Longtermism is the thesis that in a large class of decision situations, the best thing we can do is what is best for the long-term future. The scope question for longtermism asks: how large is the class of decision situations for which this is true? In this paper, I suggest that the scope of longtermism may be narrower than many longtermists suppose. I identify a restricted version of longtermism: swamping axiological strong longtermism (swamping ASL). I identify three scope-limiting factors - (...) probabilistic and decision-theoretic phenomena which, when present, tend to reduce the prospects for swamping ASL. I argue that these scope-limiting factors are often present in human decision problems, then use two case studies from recent discussions of longtermism to show how the scope-limiting factors lead to a restricted, if perhaps nonempty, scope for swamping ASL. (shrink)

Autoimmune diseases such as rheumatoid arthritis and gastrointestinal disorders such as stomach ulcers are often treated with drugs. NSAIDs, a common treatment in rheumatoid arthritis, may cause stomach ulcers which call for additional medications, notably antacids in the sense of drugs that suppress acid secretion by the stomach. Infection with Helicobacter pylori also plays a role in the ulcers. The infection is typically treated with antibiotics added to antacids. Considering NSAIDs and antacids, we suspect that overmedication is common to the (...) extent that particular diets are a better option. Current research and current treatments with these drugs are also problematic since circadian rhythms are mostly disregarded. All the processes involved in the disorders treated show marked variations in the course of the day. Hence experiments conforming to the guidelines of evidence-based medicine, and treatments in line with them, have outcomes strongly depending on the time factor. This calls for reforms in medicine with fresh inputs from biology. (shrink)

Autoimmune diseases such as rheumatoid arthritis and gastrointestinal disorders such as stomach ulcers are often treated with drugs. NSAIDs, a common treatment in rheumatoid arthritis, may cause stomach ulcers which call for additional medications, notably antacids in the sense of drugs that suppress acid secretion by the stomach. Infection with Helicobacter pylori also plays a role in the ulcers. The infection is typically treated with antibiotics added to antacids. Considering NSAIDs and antacids, we suspect that overmedication is common to the (...) extent that particular diets are a better option. Current research and current treatments with these drugs are also problematic since circadian rhythms are mostly disregarded. All the processes involved in the disorders treated show marked variations in the course of the day. Hence experiments conforming to the guidelines of evidence-based medicine, and treatments in line with them, have outcomes strongly depending on the time factor. This calls for reforms in medicine with fresh inputs from biology. (shrink)

Post COVID-19 infections resulting in long COVID symptoms remain persistent yet neglected in healthcare priorities. Although long COVID symptoms are expected to decline after some time, many people continue to endure its debilitating effects affecting their daily lives. The diversity of characteristics amongst long COVID patients adds to the complexity of communicating personal health predicaments to healthcare providers. Recent research towards building an evidence base for long COVID with the aim of delivering responsive healthcare interventions for long COVID patients has (...) utilised datasets generated from wearable devices. This paper examines the prospects presented by wearable devices for long COVID patients and physicians. It highlights distinct ethical and legal challenges arising from their use in practice. Several recommendations aiming to support their usage amongst long COVID patients are outlined for future research using wearable devices for long COVID treatment. (shrink)

BackgroundImplementation of recommendations from clinical practice guidelines is essential for evidence based clinical practice. However, the most effective methods of implementation are unclear. We conducted a national, cluster-randomised, blinded implementation trial to determine if midwife or doctor local implementation leaders are more effective in implementing a guideline for use of oral dextrose gel to treat hypoglycaemic babies on postnatal wards. To prevent any conscious or unconscious performance bias both the doctor and midwife local implementation leaders were kept unaware of (...) the trial. This paper reports the ethical dilemmas and practical challenges of ensuring clinicians remained unaware of their involvement in an implementation trial.MethodsWe sought approval from the National Health and Disability Ethics committee to keep clinicians unaware of the trial by waiving the standard requirement for locality approval usually required for each district health board. The ethics committee did not approve a waiver of consent but advised that we approach the chief executive of each district health board to ask for provisional locality approval. Ultimately it was necessary to seek ethics approval for three separate study designs to keep clinicians unaware of the trial.ResultsThe median time for chief executive approval was 16 days and for locality approval was 57 days. We completed 21 different locality approval forms for 27 hospitals.ConclusionsKeeping clinicians unaware of their involvement in a national implementation cluster-randomised trial is feasible. However, despite a national ethics committee, significant logistical challenges were time consuming and delayed trial completion. Co-ordination of the locality approval process would help facilitate multi-centre trials. (shrink)

One of the challenges that liberal neutrality faces in diverse societies is how to maintain neutrality towards conception of the good life, when establishment of a particular conception of the good and exclusion of other conceptions is inevitable, as in the case of language regulation. A possible solution is to justify this establishment by appealing to universal reasons, thus refraining from endorsing the intrinsic value of the established conception. This paper argues that such a solution is limited, as it (...) does not cover all inevitable-establishment domains. This is because there is a distinction within inevitable-establishment domains: domains in which rival options can coexist, such as language policy, and domains in which options are mutually exclusive, such as land-use policy. The paper argues that language policy is a coexistence domain, since it allows for a degree of personal agency, and it can refrain from making value judgments about the language that is endorsed by the state. Spatial organization and land-use policy, on the other hand, must rest on value judgments about the good life and cannot accommodate neutral justifications. The distinction has important implications for the scope of neutrality: neutrality turns out to be applicable in coexistence domains, and inapplicable in mutually-exclusive domains. Ultimately, it may be the case that neutrality may not be applicable even in language policy, since language policy exhibits characteristics of a mutually-exclusive domain. (shrink)

Resumen El artículo se sitúa ante los nuevos contextos que los jóvenes viven en América Latina, especialmente, considerando las estructuras de corrupción ante lo cual los jóvenes son más vulnerables por su condición de búsqueda de espacios de desarrollo y crecimiento social. Esta situación, plantea nuevos retos para la Pastoral Juvenil latinoamericana teniendo en cuenta que la misma institución eclesial no ha estado ajena a situaciones de corrupción. A través de un análisis documental, desde las Escrituras, pasando por cuatro de (...) las Conferencias Episcopales Latinoamericanas, el artículo pretende desarrollar la tensión entre jóvenes, sociedad y pastoral juvenil, para finalmente presentar una propuesta que se fundamenta en un proceso juvenil de cinco décadas que transita desde una pastoral liberadora a una pastoral regeneradora, donde los sujetos jóvenes rotos buscan renacer en nuestra América Latina.s The article is set against the new contexts that young people live in Latin America, especially considering the structures of corruption lo which young people are more vulnerable because oj their search for spaces of development and social growth. This situation poses new challenges for Latin American Youth Ministry bearing in mind that the Church institution itself has not been unaware of situations of corruption. Through a documentary analysis, from the Scriptures, through four of the Latin American Episcopal Conferences, the article aims to develop the tension between young people, socieíy and youth pastoral, lo finally present a proposal thal is based on a youth process of five decades that It goes from a liberating pastoral to a regenerative pasloral, where the broken young subjects seek to be reborn in our Latin America. (shrink)

The structure of our ethical experience depends, crucially, on a fundamental distinction between what we are responsible for doing or deciding and what is given to us. As such, the boundary between chance and choice is the spine of our conventional morality, and any serious shift in that boundary is thoroughly dislocating. Against this background, I analyze the way in which techniques of prenatal genetic diagnosis (PGD) pose such a fundamental challenge to our conventional ideas of justice and moral (...) responsibility. After a short description of the situation, I first examine the influential luck egalitarian theory of justice, which is based on the distinction between choice and luck or, more specifically, between option luck and brute luck, and the way in which it would approach PGD (section II), followed by an analysis of the conceptual incoherencies (in section III) and moral problems (in section IV) that come with such an approach. Put shortly, the case of PGD shows that the luck egalitarian approach fails to express equal respect for the individual choices of people. The paradox of the matter is that by overemphasizing the fact of choice as such, without regard for the social framework in which they are being made, or for the fundamental and existential nature of particular choices—like choosing to have children and not to undergo PGD or not to abort a handicapped fetus—such choices actually become impossible. (shrink)

Mainstream neoclassical economics, as well as heterodox schools, should be regarded as different kinds of 'political economics'. There is no value-free economics. We therefore need to bring democracy into economics. The present challenge of sustainable development suggests that a new conceptual framework in economics is needed. In this essay, a political and democratic view of individuals, organisations, decision-making, markets, assessment of investment projects and policy options is proposed. The imperative of democracy also implies that the close-to-monopoly position of neoclassical (...) theory and method at university departments of economics has to be replaced by pluralism. There is a continued role for neoclassical theory and method, considering the fact that millions of professionals globally have been indoctrinated in this particular way of understanding efficiency and governance, but the idea that neoclassical theory is best for all purposes has to be abandoned. (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be (...) discussed in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

Though most contemporary philosophers and scientists accept a physicalist view of mind, the recent surge of interest in the problem of consciousness has put the mind /body problem back into play. The physicalists' lack of success in dispelling the air of residual mystery that surrounds the question of how consciousness might be physically explained has led to a proliferation of options. Some offer alternative formulations of physicalism, but others forgo physicalism in favour of views that are more dualistic or that (...) bring in mentalistic features at the ground- floor level of reality as in pan-proto-psychism. My aim here is to give an overview of the recent philosophic discussion to serve as a map in locating issues and options. I will not offer a comprehensive survey of the debate or mark every important variant to be found in the recent literature. I will mark the principal features of the philosophic landscape that one might use as general orientation points in navigating the terrain. I will focus in particular on three central and interrelated ideas: those of emergence, reduction, and nonreductive physicalism. The third of these, which has emerged as more or less the majority view among current philosophers of mind, combines a pluralist view about the diversity of what needs to be explained by science with an underlying metaphysical commitment to the physical as the ultimate basis of all that is real. The view has been challenged from both left and right, on one side from dualists and on the other from hard core reductive materialists. Despite their differences, those critics agree in finding nonreductive physicalism an unacceptable and perhaps even incoherent position. They agree as well in treating reducibility as the essential criterion for physicality; they differ only about whether the criterion can be met. Reductive physicalists argue that it can, and dualists deny it. (shrink)

Though most contemporary philosophers and scientists accept a physicalist view of mind, the recent surge of interest in the problem of consciousness has put the mind/body problem back into play. The physicalists' lack of success in dispelling the air of residual mystery that surrounds the question of how consciousness might be physically explained has led to a proliferation of options. Some offer alternative formulations of physicalism, but others forgo physicalism in favour of views that are more dualistic or that bring (...) in mentalistic features at the ground- floor level of reality as in pan-proto-psychism. My aim here is to give an overview of the recent philosophic discussion to serve as a map in locating issues and options. I will not offer a comprehensive survey of the debate or mark every important variant to be found in the recent literature. I will mark the principal features of the philosophic landscape that one might use as general orientation points in navigating the terrain. I will focus in particular on three central and interrelated ideas: those of emergence, reduction, and nonreductive physicalism. The third of these, which has emerged as more or less the majority view among current philosophers of mind, combines a pluralist view about the diversity of what needs to be explained by science with an underlying metaphysical commitment to the physical as the ultimate basis of all that is real. The view has been challenged from both left and right, on one side from dualists and on the other from hard core reductive materialists. Despite their differences, those critics agree in finding nonreductive physicalism an unacceptable and perhaps even incoherent position. They agree as well in treating reducibility as the essential criterion for physicality; they differ only about whether the criterion can be met. Reductive physicalists argue that it can, and dualists deny it. (shrink)

We introduce a distinct type of choice that has yet to be addressed by self-control research: Choosing between activities that offer both delayed and immediate rewards. We describe when and why such mixed-reward choices pose challenges to self-control, and suggest that self-control in mixed-reward choices may be supported by delay discounting.

This contribution addresses the anthropocenic challenge from a dialectical perspective, combining a diagnostics of the present with a prognostic of the emerging future. It builds on the oeuvres of two prominent dialectical thinkers, namely Georg Wilhelm Friedrich Hegel and Pierre Teilhard de Chardin. Hegel himself was a pre-anthropocenic thinker who did not yet thematise the anthropocenic challenge as such, but whose work allows us to emphasise the unprecedented newness of the current crisis. I will especially focus on (...) his views on Earth as a planetary process, emphasising that the “spirit” of technoscience is basically monitoring the impacts of its own activities on geochemistry and evolution. Subsequently, I will turn attention to Teilhard de Chardin, a palaeontologist and philosopher rightfully acknowledged as one of the first thinkers of the Anthropocene whose oeuvre provides a mediating middle term between Hegel’s conceptual groundwork and the anthropocenic present. Notably, I will discuss his views on self-directed evolution, on the on-going absorption of the biosphere by the noosphere, and on emerging options for “sublating” the current crisis into a synthetic convergence towards the Omega point. I will conclude that, after disclosing the biomolecular essence of life, biotechnology must now take a radical biomimetic turn ; that reflection itself must become distributed and collective; and, that the anthropocenic crisis must be sublated into the noocene. (shrink)

Dominant agri-food systems are increasingly seen as unsustainable in terms of environmental degradation, mass production or high food waste. In an attempt to counteract these developments and foster sustainability transitions in agri-food systems, a variety of actors are engaging in socially innovative models of food production and consumption. Using a multiple case study approach, our study examines three contrasting alternative economic models in the city of Berlin: community gardens, the app Too Good To Go (TGTG), and a cooperative supermarket. Based (...) on 15 qualitative interviews, we provide insights into their transformative potential by exploring participants' underlying motivations, the changes they have experienced, and the challenges and potential for future development of these models. We find that participation in community gardens and the cooperative supermarket is similarly motivated by social aspects and dissatisfaction with existing food access options, while TGTG users are more motivated by financial reasons. Our study shows that change is experienced mainly at the individual level, e.g. by building new relationships, changing cognitive framings, and learning (new) practices, especially in community-oriented settings. The individualization of change shows that these models have a rather low potential to lead to more systemic accounts of changes. Yet, they can prefigure regime change, describe resistance, and foster cumulative incremental change that may spill over into society. We conclude that in order to sustain this role and drive transitions, it is important to up- and outscale these models; and we provide recommendations on how these models can mutually support their development, establishment, and protection. (shrink)

The role of uncertainty within an organization’s environment features prominently in the business ethics and management literature, but how corporate investment decisions should proceed in the face of uncertainties relating to the natural environment is less discussed. From the perspective of ecological economics, the salience of ecology-induced issues challenges management to address new types of uncertainties. These pertain to constraints within the natural environment as well as to institutional action aimed at conserving the natural environment. We derive six areas (...) of ecology-induced uncertainties and propose ecology-driven real options as a conceptual approach for systematically incorporating these uncertainties into strategic management. We combine our results in an integrative investment framework and illustrate its application with the case of carbon constraints. (shrink)

This open access collection of AI ethics case studies is the first book to present real-life case studies combined with commentaries and strategies for overcoming ethical challenges. Case studies are one of the best ways to learn about ethical dilemmas and to achieve insights into various complexities and stakeholder perspectives. Given the omnipresence of AI ethics in academic, policy and media debates, the book will be suitable for a wide range of audiences, from scholars of different disciplines (e.g. AI (...) science, ethics, politics, philosophy, economics) to policy-makers, lobbying NGOs, teachers and the educated public. (shrink)

Trading on non-public material information is fertile ground for a discussion of ethical behavior. The long-running legal tug-of-war over what constitutes illegal insider trading delivers challenges to regulatory authorities charged with detecting and enforcing the law, and is likely one of the reasons that prosecution of insider trading events remains rather uncommon. One can observe both increased volume in the equity and option markets and run-ups in the stock price prior to the announcement of the acquisitions; however, the detection (...) of illegal or unethical insider trading can be difficult. Given the legal uncertainty around insider trading and the circumstantial evidence from the trading activity, it is almost impossible to identify unethical insider trades unless there is a whistleblower or trades are large in size and impeccable in timing. Using call option trading around two merger announcements with similar firms that resulted in different ultimate treatment from the SEC, we illustrate the struggle regulators and prosecutors have with identifying and enforcing unethical insider trades. (shrink)

“Indulging herself in air and exercise” as she wanders down a lane near the great house of Rosings, Elizabeth Bennet is unaware that she is just about to experience one of her most difficult challenges, and that Mr. Darcy is on his way with his letter.1 Just like present-day personality theorists, Jane Austen manifestly directed a great deal of creative and intellectual energy into devising a great variety of tests. But what are such situations designed to test for? What aspects (...) of character or personality, or traits and abilities, are meant to be scrutinized? A likely response from critics interested in Austen’s ethics is that such challenges should reveal which, if any, of the virtues are in good working order. .. (shrink)

Identifying ethically allowable options for infants with trisomy 18 has become more challenging as medical standards of practice shift, based on emerging scientific data and changing societal perceptions of disability. Lack of a stable professional standard of practice ought not prevent ethicists from facilitating a consensus; rather, these “unsettled cases” require an individualized, narrative approach that allows the values of the family and the particularities of each case to provide the necessary additional moral grounding.

The application of artificial intelligence (AI) to judicial decision-making has already begun in many jurisdictions around the world. While AI seems to promise greater fairness, access to justice, and legal certainty, issues of discrimination and transparency have emerged and put liberal democratic principles under pressure, most notably in the context of bail decisions. Despite this, there has been no systematic analysis of the risks to liberal democratic values from implementing AI into judicial decision-making. This article sets out to fill (...) this void by identifying and engaging with challenges arising from artificial judicial decision-making, focusing on three pillars of liberal democracy, namely equal treatment of citizens, transparency, and judicial independence. Methodologically, the work takes a comparative perspective between human and artificial decision-making, using the former as a normative benchmark to evaluate the latter. -/- The chapter first argues that AI that would improve on equal treatment of citizens has already been developed, but not yet adopted. Second, while the lack of transparency in AI decision-making poses severe risks which ought to be addressed, AI can also increase the transparency of options and trade-offs that policy makers face when considering the consequences of artificial judicial decision-making. Such transparency of options offers tremendous benefits from a democratic perspective. Third, the overall shift of power from human intuition to advanced AI may threaten judicial independence, and with it the separation of powers. While improvements regarding discrimination and transparency are available or on the horizon, it remains unclear how judicial independence can be protected, especially with the potential development of advanced artificial judicial intelligence (AAJI). Working out the political and legal infrastructure to reap the fruits of artificial judicial intelligence in a safe and stable manner should become a priority of future research in this area. (shrink)

Societal evaluation of new technologies, specifically nanotechnology and genetically engineered organisms , challenges current practices of governance and science. Employing environmental risk assessment for governance and oversight assumes we have a reasonable ability to understand consequences and predict adverse effects. However, traditional ERA has come under considerable criticism for its many shortcomings and current governance institutions have demonstrated limitations in transparency, public input, and capacity. Problem Formulation and Options Assessment is a methodology founded on three key concepts in risk assessment (...) and three in governance . Developed through a series of international workshops, the PFOA process emphasizes engagement with stakeholders in iterative stages, from identification of the problem through comparison of multiple technology solutions that could be used in the future with their relative benefits, harms, and risk. It provides “upstream public engagement” in a deliberation informed by science that identifies values for improved decision making. (shrink)

We investigated the ethical decision-making processes and intentions of 151 military personnel responding to 1 of 2 ethical scenarios drawn from the deployment experiences of military commanders. For each scenario, option choice and perspective affected decision-making processes. Differences were also found between the 2 scenarios. Results add to the emerging literature concerning operational ethical conflicts and highlight the complexity and challenge that often accompanies operational ethics.

Pediatric dentists rely on access to hospital operating rooms for safe, effective, and humane delivery of dental care. The children who benefit most from dental treatment in a hospital operating room are those who are very young, have dental anxieties or phobias, are precommunicative or noncommunicative, need extensive or invasive dental treatments, or have special healthcare needs. Diminishing access to hospital operating rooms for pediatric dental treatment has become an escalating problem in contemporary times. Financial barriers, hospital costs, reimbursement (...) rates, health insurance policies and deductibles, out-of-network hospitals, socioeconomic factors, and the COVID-19 pandemic are prominent contributing factors. This problem in access to care has resulted in long waiting times for hospital operating rooms, deferral of medically necessary dental care, and pain and infection among this vulnerable patient population. Pediatric dentists have responded to the problem by utilizing alternative methods of care delivery, such as in-office deep sedation or in-office general anesthesia, and by implementing aggressive medical management of dental caries. However, the youngest of pediatric patients and children with special healthcare needs still remain at a disadvantage in receiving definitive dental treatment. This article aims to highlight the ethical challenges faced by pediatric dentists in contemporary practice in the face of limitations in hospital operating room access through four case scenarios. (shrink)

We simultaneously live in two worlds—our internal world of thoughts, values, desires, and experiences; and our external world in which we are born, and perform actions. Modernity, despite successfully developing our external world, has failed to develop our internal world. This has resulted in our lower nature being unleashed and a crisis of morals and values taking over society. This paper, drawing from the “science of consciousness” as detailed in the Indian tradition, looks at the nature of modernity and (...) how we can address the challenges being posed by it, by training our consciousness to higher levels. (shrink)

Many of the things we do, we do together with other people. Think of carpooling and playing tennis. In the past two or three decades it has become increasingly popular to analyze such collective actions in terms of collective intentions. This volume brings together ten new philosophical essays that address issues such as how individuals succeed in maintaining coordination throughout the performance of a collective action, whether groups can actually believe propositions or whether they merely accept them, and what kind (...) of evidence, if any, disciplines such as cognitive science and semantics provide in support of irreducibly collective states.The theories of the Big Four of collective intentionality -- Michael Bratman, Raimo Tuomela, John Searle, and Margaret Gilbert -- and the Big Five of Social Ontology -- which in addition to the Big Four includes Philip Pettit -- play a central role in almost all of these essays. Drawing on insights from a wide range of disciplines including dynamical systems theory, economics, and psychology, the contributors develop existing theories, criticize them, or provide alternatives to them.Several essays challenge the idea that there is a straightforward dichotomy between individual and collective level rationality, and explore the interplay between these levels in order to shed new light on the alleged discontinuities between them. These contributions make abundantly clear that it is no longer an option simply to juxtapose analyses of individual and collective level phenomena and maintain that there is a discrepancy. Some go as far as arguing that on closer inspection the alleged discontinuities dissolve. (shrink)

Background At the point of cancer diagnosis, practitioners may wrestle with ethical dilemmas associated with medico-legal implications of diagnosis, treatment options and disclosure to family members. The patient's perspective can take a different route, focusing on ethical and existential questions about the value and purpose of life, culminating in the question: how do I lead my life after diagnosis? Objective To explore the ethical and existential challenges associated with a cancer diagnosis from the perspective of cancer survivors. Design Qualitative (...) design using specifically phenomenological methods to enable focus on subjective experience. Two in-depth interviews were conducted over a 6-month period. Setting Bendigo, Victoria, Australia. Participants 15 participants (n=11 women and n=4 men) volunteered to be interviewed. Age ranged from 32 to 85 years of age; length of survival 0.5–25 years; with a range of cancer diagnoses. Results Findings demonstrated that participants experienced existential and ethical challenges associated with a cancer diagnosis and subsequent survivorhood. These challenges were present regardless of cancer stage or diagnostic type and pervaded throughout length of survival. The existential challenges included the experience of anxiety and uncertainty about recurrence and metastatic disease. In particular, participants reported iatrogenic uncertainty induced by tests and treatment with follow-up regimes underscoring the fragility of survivor status. Uncertainty served as a ‘wake-up call’ and precipitated ethical challenges. Such challenges involved making meaning of survivorhood and questioning of morals, values and relationships. At times these questions were painful and difficult, creating unease about leading a ‘good’ and purposeful life. Entering ethically rocky terrain was also considered identity enhancing, with reports that a cancer diagnosis could have benefits as well as challenges. Conclusion This study identified a number of challenges associated with a cancer diagnosis; these have implications for the preparation of medical, nursing and social work practitioners and should be considered during the design of follow-up support for cancer patients and those in recovery. (shrink)

This paper covers views on certain major challenges to the justification of ethical cosmopolitanism `s existence. They could be understood in the context of effects of the global economy on human life and values, due its social imbalances and inequalities. The foremost, guiding idea of ethical cosmopolitanism is the one that all humans must be considered as equal However, this postulate is way too much questioned today in the Globalization era. Forced migration is the first challenge in topicality nowadays. (...) It spells out global displacement of people caused by poverty and war danger. The economic and political elite in the world today ignores its obligation to treat equally victims of forced migration - and is inclined to define multiculturalism as useless. The growth of forced migration witnessed at present is caused by the existing deepening of inequalities and global injustice. We need a communitarian approach to the problem of forced migration. Another challenge is the moral criticism of global capitalism starting out from the point of view of existence of alternative globalism. Many organizations of the global civic society have established international cooperation in their collective actions for development of a socially-responsible globalization. The vast majority of people in the world are fighting against neoliberal policies and for their social rights: equal treatment from this point of view is an important aspect of cosmopolitanism. Our planet does not have adequate resources to secure a high standard of living for all humans, on a par with that of the richest peoples. Today, in the process of ongoing march of neoliberal globalization, rich men are becoming ever richer and the world community is not adequately successful in its efforts to reduce poverty. Third challenge in this context are the abuses of cosmopolitanism in its justification of the so-called “humanitarian interventions” of the international community in shouldering the responsibility for mankind`s development and securing observation of human rights. Cosmopolitanism could thus be used as an ideology by the richest elites to justify their worldwide expansionism. The idea that the international community is interested in the observation of human rights when they are violated by a “dictatorial state” is being forwarded. Yet, there is no doubt today that some of these interventions have been motivated by imperialist strategies of ‘the Great Powers’ in action. Two possible options are available here: choice of cosmopolitanism or choice republicanism; republicanism implies respect for the principle of sovereignty of each country and coalitions of countries set up on the basis of commonly-shared interests. (shrink)

In this paper, I introduce a “promises and perils” framework for understanding the “soft” impacts of emerging technology, and argue for a eudaimonic conception of well-being. This eudaimonic conception of well-being, however, presupposes that we have something like stable character traits. I therefore defend this view from the “situationist challenge” and show that instead of viewing this challenge as a threat to well-being, we can incorporate it into how we think about living well with technology. Human beings (...) are susceptible to situational influences and are often unaware of the ways that their social and technological environment influence not only their ability to do well, but even their ability to know whether they are doing well. Any theory that attempts to describe what it means for us to be doing well, then, needs to take these contextual features into account and bake them into a theory of human flourishing. By paying careful attention to these contextual factors, we can design systems that promote human flourishing. (shrink)

Understanding the clinical significance of variants associated with hereditary cancer risk requires access to a pooled data resource or network of resources—a “cancer gene variant commons”—incorporating representative, well-characterized genetic data, metadata, and, for some purposes, pathways to case-level data. Several initiatives have invested significant resources into collecting and sharing cancer gene variant data, but further progress hinges on identifying and addressing unresolved policy issues. This commentary provides insights from a modified policy Delphi process involving experts from a range (...) of stakeholder groups involved in the data-sharing ecosystem. In particular, we describe policy issues and options generated by Delphi participants in five domains critical to the development of an effective cancer gene variant commons: incentives, financial sustainability, privacy and security, equity, and data quality. Our intention is to stimulate wider discussion and lay a foundation for further work evaluating policy options more in-depth and mapping them to those who have the power to bring about change. Addressing issues in these five domains will contribute to a cancer gene variant commons that supports better care for at-risk and affected patients, empowers patient communities, and advances research on hereditary cancers. (shrink)

Funding agencies and large public scientific institutions are increasingly using the term “research portfolio” as a means of characterizing their research. While portfolios have long been used as a heuristic for managing corporate R&D, they remain ill-defined in a science policy context where research is aimed at achieving societal outcomes. In this article we analyze the discursive uses of the term “research portfolio” and propose some general considerations for their application in science policy. We explore the use of the term (...) in private R&D and related scholarly literature in existing science policy practices, and seek insight in relevant literature in science policy scholarship. While the financial analogy can in some instances be instructive, a simple transposition from the world of finance or of corporate R&D to public research is problematic. However, we do identify potentially fruitful uses of portfolio analysis in science policy. In particular, our review suggests that the concept of research portfolio can indeed be a useful analytical instrument for tackling complex societal challenges. Specifically, the strands of scholarship identified suggest that the use of research portfolio should: i) recognize the diversity of research lines relevant for a given societal challenge, given the uncertainty and ambiguity of research outcomes; ii) examine the relationships between research options of a portfolio and the expected societal outcomes; and iii) adopt a systemic perspective to research portfolios – i.e. examine a portfolio as a functional whole, rather than as the sum of its parts. We argue that with these considerations, portfolio-driven approaches may foster social inclusion in science policy decisions, help deliberation between “alternative” portfolios to tackle complex societal challenges, as well as promote cost-effectiveness and transparency. (shrink)

This paper focuses on the _ethics of how_ to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the _ethics of why_ MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that (...) drew inspiration from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option. (shrink)

God Over All: Divine Aseity and the Challenge of Platonism is a defense of God's aseity and unique status as the Creator of all things apart from Himself in the face of the challenge posed by mathematical Platonism. After providing the biblical, theological, and philosophical basis for the traditional doctrine of divine aseity, William Lane Craig explains the challenge presented to that doctrine by the Indispensability Argument for Platonism, which postulates the existence of uncreated abstract objects. (...) Craig provides detailed examination of a wide range of responses to that argument, both realist and anti-realist, with a view toward assessing the most promising options for the theist. A synoptic work in analytic philosophy of religion, this groundbreaking volume engages discussions in philosophy of mathematics, philosophy of language, metaphysics, and metaontology. (shrink)

According to some contemporary nonnaturalists about normativity (e.g., Parfit, Scanlon, Dworkin), normative facts exist in an ontologically non-committing sense. These nonnaturalists face an explanatory burden. They must explain their claim that normative facts exist in such a sense. I identify criteria for an adequate explanation, and extract five distinct candidate explanations from the writings of these authors (based on causal efficacy, analogy with modality, fundamentality, domain-relativity and first-order considerations respectively). I assess each. None is both (a) informative and (b) (...) recognizable as a version of contemporary nonnaturalism. In light of this, I assess the best options for proponents of this view. (shrink)

Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the (...) family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making. (shrink)

The paper focuses on issues of development dimensions of Medical Law and its ongoing process of standardization and harmonization on one hand, versus the traditionally rooted and available principles of biomedical ethics, on the other. The collision of new legal institutes and the spread of human rights protections is evident. This paper follows the theory and practice of medical ethics and medical law. The theoretical aspect points out medical ethics as one of the sources of medical law. Legal theory makes (...) a distinction between formal and autonomous sources of medical law. Even though ethics is morally much higher, law prevails because it has stronger sanctions and legal power. In its practical aspect, this paper gives examples of different situations of medical decision-making processes. Ethical rules are of the utmost relevance in the domain of confidentiality and options of medical treatment. But, in concrete medical procedures, where legal positions of patients are evidently very significant, law has a more distinct function. Therefore, explaining particular cases from medical malpractice, such as cases of penal, civil or professional liability have an ethical dimension as well. Members of medical professions in Serbia often find these cases unfair. Mostly this is the consequence of ignorance in this kind of medical law and ethics relations. A discussion about practical cases has in that sense a self-learning component, which could be developed to strengthen ethical reasoning and judgment. Clanak stavlja naglasak na razvojnu dimenziju medicinskog prava i pitanja u kojoj meri njegova standardizacija i harmonizacija, na jednoj strani, uticu na primenu tradicionalno ukorenjenih vazecih principa biomedicinske etike, na drugoj. Teorijski aspekt clanka upucuje na medicinsku etiku kao jedan od izvora medicinskog prava koji se smatra autonomnim izvorom. Iako je etika na visoj lestvici, pravo preteze jer ima pravnu snagu element prinude i jacu sankciju za postupanje protivno pravilima. U svom prakticnom aspektu ovaj clanak stavlja naglasak na razlicite situacije pri donosenju medicinskih odluka, gde pravni polozaj onog ko se leci postaje veoma bitan, a pravo tu ima striktno odredjenu funkciju zastite. Zbog toga, objasnjenje posebnih slucajeva pogresne medicinske prakse ima svoj eticki, ali pre svega pravni znacaj, kakvi su slucajevi procesuiranja krivicne, imovinske i staleske odgovornosti. Pripadnici medicinskih profesija u Srbiji cesto smatraju sudske postupke protiv sebe nepravednim. Vecinom je to posledica upravo nepoznavanja odnosa normi medicinskog prava i etickih pravila. Razmatranje slucajeva iz prakse ima i svoju edukativnu komponentu koja na taj nacin unapredjuje eticko promisljanje i osnazuje pravno odlucivanje. (shrink)

Godfrey-Smith’s environmental complexity thesis is most often applied to multicellular animals and the complexity of their macroscopic environments to explain how cognition evolved. We think that the ECT may be less suited to explain the origins of the animal bodily organization, including this organization’s potentiality for dealing with complex macroscopic environments. We argue that acquiring the fundamental sensorimotor features of the animal body may be better explained as a consequence of dealing with internal bodily—rather than environmental complexity. To press and (...) elucidate this option, we develop the notion of an animal sensorimotor organization that derives from an internal coordination account for the evolution of early nervous systems. The ASMO notion is a reply to the question how a collection of single cells can become integrated such that the resulting multicellular organization becomes sensitive to and can manipulate macroscopic features of both the animal body and its environment. In this account, epithelial contractile tissues play the central role in the organization behind complex animal bodies. In this paper, we relate the ASMO concept to recent work on epithelia, which provides empirical evidence that supports central assumptions behind the ASMO notion. Second, we discuss to what extent the notion applies to basic animal architectures, exemplified by sponges and jellyfish. We conclude that the features exhibited by the ASMO are plausibly explained by internal constraints acting on and within this multicellular organization, providing a challenge for the role the ECT plays in this context. (shrink)

The purpose of this essay is to critically review the design of methods for ethically robust forms of technology appraisal in the regulation of research and innovation in synthetic biology. It will focus, in particular, on the extent to which cost‐benefit analysis offers a basis for informing decisions about which technological pathways to pursue and which to discourage. A further goal is to consider what (if anything) the precautionary principle might offer in enabling better decisions. And this, in turn, raises (...) questions about why mention of precaution can excite accusations of unscientific bias or irrational, “anti‐innovation” extremism. What does the polarized debate tell us about the politics around synthetic biology? In seeking more rigorous, timely, and practical ways to govern these remarkable new technologies, what might we be missing?The sophistication, diversity, and scope of synthetic biology may seem to make it a rather idiosyncratic area for exploring these general issues. It may seem to be a special case, with the bewildering pace of change amplifying the difficulties. But at root, some of the trickiest issues are just specific instances of familiar and long‐standing conundrums in the governance of science and technology. The basic challenge is how to weigh up, for a wide range of potential options, the various pros and cons, as viewed from divergent perspectives, and find a way to justify the best course of action on behalf of society as a whole. This is the central problem addressed by a number of techniques in CBA. On the face of it, synthetic biology seems to present just one more application of these well‐established and self‐confident prescriptive methods.But there do emerge several obstinate, even prohibitive, difficulties for CBA. Although they are well acknowledged by the scholarly literature on and around this topic, they are often sidelined in practice. Yet all are central to the case for applying the concept of precaution to a field like synthetic biology. This essay will briefly explore multicriteria mapping, an appraisal method for exploring contrasting perspectives on emerging technologies, as one practical way to address them. The essay focuses on MCM, not because it presents any sort of panacea for appraisal, but because it is illustrative of the concrete implications of precaution. Setting out even just one among potentially many practical alternative methods at least refutes the last‐ditch argument that CBA is the only operational choice. (shrink)

A bewildering range of games are emerging every other day with newer elements of fun and entertainment to woo youngsters. Games are meant to reduce stress and enhance the cognitive development of children as well as adults. Teenagers are always curious to indulge in newer games; and e-gaming is one such platform providing an easy access and quicker means of entertainment. The particular game challenge which has taken the world by storm is the dangerous “Blue Whale Challenge” often (...) involving vulnerable teenagers. The Blue Whale Challenge is neither an application nor internet based game but the users get a link through social media chat groups to enter this “deadly” challenge game. This probably is the only game where the participant has to end his/her life to complete the game. The innocent teenagers are being targeted based on their depressed psychology and are coercively isolated from their social milieux on the pretext of keeping the challenges confidential. To add to the woes, no option is offered to quit the challenge even if the contender is unable to complete the challenge. Blue Whale Challenge in its sheer form could be seen as an illegal, unethical and inhumane endeavor in our present society. The present communication discusses the severe effects of the game on teenagers, the ethical concerns involved and the preventive measures necessary to curb it. (shrink)

As technology advances, and the life and death consequences of its failure become more and more removed from proximate human action, technology management requires greater degrees of ethical awareness and the management of safety becomes a matter of corporate ethical imperative. The corporate ethical imperative includes ethical mandates to take no action which places the lives of others at risk and to inform persons of dangers to their physical safety of which they may otherwise be unaware when one possesses (...) information relevant to the safety of others such that, with the possession of that knowledge, the others can make decisions relevant to protecting their safety, or if others fail to take such action, to take upon oneself the responsibility of taking such action. The ethical duty of primum non nocere implies the corresponding right of the life risking participant to be informed of the kind and degree of risk to which they are to be exposed and the freedom to refuse to take such risk without prejudice. The corporate ethical imperative is to hold human life precious and to uphold that imperative through selectively non-acting, properly informing and acting. The case of the Challenger disaster is utilised as an illustration of decision making which violated these ethical precepts. (shrink)

In the context of a public health emergency it is imperative to conduct research studies that will produce evidence rapidly while upholding ethical standards. The Ebola and Zika outbreaks highlighted the importance of devising agile processes for ethics review in emergencies, and international research ethics guidelines stress the duty to depart from standard processes for ethics review in emergency circumstances. However, before the COVID-19 pandemic it was not entirely clear what emergency procedures should look like. An additional challenge (...) is that while the same substantive ethical standards apply in emergency and non-emergency settings, deciding what these standards entail in the specific circumstances of a pandemic may be difficult. During the COVID-19 pandemic, challenges included identifying thresholds of social and scientific value, along with duties towards research participants, given the absence of therapeutic options; assessing continually changing risk–benefit profiles of studies, given rapidly emerging new evidence; developing appropriate informed consent processes, given lockdown scenarios; and even addressing the ethics of offering unproven interventions outside research settings. Additional issues raised during epidemics include devising feasible and meaningful community engagement strategies, mechanisms to ensure fairness in the distribution of the benefits that may result from research, and equitable and effective data-sharing plans that will inform pandemic response. Learning from these procedural and substantive challenges encountered in the ethics review of COVID-19 research is important for enhancing ethics preparedness for future emergencies. It can also potentially contribute to improving the ethics review of research in non-emergency circumstances. The seven cases in this chapter highlight ethical issues associated with ethics approval of multi-centre studies in pandemics, the need for careful consideration of the social and scientific value of research and challenges encountered when interventions are being transitioned from research to rollout, and issues that can arise when existing regulations and policies may limit capacities to appropriately adapt research to pandemic contexts. (shrink)

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United (...) Kingdom and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect—moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians’ moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times. (shrink)

Action research began as an ambitious epistemological and social intervention. As the concept has become reified, packaged for methodology textbooks and professional development workshops, it has degenerated into a cure that may be worse than the disease. The point is not the trivial one that action research, like any practice, sometimes shows up in cheap or corrupt forms. The very idea that action research already exists as a live option is mystifying, distracting us from the deep challenge (...) that action research ultimately represents. Though Joseph Schwab is sometimes credited as a forerunner of action research, it is likely that he would see the new talk of ‘the teacher as researcher’ as indicative of the very epitomization of which he warned. Dewey’s new conception of knowledge, action, and communication – and the vision of the teacher as learner it entails – requires nothing short of a radical rethinking of teaching and inquiry, schooling and teacher education. This essay recalls the promise of... (shrink)

This paper offers a philosophical response to an aspect of the youth question in Africa – the question of youth vulnerability and its consequences on the human development outcome. To achieve the desired goal, first, I stretch the concept of pathogenic vulnerability from being more than ordinarily vulnerable to being far more than ordinarily vulnerable. Second, I identify two elements of African cultural structure – primacy of community over the individual and the belief that elders always possess superior knowledge (...) over the youth – that influence and restrict capacity/capabilities in African youth and therefore make their transition to adulthood defective. Consequently, the African youth is deprived of the special opportunity to develop, encounter and explore the various character options from which he/she learns, selects and forms her identity. Third, I argue that these restraints of capacity/capabilities make African youths far more than ordinarily vulnerable to human development outcome. (shrink)

In this paper, I examine a case for fundamental indeterminacy (FI) by Elizabeth Barnes and offer my counterarguments. Barnes' account of FI includes both the characterization of FI and why we need to accept it. I argue that her reasons for accepting FI can be challenged even when we accept her characterization of FI. Her main claim is that finding a fundamental proposition that our fundamental theory is indeterminate about (FPF) gives us a reason to accept FI in metaphysics. I (...) challenge her claim by pointing out more plausible options to address FPFs. An FPF may either indicate that the theory is nonfundamental or lead us to accept the antirealist view; there is no room for FI in either option. One may insist on accepting FI, but I argue that it is not theoretically rewarding enough. Hence, Barnes' case for FI can be contested. (shrink)

This dissertation is a contribution to the field of empirically informed metaethics, which combines the rigorous conceptual clarity of traditional metaethics with a careful review of empirical evidence. More specifically, this work stands at the intersection of moral psychology, moral epistemology, and philosophy of action. The study comprises six chapters on three distinct (although related) topics. Each chapter is structured as an independent paper and addresses a specific open question in the literature. The first part concerns the psychological features and (...) cognitive function of moral intuition. Chapter 1 (“Moral intuition, strength, and metacognition”) is focused on the concept of intuitive strength, which is one of the defining features of moral intuition. I provide a metacognitive account of intuitive strength and show why such a view is preferable to emotional or quasi-perceptual accounts. Then, in Chapter 2 (“Dual process reflective equilibrium”), I will discuss the interplay between intuition and reflection in moral reasoning. I will contend that the influential “default-interventionist” model of reasoning, theorized by Greene, is insufficiently supported by the evidence. In light of some recent studies, I outline an account of moral reasoning in which intuition and reflection are not in conflict but cooperate to reach a reflective goal. I call this model dual process reflective equilibrium. The aim of the first part is descriptive, i.e., it argues for an accurate understanding of moral intuition and reasoning in light of the available empirical evidence. In contrast, the second part addresses a normative question: is a subject epistemically justified in forming a belief on the basis of a moral intuition? Skeptics of moral intuition argue that accepting moral intuitions should be the exception rather than the rule to the extent that epistemically defective processes determine the content of moral intuitions. Chapter 3 (“Moral intuitionism and the reliability challenge”) introduces the recent empirical challenges to the reliability of moral intuitions and elaborates a promising strategy for defending intuitionism. In short, I consider whether subjects can track the reliability of their intuitions with their confidence. In Chapter 4 (“The argument from limited cognitive resources”), I evaluate a different strategy to defend moral intuitionism. Specifically, I develop an argument according to which accepting moral intuitions is legitimate because it is the most rational option that a subject has, given her limited resources. The third and final part of the dissertation concerns the role of moral intuitions in action. The influence of automatic processes on moral conduct raises different challenges to moral philosophy. The first challenge is to explain how a subject can be motivated by certain values without the mental effort of deliberation. Chapter 5 (“Caring, moral motivation, and automatic conduct”) tackles this issue. Chapter 6 (“Moral sensitivity as skillful automaticity”) aims to explain how moral agents can be sensitive to good reasons through automatic mental processes. (shrink)

A central problem for the international governance of heritable germline gene editing is that there are important differences in attitudes and values as well as ethical and health care considerations around the world. These differences are reflected in a complicated and diverse regulatory landscape. Several publications have discussed whether reproductive uses would be legally permissible in individual countries and whether clinical applications could emerge in the context of regulatory gaps and gray areas. Systematic comparative studies that explore issues related to (...) the governance of this technology from different national and international perspectives are needed to address the lack of knowledge in this area. In this research report, we contribute to filling this gap by presenting views of stakeholders in the United Kingdom on challenges to the governance of heritable genome editing. We present findings from a multistakeholder study conducted in the United Kingdom between October 2016 and January 2018 and funded by the Wellcome Trust. This research included interviews, literature analysis, and a workshop. We involved leading U.K. scientists, in vitro fertilization clinicians, and representatives from regulatory bodies, patient organizations, and other civil societal organizations, as well as fertility companies. Part one of this article explores stakeholder perceptions of possible global developments in heritable genome editing and associated risks and governance challenges. Part two presents a range of policy options that were generated during the workshop in relation to the challenges discussed in part one. (shrink)

Fecal microbiota transplantation is reportedly the most effective therapy for relapsing Clostridium Difficile infection and a potential therapeutic option for many diseases. It also poses important ethical concerns. This study is an attempt to assess clinicians’ perception and attitudes towards ethical and social challenges raised by fecal microbiota transplantation. A questionnaire was developed which consisted of 20 items: four items covered general aspects, nine were about ethical aspects such as informed consent and privacy issues, four concerned social and regulatory (...) issues, and three were about an FMT bank. This was distributed to participants at the Second China gastroenterology and FMT conference in May 2015. Basic descriptive statistical analyses and simple comparative statistical tests were performed. Nearly three quarters of the 100 respondents were gastro-enterologist physicians. 89% of all respondents believed FMT is a promising treatment modality for some diseases and 88% of whom chose clinical efficacy as the primary reason for recommending FMT. High expectation from patients and pressure on clinicians was reported as the most frequent reasons for not recommending FMT. The clinicians who had less familiarity with FMT reported significantly more worry related to the dignity and psychological impact of FMT compared to those who have high familiarity with FMT.More than half of the respondents were concerned about the commercialization of FMT, although almost one in five respondents did not see this as a problem. We found most respondents have positive attitudes towards FMT but low awareness of published evidence. Informed consent for vulnerable patients, privacy and protection of donors were perceived as the most challenging ethical aspects of FMT. This study identified areas of limited knowledge and ways of addressing ethical issues and indicates the need to devise the education and training for clinicians on FMT. (shrink)

This article addresses the general ethical issues of accessing online personal data for research purposes. The authors discuss the practical aspects of online research with a specific case study that illustrates the ethical challenges encountered when accessing data from Kooth, an online youth web-counselling service. This paper firstly highlights the relevance of a process-based approach to ethics when accessing highly sensitive data and then discusses the ethical considerations and potential challenges regarding the accessing of public data from Digital (...) Mental Health services. It presents solutions that aim to protect young DMH service users as well as the DMH providers and researchers mining such data. Special consideration is given to service users’ expectations of what their data might be used for, as well as their perceptions of whether the data they post is public, private or open. We provide recommendations for planning and designing online research in an ethical manner that includes vulnerable young people as research participants. We emphasise the distinction between public, private and open data, which is crucial to comprehend the ethical challenges in accessing DMH data. Among our key recommendations, we foreground the need to consider a collaborative approach with the DMH providers while respecting service users’ control over personal data, and we propose the implementation of digital solutions embedded within the platform for explicit opt-out/opt-in recruitment strategies and ‘read more’ options. (shrink)

This article addresses the general ethical issues of accessing online personal data for research purposes. The authors discuss the practical aspects of online research with a specific case study that illustrates the ethical challenges encountered when accessing data from Kooth, an online youth web-counselling service. This paper firstly highlights the relevance of a process-based approach to ethics when accessing highly sensitive data and then discusses the ethical considerations and potential challenges regarding the accessing of public data from Digital (...) Mental Health services. It presents solutions that aim to protect young DMH service users as well as the DMH providers and researchers mining such data. Special consideration is given to service users’ expectations of what their data might be used for, as well as their perceptions of whether the data they post is public, private or open. We provide recommendations for planning and designing online research that includes vulnerable young people as research participants in an ethical manner. We emphasise the distinction between public, private and open data, which is crucial to comprehend the ethical challenges in accessing DMH data. Among our key recommendations, we foreground the need to consider a collaborative approach with the DMH providers while respecting service users’ control over personal data, and we propose the implementation of digital solutions embedded within the platform for explicit opt-out/opt-in recruitment strategies and ‘read more’ options. (shrink)