Taking as the background the discourses on friendship initiated by ancient Confucian and Greek philosophers, this article is focused on Xunzi’s perspective on friends by examining where and how he engages effectively ethical justifications of friendship. It will be argued that although Xunzi shows a kind of consistency with Confucius and Mencius, he comes to justify friendship through his own deliberations on human nature, on learning and education, and on the nature and function of human community. We will then (...) proceed to examine the three perspectives Xunzi takes to highlight the ethical value of friends: friendship can be justified as it is needed in overcoming the inborn tendencies towards competition and strife; friendship can be justified because it is taken as supplementary to learning and education where friends are made equivalent to teachers in terms of moral influence and exemplary models; friendship can be justified because it is necessary for communities to function well and for individuals to lead a good life. We will finally come to the conclusion that these justifications constitute a unique ethics of friendship, which is not only significantly divergent from Greek propositions on friends but also differentiable, one way or another, from those proposed or presumed by Confucius and Mencius, and that the Xunzian philosophy of friendship is still an invaluable resource for us to draw on in the age of globalisation and de-globalisation. (shrink)

The case (Dawson et al. 2024) describes an Institutional Review Board (IRB) chair who seeks consultation about waiving the requirement that investigators obtain prospective, informed consent for collection of microbiome samples by swabbing the perianal region of severely burned patients shortly after their admission to an intensive care unit (ICU). We argue that it is ethically permissible to waive informed consent requirements for the perianal swab and that the IRB should approve a waiver as permitted by regulations.

The Weatherall report on the use of non-human primates in research was published in 2006. Its main conclusion was that there is a strong scientific case for the use of non-human primates in some cases, but the report stressed the importance of evaluating each case in the light of the availability of alternatives. In addition to arguing for the scientific necessity of using non-human primates in research, the report also provided an ethical justification. As could be expected, the (...) report was harshly criticised by animal rights groups, but in the academic literature, only two critical replies appeared. In what follows, I will describe the ethical justification for non-human primate research as it is laid out in the Weatherall report and then consider the criticism in the academic literature. I conclude that the report’s ethical justification for the use of non-human primates in research, in particular in basic neuroscientific research, has not been convincingly challenged by its critics. Since the criticism of the report is limited and represents only a small part of the academic discussion about the use of non-human primates in research, and a still smaller part of the ethical discussion about animal research, it is important that the discussion continue both at the academic and social level. (shrink)

Tremendous development in recent medical science and the consequent discoveries resulting in successful prevention and also cure of different diseases are shared by clinical research involving the human volunteers. Preceding the trials in the human subjects, and to ensure safety, the proposed drug and other interventions are either tested in animals (vivo) or in laboratory (vitro) to evaluate initial safe starting dose for the human beings and to key out the benchmarks for the clinical monitoring for the potential unfavorable effects. (...) These pre human trials might not necessarily protect against the untoward effects in the human beings as happened in the case of thalidomide tragedy, which caused disability and killed thousands of babies born to the mothers, those who took this medicine. Use of healthy human volunteers in the preliminary experiments or phase I clinical trials either reduces or excludes risks of subsequent undesirable effects in the future trails (1). Phase-1 trials are conducted in order to test the safety, reactions and immunogenicity of vaccines in volunteers. Novel treatments for the cancer are first tested in phase 1 trials enrolling the patients with advanced disease, who have exhausted the standard treatment options. Phase-1 oncology trials are the pivot point in the translation of new cancer therapies from bench to bedside. Nevertheless, these trials remain ethically controversial. The controversy stems from the fact that, classically, phase-1 oncology clinical trials involve first-in-human testing of experimental treatment candidates in patients with a terminal diagnosis, who typically have exhausted standard treatment options. Commentators on the ethics of phase-1 clinical trials make diametrically opposed claims about the prospect of direct medical benefit from participation in these trials-benefits that can be attributed to receiving the experimental treatment intervention. One camp of benefit skeptics, inhabited mainly by bioethicists, characterizes this form of research as lacking any reasonable prospect of direct medical benefit. They see an ethical cloud hovering over phase-1 trials, because the vast majority of patients volunteer for phase-1 trials out of a motivation to receive medical benefit. In the view of these skeptics, such patients therefore harbor a ‘therapeutic misconception’ about research participation. This misconception calls into question the validity of informed consent and thereby undercuts the ethical basis of these trials (2). In this paper, I will discuss the ethical justification of the participation of human volunteers in phase-1 trials. (shrink)

Many health care systems include programs that allow patients in exceptional circumstances to access medical interventions of as yet unproven benefit. In this article we consider the ethical justifications for—and demands on—these special access programs (SAPs). SAPs have a compassionate basis: They give patients with limited options the opportunity to try interventions that are not yet approved by standard regulatory processes. But while they signal that health care systems can and will respond to individual suffering, SAPs have several disadvantages, (...) including the potential to undermine regulatory and knowledge-generation structures that constitute significant public goods. The “balance” between these considerations depends in part on how broadly SAPs are used, but also on whether SAPs can be made to contribute to the generation of knowledge about the effects of health interventions. We argue that patients should usually be required to contribute outcome data while using SAPs. (shrink)

This thesis is a contribution to the ethical justification for clinical research with children. A research subject’s participation in a trial is usually justified, in part, by informed consent. Informed consent helps to uphold the moral principle of respect for persons. But children’s limited ability to make informed choices gives rise to a problem. It is unclear what, if anything, justifies their participation in research. Some research ethicists propose to resolve this problem by appealing to social utility, proxy (...) consent, arguments explaining why it is permissible to expose children to some harm, and an argument concerning the appropriate balance between research harms and benefits. I argue that each of these is a necessary part of the justification for research with children, but that the argument concerning harms and benefits is under-developed. It relies on the concept of minimal risk, but minimal risk is inadequately justified. I propose an interpretation of minimal risk. I defend the idea that minimal risk should be interpreted according to the risks of daily life. I reject the most prominent defense of daily life, which claims that daily risks are morally relevant because they replace, rather than add to, the risks a child would ordinarily face. Instead, I propose that these risks are part of a reasonable trade-off between personal safety and our ability to pursue meaningful lives. I then examine whose daily life should be captured in the concept of minimal risk. I reject arguments that minimal risk should refer to healthy children or the subjects of the research and propose instead that the referent should be children who are not unduly burdened by their lives. I argue that children are not unduly burdened when they fare well and defend the idea that children fare well when they possess sufficiently high degrees of the substantive goods of childhood. I conclude by analyzing a controversial case study using my interpretation of minimal risk. I draw on this case to argue that my interpretation offers clear guidance for research ethics review and contributes to a determination that is more plausible than its rivals. (shrink)

During the 1970s, prenatal screening technologies were in their infancy, but were being swiftly harnessed to uncover and prevent spina bifida. The historical rise of this screening process and prevention programme is analysed in this paper, and the role of ethical debates in key studies, editorials and letters reported in the Lancet, and other related texts and governmental documents between 1972 and 1983, is considered. The silence that surrounded rigorous ethical debate served to highlight where discussion lay—namely, within (...) the justifications offered for the prevention of spina bifida, and the efficacy and benefits of screening. In other words, the ethical justification for screening and prevention of spina bifida, when the authors are not explicitly interested in ethics, is considered. These justifications held certain notions of disability as costly to society, with an imperative to screen and prevent spina bifida for the good of the society. (shrink)

The feminist in academe, says Paula Bennett, is like Procne married to Tereus, "inextricably wedded to the sources of her harm." An ethical justification of academic feminism can be found, not in cooperation and affiliation, but in the strategies currently necessary to ensure curricular and cultural diversity. Historically contextualized and strategically politicized, this ethic is founded on the claim that universities are places where we may all learn to know what is other than ourselves.

The implementation of education programmes in different cultures invites the question whether we are justified in doing so in cultures that may reject the programmes’ underlying principles. Are there indeed ethical principles and educational ideals that can be justified as applicable to all cultures? After a consideration of Zygmunt Bauman's postmodern rejection of the possibility of universal ethics, Ι cite and extend Harvey Siegel's defence of multiculturalism as a transcultural ethical ideal. I conclude the paper with a (...) class='Hi'>justification of the transcultural normative reach of moral principles that I have elsewhere defended as the ethics of integrity. The paper's significance lies in its justification of educational interventions founded in these principles across different cultures. (shrink)

This paper demonstrates that an ethical justification for political resistance can be found in Spinoza’s writings. It establishes that important elements of his ethical analysis of politics entail an ethical imperative to actively resist any attempt on the part of the sovereign to abolish or unduly curtail freedom of thought and expression. It shows that, under such circumstances, active resistance will be in accord with reason: (1) the less it is motivated by any species of hatred; (...) and (2) the more it serves to empower people. Since freedom of thought and expression necessarily involves the freedom to engage in the philosophical critique of prejudices, and the latter can itself function as a form of political resistance, the ethical imperative to preserve libertas philosophandi amounts to an enjoinder to preserve a form of perpetual resistance within the normal functioning of the rationally-ordered state. (shrink)

This paper demonstrates that an ethical justification for political resistance can be found in Spinoza’s writings. It establishes that important elements of his ethical analysis of politics entail an ethical imperative to actively resist any attempt on the part of the sovereign to abolish or unduly curtail freedom of thought and expression. It shows that, under such circumstances, active resistance will be in accord with reason: (1) the less it is motivated by any species of hatred; (...) and (2) the more it serves to empower people. Since freedom of thought and expression necessarily involves the freedom to engage in the philosophical critique of prejudices, and the latter can itself function as a form of political resistance, the ethical imperative to preserve libertas philosophandi amounts to an enjoinder to preserve a form of perpetual resistance within the normal functioning of the rationally-ordered state. (shrink)

Asia is the most diverse continent in the world in terms of culture, religion, population size, finance, education, health care, academic research, general population skills, and governmental drug regulations. Each Asian country has its own unique qualities when it comes to attracting industry sponsored clinical trials. Factors that influence selecting location of a study site for a sponsored trial are mainly population size, infrastructure, education levels, and quality of health care, cost and drug regulatory platform. Conducting research in traditional countries (...) like Pakistan adds another dimension to the problems in assuring that research conducted in an ethical manner. The indigenous layer of the cultural values makes it even more difficult task, but this is the task that we are morally and ethically bound to shoulder. (shrink)

Recently, shifting societal attitudes towards animals have resulted in an increasing challenge to the ‘social license’ to use animals in competitive sport. Against that background, this paper explores whether the use of animals in competitive sport is ever justifiable from the perspective of three commonly used ethical theories: deontology, utilitarianism and virtue ethics. In so doing, it recognises the importance of human understanding of animals as sentient beings. The author argues that when deontology, utilitarianism and virtue ethics are each (...) used to consider the question ‘Is the use of animals in sport ethically justifiable?’, only absolutist rights theory leads to a negative conclusion. Specified rights theory, utilitarianism and virtue ethics all allow for the human use of animals in sport. However, the author then goes onto argue that even if one does not accept an absolutist rights point of view and does believe that the use of animals in sport is generally ethically justifiable, that use should be limited by fulfilment of certain ‘qualifying constraints’: (a) minimisation of negative welfare effects and maximisation of positive welfare effects, to enable ‘good lives’ for animals (b) identification of and mitigation against avoidable, unnecessary risk and (c) compliance with governing body regulations and the law. (shrink)

This article reports the results of research aimed at developing and validating a multi-item scale to measure consumers' agreement with three main justifications for not engaging in socially responsible consumption behaviours, namely the 'economic rationalist argument' founded on the idea that the costs of SRC are greater than its benefits, the 'economic development reality argument' based on the idea that ethical and moral aspirations are less important than the economic development of countries, and the 'government dependency argument' grounded in (...) the premise that government inaction demonstrates the legal character and the banality of unethical consumption behaviours. The scale items were generated on the basis of a multi-country qualitative study of consumers. The content validity of the scale was assessed in the first study. The second study was a survey of 157 Canadian adult consumers in which the threedimensional scale and other scales measuring relevant concepts were administered. The survey results showed that the 28-item resulting scale is reliable and generally behaves as one would theoretically expect. Implications for consumption ethics researchers and policy makers are proposed. (shrink)

Health regulators must carefully monitor the real-world safety and effectiveness of marketed vaccines through post-market monitoring in order to protect the public’s health and promote those vaccines that best achieve public health goals. Yet, despite the fact that vaccines used in collective immunization programmes should be assessed in the context of a public health response, post-market effectiveness monitoring is often limited to assessing immunogenicity or limited programmatic features, rather than assessing effectiveness across populations. We argue that post-market monitoring ought to (...) be expanded in two ways to reflect a ‘public health notion of post-market effectiveness’, which incorporates normative public health considerations: effectiveness monitoring should yield higher quality data and grant special attention to underrepresented and vulnerable populations; and the scope of effectiveness should be expanded to include a consideration of the various social factors that maximize a vaccine’s effectiveness at the population level, paying particular attention to how immunization programmes impact related health gradients. We use the case of the human papillomavirus vaccine in Canada to elucidate how expanding post-market effectiveness monitoring is necessary to close the gap between clinical practice and public health, and to ensure that vaccines are effective in a morally relevant sense. (shrink)

When a new intervention or drug is developed, this has to pass through various phases of clinical testing before it achieves market approval, which can take many years. This raises an issue for drugs which could benefit terminally ill patients. These patients might set their hopes on the experimental drug but are unable to wait since they are likely to pass away before the drug is available. As a means of nevertheless getting access to experimental drug, many seriously ill and (...) terminally ill patients are therefore very willing to participate in randomised controlled trials. However, only very few terminally ill patients are able to actually participate, and those that do participate are at risk of participating solely as a way of getting experimental drugs. Currently, there are, however, ways of getting access to drugs that have not gained market approval. One such mean is via expanded access or compassionate use programs where terminally ill patients receive experimental new drugs that are not yet market approved. In this paper, I examine some of the common justifications for such programs. The most frequently voiced justifications for compassionate use or expanded access programs could be put in one of three categories. First, there are justifications of justice, where compassionate use programs could be seen as a just or fair way to distribute experimental new drugs to patients who are denied access to RCT’s through no fault of their own. Second, such programs could be justified by reference to the ethical principle of beneficence where it could be claimed that terminally ill patients stand to benefit greatly at very little risk. Third, there are considerations of autonomy where, it is claimed, patients should be able to exercise their autonomy and have access to such drugs if that is there free choice and they are fully aware of the risks associated with that choice. In this paper, I argue currently all justifications are potentially problematic. If they truly form the basis for justification, compassionate use programs should be designed to maximize justice, beneficence and autonomy. (shrink)

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily (...) under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients. (shrink)

The purpose of this paper is the analysis of both legal and ethical ways of justifying targeted killings. I compare two legal models: the law enforcement model vs the rules of armed conflicts; and two ethical ones: retribution vs the right of self-defence. I argue that, if the targeted killing is to be either legally or ethically justified, it would be so due to fulfilling of some criteria common for all acceptable forms of killing, and not because terrorist (...) activity is somehow distinguished and gives special privileges to a state that fights it. The practical implication of my analysis is that one of the most spectacular targeted killings, which was the targeting and killing of Osama bin Laden in May 2011, was not justified, because it was only supposed to be a retribution for the September 11th terrorist attacks. (shrink)

Allowing relatively inexperienced physicians-in-training to perform invasive medical procedures is a widely accepted practice, generally felt to be justified by the need to train future generations of physicians. The ethical justification of this practice, however, is rarely if ever explored in any depth. This essay examines the moral issues associated with this practice, in the setting of a specific clinical scenario involving the emergency intubation of a critically ill newborn. The practice is ultimately shown to be justified based (...) not only on the needs of society and future patients but also on the best interests of the patient being treated. However, several important qualifications need to be satisfied in order for this practice to be ethically permissible. The arguments and qualifications presented can be extended to clinical situations beyond the specific scenario discussed and are relevant to a wide range of medical and surgical settings. (shrink)

We argue that the de-extinction of the mammoth cannot be ethically grounded by duties to the extinct mammoth, to ecosystem health or to individual organisms in ecosystems missing the mammoth. However, the action can be shown to be morally permissible via the goods it will afford humans, including advances in scientific knowledge, valuable experiences of awe and pleasure, and perhaps improvements to our moral character or behaviour—if and only if suffering is minimal. Finally, we call for empirical research into how (...) the possibility of the technology affects our behaviour or our character to help the debate transcend duelling intuitions. (shrink)

John Dewey developed sophisticated theories for a liberal civil society and a deliberative democracy. These theories have recently enjoyed renewed attention, discussion, and practical application.1 However, no consensus on Dewey's primary theoretical strategies has yet emerged.2 What precisely was Dewey's justification for democracy and its superiority over other ways of life and forms of government? This essay explains how Dewey attempted to formulate a philosophical justification for democracy on ethical grounds, rather than just epistemic or satisfaction-maximization grounds (...) alone. Provided with a solid ethical foundation, progressive and participatory democracy could become a practical, achievable, and highly .. (shrink)

This article reports the results of research aimed at developing and validating a multi-item scale to measure consumers’ agreement with three main justifications for not engaging in socially responsible consumption (SRC) behaviours, namely the ‘economic rationalist argument’ founded on the idea that the costs of SRC are greater than its benefits, the ‘economic development reality argument’ based on the idea that ethical and moral aspirations are less important than the economic development of countries, and the ‘government dependency argument’ grounded (...) in the premise that government inaction demonstrates the legal character and the banality of unethical consumption behaviours. The scale items were generated on the basis of a multi-country qualitative study of consumers (Eckhardt et al., 2006, ‘Why Don’t Consumers Behave Ethically’. DVD Document, AGSM). The content validity of the scale was assessed in the first study. The second study was a survey of 157 Canadian adult consumers in which the three-dimensional scale and other scales measuring relevant concepts were administered. The survey results showed that the 28-item resulting scale is reliable and generally behaves as one would theoretically expect. Implications for consumption ethics researchers and policy makers are proposed. (shrink)

Many healthcare practices expose people to risks of harmful outcomes. However, the major theories of moral philosophy struggle to assess whether, when and why it is ethically justifiable to expose individuals to risks, as opposed to actually harming them. Sven Ove Hansson has proposed an approach to the ethical assessment of risk imposition that encourages attention to factors including questions of justice in the distribution of advantage and risk, people’s acceptance or otherwise of risks, and the scope individuals have (...) to influence the practices that generate risk. This paper investigates the ethical justifiability of preventive healthcare practices that expose people to risks including overdiagnosis. We applied Hansson’s framework to three such practices: an ‘ideal’ breast screening service, a commercial personal genome testing service, and a guideline that lowers the diagnostic threshold for hypertension. The framework was challenging to apply, not least because healthcare has unclear boundaries and involves highly complex practices. Nonetheless, the framework encouraged attention to issues that would be widely recognised as morally pertinent. Our assessment supports the view that at least some preventive healthcare practices that impose risks including that of overdiagnosis are not ethically justifiable. Further work is however needed to develop and/or test refined assessment criteria and guidance for applying them. (shrink)

Care ethics is often criticized for being incapable of outlining what responsibilities we have to persons beyond our personal relations, especially toward distant others. This criticism centres on care theorists’ claim that the concerns of morality emerge between people, generated through our relations of interdependent care: it is difficult to see how moral duties can be applied to those with whom we do not forge a relationship. In this article, I respond to this criticism by outlining a care ethical (...) justification for an interest theory of human rights. This theory will argue that the demands of global justice include various positive actions that aim toward ensuring the conditions for good caring relations to flourish, which in turn protect and promote the vital interests of all persons. In doing so, I aim to concurrently advance the sparse work on human rights within the care literature, systematizing the ideas of care theorists such as Daniel Engster, Virginia Held, and Fiona Robinson. (shrink)

Volume 20, Issue 8, August 2020, Page 27-29.

Global consumption of antibiotics has accelerated the evolution of bacterial antimicrobial resistance. Yet, the risks from increasing bacterial antimicrobial resistance are not restricted to human populations: transmission of antimicrobial resistant bacteria occurs between humans, farms, the environment and other reservoirs. Policies that take a ‘One Health’ approach deal with this cross-reservoir spread, but are often more restrictive concerning human actions than policies that focus on a single reservoir. As such, the burden of justification lies with these more restrictive policies. (...) We argue that an ethical justification for preferring One Health policies over less restrictive alternatives relies on empirical evidence as well as theory. The ethical justification for these policies is based on two arguments: (i) comparatively greater effectiveness, and (ii) comparatively better tracking of moral responsibility. Yet the empirical assumptions on which these claims rest are limited by existing empirical knowledge. Using livestock farming as an example, we suggest that scientific research into characterising antimicrobial resistance and linking practices to outcomes ought to be guided (at least in part) by the imperative to supply the context-specific data needed to ethically justify preferring a One Health policy over less restrictive alternatives. (shrink)

With the prevalence of complementary and alternative medicine (CAM) increasing in western societies, questions of the ethical justification of these alternative health care approaches and practices have to be addressed. In order to evaluate philosophical reasoning on this subject, it is of paramount importance to identify and analyse possible arguments for the ethical justification of CAM considering contemporary biomedical ethics as well as more fundamental philosophical aspects. Moreover, it is vital to provide adequate analytical instruments for (...) this task, such as separating ‘CAM as belief system’, and ‘CAM as practice’, Findings show that beneficence and non-maleficence are central issues for an ethical justification of CAM as practice, while freedom of thought and religion are central to CAM as belief system. Many justification strategies have limitations and qualifications that have to be taken into account. Singularly descriptive premises in an argument often prove to be more problematic than universal ethical principles. Thus, non-ethical issues related to a general philosophical underpinning - e.g. epistemology, semantics, and ontology - are highly relevant for determining a justification strategy, especially when strong metaphysical assumptions are involved. Even if some values are shared with traditional biomedicine, axiological differences have to be considered as well. Further research should be done about specific CAM positions. These could be combined with applied qualitative social research methods. (shrink)

Many drugs used in paediatric medicine are off-label. There is a rising call for the use of adaptive clinical trial designs in responding to the need for safe and effective drugs given their potential to offer efficiency and cost-effective benefits compared with traditional clinical trials. ADs have a strong appeal in paediatric clinical trials given the small number of available participants, limited understanding of age-related variability and the desire to limit exposure to futile or unsafe interventions. Although the ethical (...) value of adaptive trials has increasingly come under scrutiny, there is a paucity of literature on the ethical dilemmas that may be associated with paediatric adaptive designs. This paper highlights some of these ethical concerns around safety, scientific/social value and caregiver/guardian comprehension of the trial design. Against this background, the paper develops a non-static conceptual lens for understanding PADs. It shows that ADs are epistemically open and reduce some of the knowledge-associated uncertainties inherent in clinical trials as well as fast-track the time to draw conclusions about the value of evaluated drugs/treatments. On this note, the authors argue that PADs are ethically justifiable given they have multiple layers of safety, exposing enrolled children to lesser potential risks, create social/scientific value generally and for paediatric populations in particular, specifically foster the flourishing of paediatric populations and can significantly improve paediatric trial efficiency when properly designed and implemented. However, because PADs are relatively new and their regulatory, ethical and logistical characteristics are yet to be clarified in some jurisdictions, the cooperation of various public and private stakeholders is required to ensure that the interests of children, their caregivers and parents/guardians are best served while exposing paediatric research subjects to the most minimal of risks when they are enrolled in paediatric trials that use ADs. Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable. (shrink)

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily (...) under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients. (shrink)

Deep brain stimulation as investigational intervention for symptomatic relief from Alzheimer disease has generated big expectations. Our aim is to discuss the ethical justification of this research agenda by examining the underlying research rationale as well as potential methodological pitfalls. The shortcomings we address are of high ethical importance because only scientifically valid research has the potential to be ethical. We performed a systematic search on MEDLINE and EMBASE. We included 166 publications about DBS for AD (...) into the analysis of research rationale, risks and ethical aspects. Fifty-eight patients were reported in peer-reviewed journals with very mixed results. A grey literature search revealed hints for 75 yet to be published, potentially enrolled patients. The results of our systematic review indicate methodological shortcomings in the literature that are both scientific and ethical in nature. According to our analysis, research with human subjects was performed before decisive preclinical research was published examining the specific research question at stake. We also raise the concern that conclusions on the potential safety and efficacy have been reported in the literature that seem premature given the design of the feasibility studies from which they were drawn. In addition, some publications report that DBS for AD was performed without written informed consent from some patients, but from surrogates only. Furthermore, registered ongoing trials plan to enroll severely demented patients. We provide reasons that this would violate Art. 28 of the Declaration of Helsinki, because DBS for AD involves more than minimal risks and burdens, and because its efficacy and safety are not yet empirically established to be likely. Based on our empirical analysis, we argue that clinical research on interventions of risk class III should not be exploratory but grounded on sound, preclinically tested, and disease-specific a posteriori hypotheses. This also applies to DBS for dementia as long as therapeutic benefits are uncertain, and especially when research subjects with cognitive deficits are involved, who may foreseeably progress to full incapacity to provide informed consent during the required follow-up period. (shrink)

In their article ‘Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI’, Durán and Jongsma discuss the epistemic and ethical challenges raised by black box algorithms in medical practice. The opacity of black box algorithms is an obstacle to the trustworthiness of their outcomes. Moreover, the use of opaque algorithms is not normatively justified in medical practice. The authors introduce a formalism, called computational reliabilism, which allows generating justified beliefs (...) on the algorithm reliability and trustworthy outcomes of artificial intelligence systems by means of epistemic warrants, called reliability indicators. However, they remark the need for reliability indicators specific to black box algorithms and that justified knowledge is not sufficient to justify normatively the actions of the physicians using medical AI systems. Therefore, Durán and Jongsma advocate for a more transparent design and implementation of black box algorithms, providing a series of recommendations to mitigate the epistemic and ethical challenges behind their use in medical practice. In this response, I argue that a peculiar form of black box algorithm transparency, called design publicity, may efficiently implement these recommendations. Design publicity encodes epistemic, that is, reliability indicators, and ethical recommendations for black box algorithms by means of four subtypes of transparency. These target the values and goals, their translation into design requirements, the performance and consistency of the algorithm altogether. I discuss design publicity applying it to a use case focused on the automated classification of skin lesions from medical images. (shrink)

Caregivers should usually accede to parents’ requests for life-sustaining treatment. For such decision-making, the best interests standard is too limited. John Arras’s “relational potential standard,” con-joined to a contemporary care ethics framework, provides a better guide.

BackgroundDespite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that SDM practices differ in the degree of involvement of patients or family members, or in the amount of medical information disclosed to patients in order to “share” meaningfully in treatment decisions. Little is known on which representations and moral justifications physicians hold when realizing SDM. This study explored physicians’ experiences of SDM in the management of paediatric patients with (...) prolonged disorders of consciousness (PDOC). Specifically, we focused on physicians’ SDM approaches, representations, and ethical justifications for engaging in SDM.MethodsWe used a qualitative approach to explore the SDM experiences of 13 ICU physicians, paediatricians, and neurologists based in Switzerland who have been or were involved in the care of paediatric patients living with PDOC. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data were analysed through thematic analysis.ResultsWe found that participants followed three main decision-making approaches: the “brakes” approach, characterized by maximized family’s decisional freedom, though conditional to physician’s judgment regarding the medical appropriateness of a treatment; the “orchestra director” approach, characterized by a multi-step decision-making process led by the main physician aimed at eliciting the voices of the care team members and of the family; and the “sunbeams” approach, characterized by a process oriented to reach consensus with family members through dialogue, where the virtues of the physician are key to guide the process. We also found that participants differed in the moral justifications sustaining each approach, citing the duty to respect parental autonomy, to invest in an ethics of care, and to employ physicians’ virtues to guide the decision-making process.ConclusionOur results show that physicians come to perform SDM in different ways, with several representations, and distinct ethical justifications. SDM training among health care providers should clarify the ductility of SDM and the several ethical motivations underpinning it, rather than insisting on the principle of respect for patient’s autonomy as its only moral foundation. (shrink)

Is Female Genital Cosmetic Surgery for an adolescent with Body Dysmorphic Disorder ever ethically justified? Cosmetic genital surgery for adolescent girls is one of the most ethically controversial forms of cosmetic surgery and Body Dysmorphic Disorder is typically seen as a contraindication for cosmetic surgery. Two key ethical concerns are that Body Dysmorphic Disorder undermines whatever capacity for autonomy the adolescent has; and even if there is valid parental consent, the presence of Body Dysmorphic Disorder means that cosmetic surgery (...) will fail in its aims. In this article, we challenge, in an evidence-based way, the standard view that Body Dysmorphic Disorder is a contraindication for genital cosmetic surgery in adolescents. Our argument gathers together and unifies a substantial amount of disparate research in the context of an ethical argument. We focus on empirical questions about benefit and harm, because these are ethically significant. Answers to these questions affect the answer to the ethical question. We question the claim that there would be no benefit from surgery in this situation, and we consider possible harms that might be done if treatment is refused. For an adolescent with Body Dysmorphic Disorder, the most important thing may be to avoid harm. We find ourselves arguing for the ethical justifiability of cosmetic labioplasty for an adolescent with Body Dysmorphic Disorder, even though we recognize that it is a counter intuitive position. We explain how we reached our conclusion. (shrink)

레비 (David Levy)는 2007년 그의 저서 Love and Sex with Robot 에서 인간이 로봇과 성관계를 갖는 것이 일상화 될 날이 멀지 않았고, 매춘과 같은 부분에 있어 로봇이 인간을 대체하게 될 것이라고 주장한다. 실제로 2010년 기존의 섹스돌(sex doll)에 인공지능을 탑재한 트루컴퍼니언(Truecompanion)사의 ‘록시(Roxxxy)’로부터 성적 교감뿐만 아니라 철학, 과학, 음악에 이르는 다양한 분야의 대화와 일상적인 농담 역시 가능한 2015년 리얼보틱스(Realbotix) 사의 ‘하모니(Harmony)’에 이르기까지 섹스로봇산업의 규모와 기술력은 나날이 발전하고 있다. 이에 섹스로봇이 인간의 모든 성생활에 있어 중요한 역할을 담당하게 될 것이라는 예측 역시 가능할 수 (...) 있다. 하지만 이에 대한 우려도 적지 않다. 대표적으로 리차드슨(Kathleen Richardoson)은 레비의 주장에 내재된 심각한 윤리적 문제에 주목하며 섹스로봇의 개발과 상용화를 반대한다. 특히, 레비가 예를 들고 있는 매춘 산업에 있어 섹스로봇이 사람을 대신할 수 있다는 주장에 대하여, “여러 관계 속에서 마주하게 되는 사람을 권리를 가진 인격체(person)가 아닌 사물(things)로 간주하게 되는 문제가 발생할 수 있다”며 섹스로봇의 개발과 사용은 윤리적으로 정당하지도 안전하지도 않다고 주장한다. 본 논문은 이들 중 하나의 입장을 견지하거나 옹호하지 않는다. 본 논문의 목적은 섹스로봇의 개발과 사용이 갖는 이점과 리차드슨이 제시한 윤리적 문제점 등을 검토하고, 이에 대해 취할 수 있는 윤리적 관점을 제시하는 것이다. 본 논문의 말미에는 피터 싱어의 ‘이익평등고려의 원칙 (The principle of equal consideration of interests)’에 근거하여 섹스로봇의 개발과 사용은 윤리적으로 정당화 될 가능성이 있음을 조심스럽게 검토해 볼 것이다. (shrink)

Tom Regan has made a very important contribution to the debate on environmental ethics in his “On the Nature and Possibility of an Environmental Ethic.” The debate can be brought out yet more clearly by contrasting Regan’s views with those of an eminent critic of environmental ethics in Regan’s sense, William K. Frankena. I argue that Regan’s position has much to recommend it, but has a fatal flaw whichwould render environmental ethics unjustifiable. I suggest this flaw can be remedied by (...) divorcing an environmental ethic from a dubious ontological commitment. Reflection on metaethics, ontological commitments, and the nature of ethical justification leads to a conclusion favorable to an environmental ethic. (shrink)

Tom Regan has made a very important contribution to the debate on environmental ethics in his “On the Nature and Possibility of an Environmental Ethic.” The debate can be brought out yet more clearly by contrasting Regan’s views with those of an eminent critic of environmental ethics in Regan’s sense, William K. Frankena. I argue that Regan’s position has much to recommend it, but has a fatal flaw whichwould render environmental ethics unjustifiable. I suggest this flaw can be remedied by (...) divorcing an environmental ethic from a dubious ontological commitment. Reflection on metaethics, ontological commitments, and the nature of ethical justification leads to a conclusion favorable to an environmental ethic. (shrink)