between the two platforms regarding the investigational medicinal product (IMP), the comparator, ethics committee/institutional review board approval, plan to share individual participant data, study phase, site, IMP, and design-related issues. Conflict of interest, sponsor information, and management of vulnerable groups were the main areas wherein both platforms lacked sufficient information. ConclusionWith this analysis, we aimed to define a minimum set of ethical criteria for clinical trial platforms to obtain standardization between these two platforms. (shrink)

BackgroundThe coronavirus disease (COVID-19) treatment must be based on scientific methods such as clinical trials. Trials involving human subjects and those requiring a risk-benefit analysis may occasionally face challenges owing to the time limitations in the pandemic. MethodologyThis study analyses the WHO's International Clinical Trials Registry Platform and clinicaltrials.gov, where most COVID-19 clinical trials are registered, according to ethical criteria including study design, conflicts of interest, enrollment of healthcare workers, study locations, site-, design-, and participant-related issues. The discussion (...) is based on three aspects: the quality of the information to be produced, the relevance to significant health problems, and the creation or evaluation of interventions, policies, or practices that promote individual or public health. ResultsThere were significant differences between the two platforms regarding the investigational medicinal product (IMP), the comparator, ethics committee/institutional review board approval, plan to share individual participant data, study phase, site, IMP, and design-related issues. Conflict of interest, sponsor information, and management of vulnerable groups were the main areas wherein both platforms lacked sufficient information. ConclusionWith this analysis, we aimed to define a minimum set of ethical criteria for clinical trial platforms to obtain standardization between these two platforms. (shrink)

BackgroundThe coronavirus disease (COVID-19) treatment must be based on scientific methods such as clinical trials. Trials involving human subjects and those requiring a risk-benefit analysis may occasionally face challenges owing to the time limitations in the pandemic. MethodologyThis study analyses the WHO's International Clinical Trials Registry Platform and clinicaltrials.gov, where most COVID-19 clinical trials are registered, according to ethical criteria including study design, conflicts of interest, enrollment of healthcare workers, study locations, site-, design-, and participant-related issues. The discussion (...) is based on three aspects: the quality of the information to be produced, the relevance to significant health problems, and the creation or evaluation of interventions, policies, or practices that promote individual or public health. ResultsThere were significant differences between the two platforms regarding the investigational medicinal product (IMP), the comparator, ethics committee/institutional review board approval, plan to share individual participant data, study phase, site, IMP, and design-related issues. Conflict of interest, sponsor information, and management of vulnerable groups were the main areas wherein both platforms lacked sufficient information. ConclusionWith this analysis, we aimed to define a minimum set of ethical criteria for clinical trial platforms to obtain standardization between these two platforms. (shrink)

BackgroundThe coronavirus disease (COVID-19) treatment must be based on scientific methods such as clinical trials. Trials involving human subjects and those requiring a risk-benefit analysis may occasionally face challenges owing to the time limitations in the pandemic. MethodologyThis study analyses the WHO's International Clinical Trials Registry Platform and clinicaltrials.gov, where most COVID-19 clinical trials are registered, according to ethical criteria including study design, conflicts of interest, enrollment of healthcare workers, study locations, site-, design-, and participant-related issues. The discussion (...) is based on three aspects: the quality of the information to be produced, the relevance to significant health problems, and the creation or evaluation of interventions, policies, or practices that promote individual or public health. ResultsThere were significant differences between the two platforms regarding the investigational medicinal product (IMP), the comparator, ethics committee/institutional review board approval, plan to share individual participant data, study phase, site, IMP, and design-related issues. Conflict of interest, sponsor information, and management of vulnerable groups were the main areas wherein both platforms lacked sufficient information. ConclusionWith this analysis, we aimed to define a minimum set of ethical criteria for clinical trial platforms to obtain standardization between these two platforms. (shrink)

Policymakers use financial incentives to achieve a wide variety of public objectives, from pollution reduction to the employment of welfare recipients. Combining insights from economic theory with lessons learned from actual implementation, this article analyzes the implications of two such policies: first, subsidizing contraception, and second, offering financial incentives to individuals for sterilization or for using a long-term, semipermanent method of contraception such as the Intra-Uterine Device, Depo-Provera or Norplant. These subsidy and incentive policies achieve their goals through a myriad (...) of individuals who make their reproductive choices in response to particular costs and benefits. Such programs are ethically and politically controversial. In this paper, I address the question of whether they can be justified either economically or ethically.The first section of this article presents an economic theory to assess whether a subsidy, tax, or incentive is economically efficient, both generally and in the context of contraception. (shrink)

Business Ethics, the Environment & Responsibility, Volume 31, Issue 2, Page 589-600, April 2022.