Background:The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients’ rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.Objectives:To examine ethics interventions conducted (...) on healthcare professionals and healthcare students to achieve ethics-related outcomes.Research design:A systematic review.Methods:Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher’s Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis.Ethical consideration:This systematic review was conducted following good scientific practice in every phase.Findings:It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.Conclusion:Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals. (shrink)

Promoting the ethical formation of engineering students through the cultivation of their discipline-specific knowledge, sensitivity, imagination, and reasoning skills has become a goal for many engineering education programs throughout the United States. However, there is neither a consensus throughout the engineering education community regarding which strategies are most effective towards which ends, nor which ends are most important. This study provides an overview of engineering ethics interventions within the U.S. through the systematic analysis of articles that featured ethical (...) interventions in engineering, published in select peer-reviewed journals, and published between 2000 and 2015. As a core criterion, each journal article reviewed must have provided an overview of the course as well as how the authors evaluated course-learning goals. In sum, 26 articles were analyzed with a coding scheme that included 56 binary items. The results indicate that the most common methods for integrating ethics into engineering involved exposing students to codes/standards, utilizing case studies, and discussion activities. Nearly half of the articles had students engage with ethical heuristics or philosophical ethics. Following the presentation of the results, this study describes in detail four articles to highlight less common but intriguing pedagogical methods and evaluation techniques. The findings indicate that there is limited empirical work on ethics education within engineering across the United States. Furthermore, due to the large variation in goals, approaches, and evaluation methods described across interventions, this study does not detail “best” practices for integrating ethics into engineering. The science and engineering education community should continue exploring the relative merits of different approaches to ethics education in engineering. (shrink)

The purpose of this exploratory study is to examine the use of an ethical intervention strategy - counterexplanation - on individuals' ethical decision-Making. As opposed to providing reasons to support a decision in the case of explanation, counterexplanation is the provision of reasons that either speak against or provide evidence against a chosen course of action. The number of explanations and/or counterexplanations provided by the participants is expected to have a significant effect on ethical evaluation and intention. The number of (...) explanations is expected to be negatively related to ethical decision-making while the number of counterexplanations is expected to be positively related to ethical decision-making. The experiment, that made use of five ethical vignettes, manipulated four treatment groups - explanation, counterexplanation, explanation/counterexplanation, and counterexplanation/explanation. Participants were randomly assigned to one of the four reatments. They performed the requirements of their treatment before recording their ethical evaluations and intentions. As expected, larger numbers of explanations led to less ethical decision-making and larger numbers of counterexplanations led to more ethical decision-making. However, when both types of explanations are required, the order of counterexplaining before explaining is more desirable as it leads to more ethical decision-making. The study also reports that individuals with high social desirability bias may generate less counterexplanations. Implications of the findings are explained in the paper. (shrink)

The purpose of this study was to determine whether accounting students’ perception of moral intensity could be enhanced through a limited ethics intervention in an Advanced Accounting course. Ethical decisions are heavily influenced by the intensity of the moral problem: the more egregious the act, the more the people view it as unethical. This controlled experiment measures the change in perceptions of moral intensity with the pre- and post-test instruments using five accounting specific vignettes containing moral dilemmas which are (...) progressively more intense. While other studies have shown that perceived moral intensity directly influences a persons’ moral decision-making process, as far as we are aware, this is the first study that assesses and tests whether the coverage of specific ethics content integrated into an accounting class can positively influence the students’ perception of moral intensity, moral sensitivity/awareness, moral judgment, and moral intentions. Positively influencing students’ moral sensitivity/awareness, moral judgment, and moral intentions is a critical first step to ensuring that our courses and curricula provide the learning environment in which students can develop knowledge and competencies required to become the ethical leaders of tomorrow. (shrink)

The purpose of this exploratory study is to examine the use of an ethical intervention strategy – counterexplanation – on individuals’ ethical decision-making. As opposed to providing reasons to support a decision in the case of explanation, counterexplanation is the provision of reasons that either speak against or provide evidence against a chosen course of action. The number of explanations and/or counterexplanations provided by the participants is expected to have a significant effect on ethical evaluation and intention. The number of (...) explanations is expected to be negatively related to ethical decision-making while the number of counterexplanations is expected to be positively related to ethical decision-making. The experiment, that made use of five ethical vignettes, manipulated four treatment groups – explanation, counterexplanation, explanation/counterexplanation, and counterexplanation/explanation. Participants were randomly assigned to one of the four reatments. They performed the requirements of their treatment before recording their ethical evaluations and intentions. As expected, larger numbers of explanations led to less ethical decision-making and larger numbers of counterexplanations led to more ethical decision-making. However, when both types of explanations are required, the order of counterexplaining before explaining is more desirable as it leads to more ethical decision-making. The study also reports that individuals with high social desirability bias (a tendency to present oneself in a culturally acceptable manner) may generate less counterexplanations. Implications of the findings are explained in the paper. (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the (...) brain — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

Background Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders’ perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic (...) stimulation (rTMS), deep brain stimulation (DBS), and adaptive brain implants (ABI).Methods We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs.Results Participants’ ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies.Conclusions To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs. (shrink)

In recent years, discussion around memory modification interventions has gained attention. However, discussion around the use of memory interventions in the criminal justice system has been mostly absent. In this paper we start by highlighting the importance memory has for human well-being and personal identity, as well as its role within the criminal forensic setting; in particular, for claiming and accepting legal responsibility, for moral learning, and for retribution. We provide examples of memory interventions that are currently (...) available for medical purposes, but that in the future could be used in the forensic setting to modify criminal offenders’ memories. In this section we contrast the cases of dampening and enhancing memories of criminal offenders. We then present from a pragmatic approach some pressing ethical issues associated with these types of memory interventions. The paper ends up highlighting how these pragmatic considerations can help establish ethically justified criteria regarding the possibility of interventions aimed at modifying criminal offenders’ memories. (shrink)

This collection breaks new ground in four key areas of feminist social thought: the sex/gender debates; challenges to liberalism/equality; feminist ethics; and feminist perspectives on global ethics and politics in the 21st century. Altogether, the essays provide an innovative look at feminist philosophy while making substantive contributions to current debates in gender theory, ethics, and political thought.

This combination textbook and anthology provides coverage of the fundamental topics in current medical ethics adn familiarizes the reader with the basic moreal and social issues confronting the medical profession today.

Animals, like humans, suffer and die from natural causes. This is particularly true of animals living in the wild, given their high exposure to, and low capacity to cope with, harmful natural processes. Most wild animals likely have short lives, full of suffering, usually ending in terrible deaths. This book argues that on the assumption that we have reasons to assist others in need, we should intervene in nature to prevent or reduce the harms wild animals suffer, provided that it (...) is feasible and that the expected result is positive overall. It is of the utmost importance that academics from different disciplines as well as animal advocates begin to confront this issue. The more people are concerned with wild animal suffering, the more probable it is that safe and effective solutions to the plight of wild animals will be implemented in the future. (shrink)

The importance of fairness in machine learning models is widely acknowledged, and ongoing academic debate revolves around how to determine the appropriate fairness definition, and how to tackle the trade-off between fairness and model performance. In this paper we argue that besides these concerns, there can be ethical implications behind seemingly purely technical choices in fairness interventions in a typical model development pipeline. As an example we show that the technical choice between in-processing and post-processing is not necessarily value-free (...) and may have serious implications in terms of who will be affected by the specific fairness intervention. The paper reveals how assessing the technical choices in terms of their ethical consequences can contribute to the design of fair models and to the related societal discussions. (shrink)

In the field of health technology assessment, there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. (...) However, the potential methodological challenges for ethical analysis are as yet unknown.Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors’ experiences of developing, applying and assessing the approaches.The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach.This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general. (shrink)

Structural interventions to historic stone masonry buildings require that both structural and heritage values be considered simultaneously. The absence of one of these value systems in implementation can be regarded as an unethical professional action. The research objective of this article is to prepare a guideline for ensuring ethical structural interventions to small-scale stone historic masonry buildings in the conservation areas of Northern Cyprus. The methodology covers an analysis of internationally accepted conservation documents and national laws related to (...) the conservation of historic buildings, an analysis of building codes, especially Turkish building codes, which have been used in Northern Cyprus, and an analysis of the structural interventions introduced to a significant historic building in a semi-intact state in the walled city of Famagusta. This guideline covers issues related to whether buildings are intact or ruined, the presence of earthquake risk, the types of structural decisions in an architectural conservation project, and the values to consider during the decision making phase. (shrink)

This book is a collection of original essays by some of the leading moral and political thinkers of our time on the ethical and legal implications of humanitarian military intervention. As the rules for the 'new world order' are worked out in the aftermath of the Cold War, this issue is likely to arise more and more frequently, and the moral implications of such interventions will become a major focus for international law, the United Nations, regional organizations such as (...) NATO, and the foreign policies of nations. The essays collected here present a variety of normative perspectives on topics such as the just-war theory and its limits, secession and international law, and new approaches toward the moral legitimacy of intervention. They form a challenging and timely volume that will interest political philosophers, political theorists, readers in law and international relations, and anyone interested in moral dimensions of international affairs. (shrink)

Several authors in psychology and philosophy have recently raised the following question: when is it permissible to intentionally change the meaning and use of our words and concepts? I argue that an arguably prior question has received much less attention: Even if there were good moral or epistemic reasons for conceptual or semantic changes, this does not yet justify pushing or lobbying for such changes if they are socially and conceptually disruptive. In this paper, I develop the beginnings of an (...) ethics of conceptual disruption as well as a set of norms of linguistic interventions based on it. (shrink)

The global pandemic has intensified the risk of moral distress due to increased demands on already limited human resources and uncertainty of the pandemic’s trajectory. Nurses commonly experience moral distress: a conflict between the morally correct action and what they are required or capable of doing. Effective moral distress interventions are rare. For this reason, our team conducted a multi-phase research study to develop a moral distress intervention for pediatric critical care nurses. In this article, we discuss our multi-phase (...) approach to develop a moral distress intervention—proactive, interdisciplinary meeting. Our proposed intervention is a sequential compilation of empirical work couched within a relational ethics lens thus should point to enhanced potential for intervention effectiveness. (shrink)

Humans often intervene in the wild for anthropocentric or environmental reasons. An example of such interventions is the reintroduction of wolves in places where they no longer live in order to create what has been called an “ecology of fear”, which is being currently discussed in places such as Scotland. In the first part of this paper I discuss the reasons for this measure and argue that they are not compatible with a nonspeciesist approach. Then, I claim that if (...) we abandon a speciesist viewpoint we should change completely the way in which we should intervene in nature. Rather than intervening for environmental or anthropocentric reasons, we should do it in order to reduce the harms that nonhuman animals suffer. This conflicts significantly with some fundamental environmental ideals whose defence is not compatible with the consideration of the interests of nonhuman animals. (shrink)

When applied in population-level contexts, such as schools or business, mindfulness-based interventions (MBIs) find themselves in a crossfire between two different kinds of criticisms. On one side, some worry that MBIs’ normative commitments might be “too thick,” worrying that MBIs might come with a particular conception of the good, and significant ethical and religious commitments. On the other side, some worry that contemporary MBIs are ethically “too thin,” as they shed too many of their original Buddhist ethical and soteriological (...) goals. In this chapter, it is argued that contemporary MBIs should remain normatively thin, as that makes them more suitable for population-level contexts. Against “thickness worries,” it is argued that MBIs are compatible with liberal respect for autonomy, as the benefits are often autonomy-enhancing, which makes MBIs potentially valuable across a broad range of conceptions of the good. The second line of argument is developed through a discussion of MBIs in schools. (shrink)

Recently, there has been a lot of enthusiasm for mindfulness practice and its use in healthcare, businesses and schools. An increasing number of studies give us ground for cautious optimism about the potential of mindfulness-based interventions (MBIs) to improve people's lives across a number of dimensions. This paper identifies and addresses some of the main ethical and political questions for larger-scale MBIs. First, how far are MBIs compatible with liberal neutrality given the great diversity of lifestyles and conceptions of (...) the good characteristic of modern societies? It will be argued that the potential benefits of contemporary secular mindfulness practice are indeed of a sufficiently primary or all-purpose nature to qualify as suitable goals of liberal public policy. Second, what challenges are brought up if mindfulness is used in contexts and applications—such as military settings—whose goals seem incompatible with the ethical and soteriological views of traditional mindfulness practice? It will be argued that, given concerns regarding liberal neutrality and reasonable disagreement about ethics, MBIs should avoid strong ethical commitments. Therefore, it should, in principle, be applicable in contexts of controversial moral value. Finally, drawing on recent discussions within the mindfulness community, it is argued that we should not overstate the case for mindfulness and not crowd out discussion of organisational and social determinants of stress, lowered well-being, and mental illness and the collective measures necessary to address them. (shrink)

The moral complexity surrounding intervention is influenced by a broad spectrum of both ethical and practical assumptions and considerations.

Fetal alcohol spectrum disorders is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD. Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series (...) of discussions with experts in the field, published literature, and medical ethicists. Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the social services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. The value for the concerned individuals of obtaining a FASD-related description of their condition – for instance, in terms of wellbeing – is not established. Nor is it established that allocating resources based on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs. (shrink)

Early intervention aims to identify children or families at risk of poor health, and take preventative measures at an early stage, when intervention is more likely to succeed. EI is concerned with the just distribution of “life chances,” so that all children are given fair opportunity to realize their potential and lead a good life; EI policy design, therefore, invokes ethical questions about the balance of responsibilities between the state, society, and individuals in addressing inequalities. We analyze a corpus of (...) EI policy guidance to investigate explicit and implicit ethical arguments about who should be held morally responsible for safeguarding child health and well-being. We examine the implications of these claims and explore what it would mean to put the proposed policies into practice. We conclude with some remarks about the useful role that philosophical analysis can play in EI policy development. (shrink)

Psychiatric research is of critical importance in improving the care of persons with mental illness. Yet it may also raise difficult ethical issues. This article explores those issues in the context of a particular kind of research: psychosocial intervention research with control groups. We discuss 4 broad categories of ethical issues: consent, confidentiality, boundary violations, and risk-benefit issues. We believe that, despite the potential difficulties, psychosocial intervention research is vital and can be accomplished in an ethical manner. Further discussion and (...) research into these issues are warranted. (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)

Traditionally, biomedical research has been devoted to improvement in the understanding and treatment or prevention of disease. Building on the knowledge generated by the long history of disease-oriented research, the next few decades will witness an explosion of biomedical enhancements to make people faster, stronger, smarter, less forgetful, happier, prettier, and live longer (Turner et al. 2003; Vastag 2004; Rose 2002). As with other biomedical interventions, research to assess the safety and efficacy of these enhancements in humans should be (...) conducted before their introduction into clinical practice.1 However, various concerns regarding the ethics of enhancement research could be raised. Those who .. (shrink)

'The genocide in Rwanda showed us how terrible the consequences of inaction can be in the face of mass murder. But the conflict in Kosovo raised equally important questions about the consequences of action without international consensus and clear legal authority. On the one hand, is it legitimate for a regional organization to use force without a UN mandate? On the other, is it permissible to let gross and systematic violations of human rights, with grave humanitarian consequences, continue unchecked?'. This (...) book is a comprehensive, integrated discussion of 'the dilemma' of humanitarian intervention. Written by leading analysts of international politics, ethics, and law, it seeks, among other things, to identify strategies that may, if not resolve, at least reduce the current tension between human rights and state sovereignty. This volume is an invaluable contribution to the debate on all aspects of this vital global issue. (shrink)

This book contains essays, written between 1965 and 1990, which focus on the need to explore such issues as the nature of moral endeavor, the request for a justification of moral endeavor; the appeal to human flourishing; the nature of the ...

The purpose of this paper is to establish ethical guidelines for the use of paradoxical interventions in psychotherapy. These are defined as interventions which are counterintuitive, coercive, and which require non-observance by the client. Arguments are developed to show that such interventions are associated with a psychology that understands individuals solely in terms of their relationship: a 'strong interactionist' position. Ethical principles consistent with such a position are considered, and from these it is derived that: paradox is (...) an ethical technique with resistive patients; it requires consent; its content should be consistent with general ethical principles, especially those of beneficence and non-maleficence; non-paradoxical techniques should be preferred when possible; and it should not be used as an assessment procedure. It is concluded that research is needed to explore the effect of such ethical guidelines of effectiveness, though preliminary impressions are encouraging. (shrink)

This paper reflects on fundamental ethical issues concerning designing for behavioural change, in order to raise questions about the factors that should be considered by design practitioners when developing interventions. It draws on existing literature on philosophical ethics, moral psychology and design. It proposes a list of ethical questions and considerations to be made throughout the design process. A case study addressing behavioural changes in antibiotics prescriptions (for Urinary Tract Infections) was carried out to demonstrate how the ethical (...) questions identified are asked and considered. We provide a framework for addressing these issues with the hope that it will help minimise the risk of problematic and unethical intervention design processes. (shrink)

This dissertation is a comparative analysis of the work of Emmanuel Levinas and Jacques Lacan, two important thinkers in a landscape of thought roughly labeled "post-humanist." Through a close reading of several of their most important texts, it illuminates their positions on the nature of human subjectivity in general, and ethical subjectivity in particular. ;The first section of this dissertation reads key texts by Levinas and Lacan side by side in order to see the points at which their thinking converges (...) and the points at which their thinking diverges. In three chapters, it focuses on topics of central concern to each thinker: the intervention of the other as the founding moment of subjectivity either uncovering an original goodness or creating an original alienation ; sexual difference as either a model for or a constitutive mode of subjectivity; and language as constitutive of subjectivity as either ethical or ordered by the unconscious . Here we come to see the ways in which Levinas's conception of the ethical subject is representative of a "humanism of the other person" while Lacan's conception, of the split subject is representative of an anti-humanism. The second and third sections look at key texts by Levinas and Lacan in isolation from one another. In two chapters, section two focuses on Levinas's treatments of the idea of God and the concept of time as diachronous, in order to posit "an-archic" foundations for the ethical subject. Also in two chapters, section three focuses on Lacan's treatment of the four fundamental concepts of psychoanalysis and the psychoanalytic notion of "desire" as constitutive of human subjectivity, in order to explain an "ethic" of psychoanalysis as an ethic of the knowledge of the unconscious. In this, I make way for the conclusion in which I bring together these two disparate thinkers in order to posit a vision ethical of subjectivity which takes seriously Levinas and Lacan precisely in their disagreements---a vision of the ethical subject as the "desiring subject for-the-other.". (shrink)

Organisations increasingly use automated decision-making systems (ADMS) to inform decisions that affect humans and their environment. While the use of ADMS can improve the accuracy and efficiency of decision-making processes, it is also coupled with ethical challenges. Unfortunately, the governance mechanisms currently used to oversee human decision-making often fail when applied to ADMS. In previous work, we proposed that ethics-based auditing (EBA)—that is, a structured process by which ADMS are assessed for consistency with relevant principles or norms—can (a) help (...) organisations verify claims about their ADMS and (b) provide decision-subjects with justifications for the outputs produced by ADMS. In this article, we outline the conditions under which EBA procedures can be feasible and effective in practice. First, we argue that EBA is best understood as a ‘soft’ yet ‘formal’ governance mechanism. This implies that the main responsibility of auditors should be to spark ethical deliberation at key intervention points throughout the software development process and ensure that there is sufficient documentation to respond to potential inquiries. Second, we frame AMDS as parts of larger sociotechnical systems to demonstrate that to be feasible and effective, EBA procedures must link to intervention points that span all levels of organisational governance and all phases of the software lifecycle. The main function of EBA should, therefore, be to inform, formalise, assess, and interlink existing governance structures. Finally, we discuss the policy implications of our findings. To support the emergence of feasible and effective EBA procedures, policymakers and regulators could provide standardised reporting formats, facilitate knowledge exchange, provide guidance on how to resolve normative tensions, and create an independent body to oversee EBA of ADMS. (shrink)

Recent improvements in virtual reality allow for the representation of authentic environments and multiple users in a shared complex virtual world in real time. These advances have fostered clinical applications including in psychiatry. However, although VR is already used in clinical settings to help people with mental disorders, the related ethical issues require greater attention. Based on a thematic literature search the authors identified five themes that raise ethical concerns related to the clinical use of VR: reality and its representation, (...) autonomy, privacy, self-diagnosis and self-treatment, and expectation bias. Reality and its representation is a theme that lies at the heart of VR, but is also of specific significance in a clinical context when perceptions of reality are concerned, for example, during psychosis. Closely associated is the autonomy of VR users. Although autonomy is a much-considered topic in biomedical ethics, it has not been sufficiently discussed when it comes to applications of VR in psychiatry. In this review, the authors address the different themes and recommend the development of an ethical framework for the clinical use of VR. (shrink)

Evaluating clinical ethics support services has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. In this paper, we argue that a first necessary step for progress is to better understand the intervention in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, (...) we introduce principles of “complex intervention research” and show how CESS fulfil the criteria of “complex interventions”. In a second step, we develop a generic “conceptual framework” for “ethics consultation on request” as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of “bioethics mediation” to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: “proactive ethics consultation” and “moral case deliberation” and discuss implications for evaluating both types of CESS. To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer “good” CESS. (shrink)

While nudging has garnered plenty of interdisciplinary attention, the ethics of applying it to climate policy has been little discussed. However, not all ethical considerations surrounding nudging are straightforward to apply to climate nudges. In this article, we overview the state of the debate on the ethics of nudging and highlight themes that are either specific to or particularly important for climate nudges. These include: the justification of nudges that are not self-regarding; how to account for climate change (...) denialists; transparency; knowing the right or best behaviours; justice concerns; and whether the efficacy of nudges is sufficient for nudges to be justified as a response to the climate crisis. We conclude that climate nudges raise distinct ethical questions that ought to be considered in developing climate nudges. (shrink)

For more than 30 years, beginning with the Reagan administration's refusal to support and provide oversight for embryo research, and continuing to the present in congressionally imposed limits on funding for such research, progress in infertility medicine and the development of stem cell therapies has been seriously delayed by a series of political interventions. In almost all cases, these interventions result from a view of the moral status of human embryo premised largely on religious assumptions. Although some believe (...) that these interventions are valid expressions of religious values in the public sector, it is argued here that they, in fact, contradict Rawls's conception of public reasoning. Both the prohibition of research involving the human embryo as well as bans on federal funding for embryo-related research place the particular religious views of some citizens above the pressing health needs of almost all, and thus violate the ideal of civility implicit in the Rawlsian standard. (shrink)

The moral permissibility of the intervention in Libya largely turns on two fairly tricky assessments: whether the situation was sufficiently serious at the time the intervention was launched and what the predominant purposes of the intervention were.

There has been considerable recent debate on the ethics of human enhancement. A number of prominent authors have been concerned about or critical of the use of technology to alter or enhance human beings, citing threats to human nature and dignity as one basis for these concerns. Frances Kamm has given a detailed rebuttal of Sandel's arguments, arguing that human enhancement is permissible. Nicholas Agar, in his book Liberal Eugenics, argues that enhancement should be permissible but not obligatory. He (...) argues that what distinguishes liberal eugenics from the objectionable eugenic practices of the Nazis is that it is not based on a single conception of a desirable genome and that it is voluntary and not obligatory. This article takes a more provocative position. It aims to argue that, far from its being merely permissible, we have a moral obligation or moral reason to enhance ourselves and our children. Indeed, we have the same kind of obligation as we have to treat and prevent disease. It begins by considering the current interests in and possibilities of enhancement. It then offers three arguments that we have very strong reasons to seek to enhance. (shrink)

This essay explores the obligations that may arise from benevolently intended interventions that go awry. The author argues that even when the intervening agent has acted with good intentions and in a non-negligent manner, she may be required to continue aid in cases where her initial intervention failed. This is surprising because it means that persons who perform supererogatory acts run the risk of incurring additional heavy obligations through no fault of their own. The author also considers deflationary accounts (...) that run counter to her own analysis. (shrink)

Public health and service delivery programmes, interventions and policies are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well as informing design and implementation of future programmes. Such studies might be termed ‘opportunistic evaluations’, since they are responsive to emergent opportunities rather than being studies of interventions that are initiated or designed by researchers. However, current (...) ethical guidance and registration procedures make little allowance for scenarios where researchers have played no role in the development or implementation of a programme, but nevertheless plan to conduct a prospective evaluation. We explore the limitations of the guidance and procedures with respect to opportunistic evaluations, providing a number of examples. We propose that one key missing distinction in current guidance is moral responsibility: researchers can only be held accountable for those aspects of a study over which they have control. We argue that requiring researchers to justify an intervention, programme or policy that would occur regardless of their involvement prevents or hinders research in the public interest without providing any further protections to research participants. We recommend that trial consent and ethics procedures allow for a clear separation of responsibilities for the intervention and the evaluation. (shrink)

In recent years, there has been a particular emphasis placed on conducting randomized controlled trials (RCTs) that compare the relative efficacy of psychosocial and pharmacological interventions. This article addresses relevant ethical considerations in the conduct of these treatment trials, with a focus on RCTs with children. Ethical concerns, including therapeutic misconception, treatment preference, therapeutic equipoise, structure of treatments, and balancing risks versus benefits, are introduced through a clinical scenario and discussed as they relate to psychotherapy versus medication RCTs. In (...) each case, suggestions are made for researchers seeking to minimize the impact of these ethical concerns on research participants. (shrink)

In a widely cited and controversial speech, UN Secretary-General Kofi Annan highlighted the moral character of the boundaries of political sovereignty when he questioned whether respecting national sovereignty everywhere and always precluded the international protection of human rights. He argued that it did not and highlighted the importance of multilateral authorization. In this article, I explore the difference that multilateral authority, as opposed to unilateral national decision, should make in justifying armed intervention. Should the more salient role of the United (...) Nations lead us to a more expansive tolerance of international intervention? And, if multilateralism does make a difference—and many think its impartiality is key—are good intentions enough? Had the international community also discovered how to intervene more effectively, with a better prospect of self-sustaining self-determination, at an acceptable humanitarian cost? I will conclude that multilateralism should widen our acceptance of intervention, even though the intentions at play are not reliably superior to unilateral intentions. (shrink)

LaBerge examines the ethical positions of Rawls, Kant, John Walzer adapted from J. S. Mill, and Canadian philosopher Howard Adelman are, and writes that they constitute "an ethics of human rights, ethics of the right to a historical community, and an ethics of peace.".

Public health scholars and public health officials increasingly worry about health-related misinformation online, and they are searching for ways to mitigate it. Some have suggested that the tools of digital influence are themselves a possible answer: we can use targeted, automated digital messaging to counter health-related misinformation and promote accurate information. In this commentary, I raise a number of ethical questions prompted by such proposals—and familiar from the ethics of influence and ethics of AI—highlighting hidden costs of targeted (...) digital messaging that ought to be weighed against the health benefits they promise. (shrink)

The methodology of the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study raises a number of important ethical questions. Many of these are already well recognised in ethical guidelines that uphold principles of individual and parental consent, confidentiality and scientific review. There are, however, wider issues that require ethical reflection. In this paper, we focus on a set of problems surrounding the evaluation of complex social interventions, and argue that comprehensive and objective (...) evaluation is a much more ethically charged aim than it may first appear. In particular, we contend that standard scientific measures - of body size and biomarkers - convey only part of the story. This is partly because, when we intervene in communities, we are also concerned with complex social effects. These effects are made even more complex by contemporary social anxieties about fat and physical appearance, as well as about the safety and security of children. Such anxieties increase the risk of undesirable side effects that are themselves difficult to gauge. In the face of these and other complexities, we argue that the evaluation of interventions should involve a strong ethical dimension. First, it must include - as does the IDEFICS study - consideration of the opinions of the people affected, who are subjected to interventions in ways that necessarily go beyond individual consent. Second, we suggest that interventions might also be assessed by how much they empower people - and especially those persons, such as children, who are otherwise often disempowered. (shrink)