A background assumption in much contemporary political philosophy is that justice is the first virtue of social institutions, taking priority over other values such as beneficence. This assumption is typically treated as a methodological starting point, rather than as following from any particular moral or political theory. In this paper, I challenge this assumption. To frame my discussion, I argue, first, that justice doesn’t in principle override beneficence, and second, that justice doesn’t typically outweigh beneficence, since, (...) in institutional contexts, the stakes of beneficence are often extremely high. While there are various ways one might resist this argument, none challenge the core methodological point that political philosophy should abandon its preoccupation with justice and begin to pay considerably more attention to social beneficence—that is, to beneficence understood as a virtue of social institutions. Along the way, I also highlight areas where focusing on social beneficence would lead political philosophers in new and fruitful directions, and where normative ethicists focused on personal beneficence might scale up their thinking to the institutional case. GPI Working Paper No. 11-2022. (shrink)

The target article by Laacke et al. focuses on the specific context of identifying people in social media with a high risk of depression by using artificial intelligence technologies. I...

Appreciation and gratitude get good press: They are central virtues in many religious and secular ethical frameworks, core in positive psychology research, and they come highly recommended by the self‐improvement set. Generally, appreciation and gratitude feature as good things, in popular consciousness. Of course, on an Aristotelian model, the belief that these are virtues implies they are something people can get right or wrong. This paper examines bad appreciation and bad gratitude, characterizing forms of appreciation and gratitude at the center (...) of some major social norms and practices, and demonstrating that they mask familiar oppressive expectations and power relations. (shrink)

This paper argues that societal duties of health promotion are underwritten (at least in large part) by a principle of beneficence. Further, this principle generates duties of justice that correlate with rights, not merely “imperfect” duties of charity or generosity. To support this argument, I draw on a useful distinction from bioethics and on a somewhat neglected approach to social obligation from political philosophy. The distinction is that between general and specific beneficence; and the approach from political (...) philosophy has at times been called equality of concern. After clarifying the distinction and setting out the basis of the equality of concern view, I argue that the result is a justice-based principle of “specific” beneficence that should be reflected in a society’s health policy. I then draw on this account to criticize, refine, and extend some prominent health care policy proposals from the bioethics literature. (shrink)

It is plausible to think that it is wrong to cure many people’s headaches rather than save someone else’s life. On the other hand, it is plausible to think that it is not wrong to expose someone to a tiny risk of death when curing this person’s headache. I will argue that these claims are inconsistent. For if we keep taking this tiny risk then it is likely that one person dies, while many others’ headaches are cured. In light of (...) this inconsistency, there is a conflict in our intuitions about beneficence and chance. This conflict is perplexing. And I have not been able to find a satisfactory way of resolving it. Perhaps you can do better? (shrink)

This article proposes that, in line with moral-cosmopolitan theorists, affluent nations have an obligation, founded in justice and not merely altruism or beneficence, to share the responsibility of the burden of public health implementation in low-income contexts. The current Ebola epidemic highlights the fact that countries with under-developed health systems and limited resources cannot cope with a significant and sudden health threat. The link between burden of disease, adverse factors in the social environment and poverty is well established (...) and confirmed by the 2008 World Health Organization (WHO)’s Social Determinants of Health Commission report. Well-resourced nations generally consider that they have some humanitarian obligation to assist where possible, but this obligation is limited. The following questions are considered: Is reliance on the principle of beneficence to address the global disparities in the social determinants of health and life expectancy at birth good enough? Do well-resourced nations have some obligation from justice, which is stronger than from beneficence, and which cannot be as easily cast aside or diminished, to address these issues? In a globalised world, shaped by centuries of historical injustice and where first-world economies are now so intertwined and reliant on third-world labour, beneficence is not a strong enough principle on which to base an obligation to achieve the WHO vision of ‘health equity through action on the social determinants of health’. (shrink)

The prevailing discourse around AI ethics lacks the language and formalism necessary to capture the diverse ethical concerns that emerge when AI systems interact with individuals. Drawing on Sen and Nussbaum's capability approach, we present a framework formalizing a network of ethical concepts and entitlements necessary for AI systems to confer meaningful benefit or assistance to stakeholders. Such systems enhance stakeholders' ability to advance their life plans and well-being while upholding their fundamental rights. We characterize two necessary conditions for morally (...) permissible interactions between AI systems and those impacted by their functioning, and two sufficient conditions for realizing the ideal of meaningful benefit. We then contrast this ideal with several salient failure modes, namely, forms of social interactions that constitute unjustified paternalism, coercion, deception, exploitation and domination. The proliferation of incidents involving AI in high-stakes domains underscores the gravity of these issues and the imperative to take an ethics-led approach to AI systems from their inception. (shrink)

This paper contributes to the discussion of the moral demandingness of Kantian ethics by critically discussing an argument that is currently popular among Kantians. The argument from the system of duties holds that in the Kantian system of duties the demandingness of our duty of beneficence is internally moderated by other moral prescriptions, such as the indirect duty to secure happiness, duties to oneself and special obligations. Furthermore, proponents of this argument claim that via these prescriptions Kant’s system of (...) duties incorporates into morality what current debates on demandingness call happiness and personal projects. These two claims are in conjunction supposed to establish that Kant’s ethics, at least when it comes to beneficence, is not plagued by the problem of excessive moral demands. We show that claims and are mistaken given what Kant says about beneficence, the application of imperfect duties and about emergencies. We finally argue that special obligations towards loved ones, a class of obligations largely overlooked by advocates of the system of duties, are the most promising candidates for internal moderation. These duties are, however, of a narrow scope. (shrink)

This paper contributes to the discussion of the moral demandingness of Kantian ethics by critically discussing an argument that is currently popular among Kantians. The argument from the system of duties holds that (a) in the Kantian system of duties the demandingness of our duty of beneficence is internally moderated by other moral prescriptions, such as the indirect duty to secure happiness, duties to oneself and special obligations. Furthermore, proponents of this argument claim (b) that via these prescriptions Kant’s (...) system of duties incorporates into morality what current debates on (over-)demandingness call happiness and personal projects. These two claims are in conjunction supposed to establish that Kant’s ethics, at least when it comes to beneficence, is not plagued by the problem of excessive moral demands. We show that claims (a) and (b) are mistaken given what Kant says about beneficence, the application of imperfect duties and about emergencies. We finally argue that special obligations towards loved ones, a class of obligations largely overlooked by advocates of the system of duties, are the most promising candidates for internal moderation. These duties are, however, of a narrow scope. (shrink)

What is a duty of justice? And how is it different from a duty of beneficence? We need a clear account of the contrast. Unfortunately, there is no consensus in the philosophical literature as to how to characterize it. Different articulations of it have been provided, but it is hard to identify a common core that is invariant across them. In this paper, I propose an account of how to understand duties of justice, explain how it contrasts with several (...) proposals as to how to distinguish justice and beneficence, respond to some objections and suggest further elaborations of it. The conceptual exploration pursued in this paper has practical stakes. A central aim is to propose and defend a capacious concept of justice that makes a direct discussion of important demands of justice (domestic and global) possible. Duties of justice can be positive besides negative, they can be imperfect as well as perfect, they can range over personal besides institutional contexts, they can include multiple associative reasons such us non-domination, non-exploitation and reciprocity, and they can even go beyond existing national, political, and economic associative frameworks to embrace strictly universal humanist concerns. We should reject ideological abridgments of the concept of justice that render these possibilities, and the important human interests and claims they may foster, invisible. (shrink)

I begin with a note about moral goodness as a quality, disposition, or trait of a person or human being. This has at least two different senses, one wider and one narrower. Aristotle remarked that the Greek term we translate as justice sometimes meant simply virtue or goodness as applied to a person and sometimes meant only a certain virtue or kind of goodness. The same thing is true of our word “goodness.” Sometimes being a good person means having all (...) the virtues, or at least all the moral ones; then goodness equals the whole of virtue. But sometimes, being a good person has a narrower meaning, namely, being kind, generous, and so forth. Thus, my OED sometimes equates goodness with moral excellence as a whole and sometimes with a particular moral excellence, viz., kindness, beneficence, or benevolence; and the Bible, when it speaks of God as being good sometimes means that God has all the virtues and sometimes only that he is kind, mereiful, or benevolent. When Jesus says, “Why callest thou me good: None is good, save one, that is God,” he seems to be speaking of goodness in the inclusive sense, but when the writer of Exodus has God himself say that he is “merciful and gracious, long-suffering, and abundant in goodness and truth,” God is using “goodness” in the narrower sense in which it means benevolence, for he goes on to make it clear that he is also just and severe. Similarly, “good will” may mean either “morally good will” in general, as it does in Kant, or it may mean only “benevolent will,” as it usually does; in “men of good will” it is perhaps ambiguous. (shrink)

Euthanasia and physician-assisted suicide are controversial issues in medical ethics and medical law. In the debate, several arguments against the moral acceptability and legal feasibility of active involvement of physicians in bringing about a patient’s death can be found.One argument refers back to the Ten Commandments: “Thou shall not kill”. Killing another human being is morally abject. According to the argument, this is certainly so for medical doctors, as can be seen in the Hippocratic Oath, which explicitly forbids abortion and (...) euthanasia. A less apodictic argument refers to the slippery slope: if euthanasia would be permitted, a downhill movement is set in motion. The end of this movement would be, on the one hand, that physicians will feel forced to assist people who ask for termination of life on whatever grounds. On the other hand, it might lead to a situation in which it becomes normal to kill people who are no longer useful for society.In the literature and in the public debate, there are also arguments in favour of euthanasia and physician-assisted suicide. One such argument invokes the right to die. According to this argument, decisions concerning life and death should be up to the individual who is concerned. In many countries, suicide is morally and legally accepted. If people are allowed to kill themselves, why should they be without rights when they are no longer able to perform the act themselves?In medical ethics and medical law, patient autonomy is a central pivot. Patients have the right to refuse treatment even if this leads to their death. Shouldn’t people also have the right to determine the moment of dying, if they are in a situation which is unbearable, and without prospect of improvement? Another argument focuses on the duty of the physician to alleviate pain and suffering. If there is no other option, the doctor, in fulfilling this duty, should be allowed to actively end the patient’s life. This argument is not based on autonomy, but on beneficence.The debate concerning euthanasia involves fundamentally different moral principles. This makes the debate interesting, if not central to medical ethics and medical law. Yet, the principles are normally presented in an abstract way. Discussants stick to very general ideas, which lack reference to specific social and historical conditions, and are not related to concrete experiences. To invoke the Ten Commandments, or plea for a right to die, implies the use of universal standards, which tend to be general and empty.From a philosophical perspective, this type of argumentation can be criticized. Following Aristotle, ethics should be based upon experience. Ethical knowledge requires participation in concrete practices. Central to ethics is a feeling for the concrete situation, which is always contingent and historical. From this perspective, it makes sense to consider how practitioners in specific situations deal with moral issues, for instance concerning euthanasia. What role do they give to notions such as autonomy and beneficence, how do they interpret them and apply them to the concrete situation?In this paper I will present the Dutch experience with euthanasia. I will focus upon the way in which during the past thirty years the arguments in favour of euthanasia have been developed, in interaction with euthanasia practice. I will show that patient autonomy has been a crucial pivot. Yet, the Dutch interpretation of autonomy is not purely liberal. It does not only involve rights, but also obligations. Next, I will make clear that the physician plays a central role, in that the moral and legal basis of euthanasia is a conflict of duties on the side of the physician.This brings in the issue of beneficence. Yet the Dutch interpretation of the duty to help is not simply paternalistic. In Dutch health care, the physician-patient relationship is based upon deliberation and mutual agreement. Therefore, my conclusion will be that the Dutch practice of euthanasia has a moral ground, which goes beyond the traditional opposition between autonomy and beneficence. (shrink)

Artificial intelligence-driven technology increasingly shapes work practices and, accordingly, employees’ opportunities for meaningful work (MW). In our paper, we identify five dimensions of MW: pursuing a purpose, social relationships, exercising skills and self-development, autonomy, self-esteem and recognition. Because MW is an important good, lacking opportunities for MW is a serious disadvantage. Therefore, we need to know to what extent employers have a duty to provide this good to their employees. We hold that employers have a duty of beneficence (...) to design for opportunities for MW when implementing AI-technology in the workplace. We argue that this duty of beneficence is supported by the three major ethical theories, namely, Kantian ethics, consequentialism, and virtue ethics. We defend this duty against two objections, including the view that it is incompatible with the shareholder theory of the firm. We then employ the five dimensions of MW as our analytical lens to investigate how AI-based technological innovation in logistic warehouses has an impact, both positively and negatively, on MW, and illustrate that design for MW is feasible. We further support this practical feasibility with the help of insights from organizational psychology. We end by discussing how AI-based technology has an impact both on meaningful work (often seen as an aspirational goal) and decent work (generally seen as a matter of justice). Accordingly, ethical reflection on meaningful and decent work should become more integrated to do justice to how AI-technology inevitably shapes both simultaneously. (shrink)

A life without liberty and material resources is not a good life. Equally, a life devoid of meaningful social relationships—such as friendships, family attachments, and romances—is not a good life. From this it is tempting to conclude that just as individuals have rights to liberty and material resources, they also have rights to access meaningful social relationships. I argue that this conclusion can be defended only in a narrow set of cases. ‘Pure’ social relationship deprivation—that is, deprivation (...) that is not caused, or accompanied, by deficits in liberties and material resources— mostly generates demands of private beneficence. I suggest that social relationship deprivation is unjust, hence a rights violation, only when it is due to factors—such as one’s race—that are irrelevant to one’s being a good participant in social relationships. I thus conclude that access to meaningful social relationships is not a fundamental concern for theories of justice. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause (...) such harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

Discussions of reproductive responsibility generally draw heavily upon the principles of nonmaleficence and beneficence. However, these principles are typically only applied to women due to the incorrect belief that only women can cause fetal harm. The cultural perception that women are likely to cause fetal and child harm is reflected in numerous social norms, policies, and laws. Conversely, there is little public discussion of men and fetal and child harm, which implies that men do not (or cannot) cause (...) such harm. My goal in this paper is to begin to fill the void in the academic literature about men’s reproductive responsibility by highlighting the health-related, economic, and social harms men can cause to potential fetuses and children and then examining what it would mean to hold them responsible for preventing these harms. Applying the principles of nonmaleficence and beneficence to men, I conclude that men have a moral duty to use contraception if their behavior—past, current, or future—could harm the potential fetuses and children who result from their unprotected sexual behavior. (shrink)

What, if anything, are we morally required to do on behalf of others besides respecting their rights? And why is such regard for others a reasonable moral requirement? These two questions have long been major concerns of ethical theory, but the answers that philosophers give tend to vary with their beliefs about human nature. More specifically, their answers typically depend on the position they take on a third-question: To what extent, if any, is it possible for us to act altruistically?

This paper will examine the social and ethical impacts of using artificial intelligence (AI) in the agricultural sector. It will identify what are some of the most prevalent challenges and impacts identified in the literature, how this correlates with those discussed in the domain of AI ethics, and are being implemented into AI ethics guidelines. This will be achieved by examining published articles and conference proceedings that focus on societal or ethical impacts of AI in the agri-food sector, through (...) a thematic analysis of the literature. The thematic analysis will be divided based on the classifications outlined through 11 overarching principles, from an established lexicon (transparency, justice and fairness, non-maleficence, responsibility, privacy, beneficence, freedom and autonomy, trust, dignity, sustainability, and solidarity). While research on AI agriculture is still relatively new, this paper aims to map the debate and illustrate what the literature says in the context of social and ethical impacts. It aim is to analyse these impacts, based on these 11 principles. This research will contrast which impacts are not being discussed in agricultural AI and which issues are not being discussed in AI ethics guidelines, but which are discussed in relation to agricultural AI. The aim of this is to identify gaps within the agricultural literature, and gaps in AI ethics guidelines, that may need to be addressed. (shrink)

In ways accentuated by the global coronavirus pandemic, corporations constitute vital instruments of the acts of beneficence needed by the people of the world to make progress in public health and increase collective and individual well-being. This article contributes to understanding the variety of moral forces that may lead corporations to commit acts of beneficence, including Friedman’s business case for corporate beneficence, the duty of beneficence as developed by business ethicists, and Dunfee’s social contract account (...) of corporate obligation. Whereas Mejia recently contributed to scholarship on corporate beneficence by expressly adopting shareholder primacy’s conception of corporate governance, this article embraces a stakeholder-oriented, managerialist picture of corporate governance. I extend the literature on beneficence by incorporating what I argue is the intuition underlying Dunfee’s contractualist formula of minimal contribution, namely that management’s duty to do good is awakened and unshackled to the extent management judges the corporation can afford to commit acts of beneficence, all stakeholders considered. The all-stakeholders-considered case for corporate beneficence compels management to act, I argue, when inaction would undermine the moral integrity of managers personally committed to promoting the well-being of humanity. (shrink)

In this paper, we address the question of whether AI should be used for suicide prevention on social media data. We focus on algorithms that can identify persons with suicidal ideation based on their postings on social media platforms and investigate whether private companies like Facebook are justified in using these. To find out if that is the case, we start with providing two examples for AI-based means of suicide prevention in social media. Subsequently, we frame suicide (...) prevention as an issue of beneficence, develop two fictional cases to explore the scope of the principle of beneficence and apply the lessons learned to Facebook’s employment of AI for suicide prevention. We show that Facebook is neither acting under an obligation of beneficence nor acting meritoriously. This insight leads us to the general question of who is entitled to help. We conclude that private companies like Facebook can play an important role in suicide prevention, if they comply with specific rules which we derive from beneficence and autonomy as core principles of biomedical ethics. At the same time, public bodies have an obligation to create appropriate framework conditions for AI-based tools of suicide prevention. As an outlook we depict how cooperation between public and private institutions can make an important contribution to combating suicide and, in this way, put the principle of beneficence into practice. (shrink)

I contend that there are important moral reasons for individuals, organisations and states to aid others that have gone largely unrecognised in the literature. Most of the acknowledged reasons for acting beneficently in the absence of a promise to do so are either impartial and intrinsic, on the one hand, being grounded in properties internal to and universal among individuals, such as their pleasure or autonomy, or partial and extrinsic, on the other, being grounded in non-universal properties regarding an actual (...) relation to the agent, such as common membership in a family or culture. In contrast, I articulate and defend the existence of two unrecognised reasons for beneficence that can take the form of being impartial and extrinsic. One is that a being’s capacity to be part of a sharing relationship with us can provide some reason to help it, and another is that a sharing relationship qua relationship is an end-in-itself that can provide some reason to help another. I differentiate these considerations from one another and from the more standard reasons for beneficence, provide arguments for thinking that they are central to beneficence, and rebut objections that are likely to be offered by friends of the more standard reasons. (shrink)

Artificial Social Agents (ASAs), which are AI software driven entities programmed with rules and preferences to act autonomously and socially with humans, are increasingly playing roles in society. As their sophistication grows, humans will share greater amounts of personal information, thoughts, and feelings with ASAs, which has significant ethical implications. We conducted a study to investigate what ethical principles are of relative importance when people engage with ASAs and whether there is a relationship between people’s values and the ethical (...) principles they prioritise. The study uses scenarios, embedded with the five AI4People ethical principles (Beneficence, Non-maleficence, Autonomy, Justice, and Explicability), involving ASAs taking on roles traditionally played by humans to understand whether these roles and behaviours (including dialogues) are seen as acceptable or unacceptable. Results from 268 participants reveal the greatest sensitivity to ASA behaviours that relate to Autonomy, Justice, Explicability, and the privacy of their personal data. Models were created using Schwartz’s Refined Values as a possible indicator of how stakeholders discern and prioritise the different AI4People ethical principles when interacting with ASAs. Our findings raise issues around the ethical acceptability of ASAs for nudging and changing behaviour due to participants’ desire for autonomy and their concerns over deceptive ASA behaviours such as pretending to have memories and emotions. (shrink)

According to prominent bioethics scholars and international guidelines, researchers and sponsors have obligations to ensure that the products of their research are reasonably available to research participants and their communities. In other words, the claim is that research is unethical unless it has local social value. In this article, we argue that the existing conception of reasonable availability should be replaced with a social value obligation that extends to the global poor. To the extent the social value (...) requirement has been understood as geographically constrained to the communities that host research and the countries that can afford the products of research, it has neglected to include the global poor as members of the relevant society. We argue that a new conception of social value obligations is needed for two reasons. First, duties of global beneficence give reason for researchers, sponsors, and institutions to take steps to make their products more widely accessible. Second, public commitments made by many institutions acknowledge and engender responsibilities to make the products of research more accessible to the global poor. Future research is needed to help researchers and sponsors discharge these obligations in ways that unlock their full potential. (shrink)

In late 2012, Hurricane Sandy hit the East Coast of the U.S., causing much suffering and devastation. Those who could have easily helped Sandy’s victims had a duty to do so. But was this a rightfully enforceable duty of justice, or a non-enforceable duty of beneficence? The answer to this question is often thought to depend on the kind of help offered: the provision of immediate bodily services is not enforceable; the transfer of material resources is. I argue that (...) this double standard is unjustified, and defend a version of what I call “Social Samaritanism.” On this view, within political communities, the duty to help the needy—whether via bodily services or resource transfers—is always an enforceable demand of justice, except when the needy are reckless; across independent political communities, it is always a matter of beneficence. I defend this alternative double standard, and consider its implications for the case of Sandy. (shrink)

Resumen Tomando como punto de partida las condiciones del contexto socio político donde se originó el brote epidémico del virus SARS-CoV-2, los autores analizan la influencia que tuvo el principio de beneficencia como una de las razones éticas que condujeron al oftalmólogo Li Wenliang a alertar a través de la red social Weibo, sobre el surgimiento de un brote epidémico distinto, por su agresividad, al del SARS. Se asume que dicho principio puede comprenderse a partir de un enfoque donde (...) se conjugan referentes occidentales -la primera formulación del imperativo categórico kantiano y el legado hipocrático- y orientales -el principio del Ren o humanidad, derivado del pensamiento confuciano-. El artículo concluye señalando que en un mundo interrelacionado donde las prácticas médicas tienen fundamentos científicos universales, es posible tomar decisiones éticas médicas válidas para diferentes contextos culturales, siempre y cuando se continúe avanzando en el terreno de un diálogo inter-civilizatorio con perspectiva horizontal.This article analyzes the influence of the principle of beneficence as one of the ethical reasons that led ophthalmologist Li Wenliang to alert, using the Weibo plaform, about the emergence of an epidemic outbreak different from SARS. Accordingly, we discuss the socio-political context of the SARS-CoV-2 epidemic in China. We assume that the principle of beneficence might be understood from an approach combining Western references - the first formulation of the Kantian categorical imperative and the Hippocratic legacy - with Oriental ones - the Ren or humanity, derived from Confucian thought. We conclude that in an interrelated world, with medical practices having universal scientific foundations, it is possible to validate medical ethical decisions from different cultural contexts, as long as progress continues in the field of an inter-civilizational dialogue with a horizontal perspective. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might (...) be causing them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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The principles of autonomy, beneficence, non-maleficence, and justice are well established ethical principles in health research. Of these principles, justice has received less attention by health researchers. The purpose of this article is to broaden the discussion of health research ethics, particularly the ethical principle of justice, to include societal considerations — who and what are studied and why? — and to critique current applications of ethical principles within this broader view. We will use a feminist intersectional approach in (...) the context of health disparities research to firmly establish inseparable links between health research ethics, social action, and social justice. The aim is to provide an ethical approach to health disparities research that simultaneously describes and seeks to eliminate health disparities. (shrink)

In the contemporary digital age, recommender systems (RSs) play a fundamental role in managing information on online platforms: from social media to e-commerce, from travels to cultural consumptions, automated recommendations influence the everyday choices of users at an unprecedented scale. RSs are trained on users’ data to make targeted suggestions to individuals according to their expected preference, but their ultimate impact concerns all the multiple stakeholders involved in the recommendation process. Therefore, whilst RSs are useful to reduce information overload, (...) their deployment comes with significant ethical challenges, which are still largely unaddressed because of proprietary constraints and regulatory gaps that limit the effects of standard approaches to explainability and transparency. In this context, I address the ethical and social implications of automated recommendations by proposing a pro-ethical design framework aimed at reorienting the influence of RSs towards societal interest. In particular, after highlighting the problem of explanation for RSs, I discuss the application of beneficent informational nudging to the case of conversational recommender systems (CRSs), which rely on user-system dialogic interactions. Subsequently, through a comparison with standard recommendations, I outline the incentives for platforms and providers in adopting this approach and its benefits for both individual users and society. (shrink)

If an organization cares for nature, this paper contends, it will act so as not to harm the ecosystems it affects, or when it cannot so act at the moment it will commit itself to such action over time. For an organization's commitment to ecologically beneficent performance to be credible, one requires an action plan with specified targets determining the best ecologically beneficent pollution abatement and ecosystem improvement approaches in a situation. To this end the 4 Direct Environmental Performance Measures (...) are generally used: L, pollutant loads; C: pollutant concentrations; I, ecosystem impacts; and R, ecosystem restoration. These direct EPMS are preferred to the indirect social performance indices customary in business ethics discourse, such as O: positioning organizations along the social performance spectrum from reactive to proactive; or E: economic indicators; and T: technology development; for environmental performance improvement is what is at issue. This one ground rule of environmental performance ethic; a second is that reducing harmful impacts or restoring an ecosystem are to be preferred over pollutant load/concentration reduction. The scientific, technical form of Direct EPMs is important, for it reinforces economic and technological development and yields performance-related environmental knowledge, in contrast to subjective perception and social debate. It offers management a model of ecologically beneficent performance that is microscopic in detail and regional in scope. It further suggests good environmental management involves linking ecosystem improvement with economic/technological benefits. An important aspect of this model of good environmental performance is to integrate economic, technical and social concerns with environmental ethics. It shows that economics and ecology should be mutually reinforcing, just as sustainable development suggests. (shrink)

Abortion, euthanasia, racism, sexism, pater­nalism, the rights of children, the population explosion, and the dynamics of economic growth are examined in the light of ethical principles by leading philosophers in order to suggest reasonable judgments. Originally prepared for the distinguished Wayne Leys Memorial Lecture Series at Southern Illinois University, Carbondale, the essayists have addressed themselves to the most pressing ethical questions being asked today. William K. Frankena, Professor Emer­itus, University of Michigan, in “The Ethics of Respect for Life” argues for (...) a qualified view of moral respect for human personality. From his viewpoint it is always prima facie wrong to shorten or prevent human life, but not always actually wrong as other moral conditions may counter the presumed wrong. The late William T. Blackstone in “Zero Population Growth and Zero Economic Growth” contends that justice will require the production of the maximal level of goods to fulfill basic human needs com­patible with the avoidance of ecological catastrophe. Richard Wasserstrom, Professor of Phi­losophy at the University of California, Santa Cruz, proposes an assimilationist ideal in “Racism, Sexism, and Preferential Treat­ment.” Gerald Dworkin, Professor of Phi­losophy at the University of Illinois, Chicago Circle, dares to ask “Is More Choice Better than Less?” Joel Feinberg, Professor of Phi­losophy at the University of Arizona, in “The Child’s Right to an Open Future,” offers a defense of “rights-in-trust” of children. Tom L. Beauchamp, Professor of Philosophy and Senior Research Scholar at the Kennedy In­stitute-Center for Bioethics of Georgetown University, considers the paternalism used to justify social policies in the practice of medi­cine and insists that it invariably involves a conflict between the ethical principles of be­neficence and autonomy. (shrink)

Urban Chinese today do not appear to trust foreign countries. Why are they so suspicious? Over the past quarter century, the Chinese Communist Party has utilized its educational and propaganda systems to produce historical narratives of imperial China's beneficence towards its East Asian neighbors, and of an early modern at the hands of foreign powers. Qualitative analysis of Chinese social media today suggests that these narratives are tied to widespread popular distrust of China's East Asian neighbors and the (...) West today. Interrogating a 2012 survey of urban Chinese, this paper explores the sources of international attitudes quantitatively. It first examines whether Chinese today do indeed distrust foreign countries. It then tests two hypotheses about the drivers of Chinese distrust towards the world today. A socialization hypothesis holds that political and/or social pressures shape the international attitudes of the Chinese people. A psychological hypothesis, by contrast, holds that individual differences like age and gender shape Chinese attitudes. We find substantial support for the former: more years of education are associated with levels of dis/trust in foreign countries in the socially or politically appropriate ways. However, we also find that individual differences in subjective interest in international affairs interact with socialization processes like education and media exposure in shaping the international attitudes of urban Chinese today. The prevalence of public discourses of distrust towards foreign countries does not bode well for Chinese foreign policy in the twenty-first century. (shrink)

If an organization cares for nature, this paper contends, it will act so as not to harm the ecosystems it affects, or when it cannot so act at the moment it will commit itself to such action over time. For an organization's commitment to ecologically beneficent performance to be credible, one requires an action plan with specified targets determining the best ecologically beneficent pollution abatement and ecosystem improvement approaches in a situation. To this end the 4 Direct Environmental Performance Measures (...) (EPMs) are generally used: L, pollutant loads; C: pollutant concentrations; I, ecosystem impacts; and R, ecosystem restoration. These direct EPMS are preferred to the indirect social performance indices customary in business ethics discourse, such as O: positioning organizations along the social performance spectrum from reactive to proactive; or E: economic indicators; and T: technology development; for environmental performance improvement is what is at issue. This one ground rule of environmental performance ethic; a second is that reducing harmful impacts or restoring an ecosystem are to be preferred over pollutant load/concentration reduction. The scientific, technical form of Direct EPMs is important, for it reinforces economic and technological development and yields performance-related environmental knowledge, in contrast to subjective perception and social debate. It offers management a model of ecologically beneficent performance that is microscopic in detail and regional in scope. It further suggests good environmental management involves linking ecosystem improvement with economic/technological benefits. An important aspect of this model of good environmental performance is to integrate economic, technical and social concerns with environmental ethics. It shows that economics and ecology should be mutually reinforcing, just as sustainable development suggests. (shrink)

The COVID-19 pandemic and its related policies (e.g., stay at home and social distancing orders) have increased people’s use of digital technology, such as social media. Researchers have, in turn, utilized artificial intelligence to analyze social media data for public health surveillance. For example, through machine learning and natural language processing, they have monitored social media data to examine public knowledge and behavior. This paper explores the ethical considerations of using artificial intelligence to monitor social (...) media to understand the public’s perspectives and behaviors surrounding COVID-19, including potential risks and benefits of an AI-driven approach. Importantly, investigators and ethics committees have a role in ensuring that researchers adhere to ethical principles of respect for persons, beneficence, and justice in a way that moves science forward while ensuring public safety and confidence in the process. (shrink)

Artificially intelligent (AI) technologies are increasingly being used in many workplaces. It is recognised that there are ethical dimensions to the ways in which organisations implement AI alongside, or substituting for, their human workforces. How will these technologically driven disruptions impact the employee–employer exchange? We provide one way to explore this question by drawing on scholarship linking Integrative Social Contracts Theory (ISCT) to the psychological contract (PC). Using ISCT, we show that the macrosocial contract’s ethical AI norms of (...) class='Hi'>beneficence, non-maleficence, autonomy, justice, and explicability can feed into national- and organisational-level microsocial contracts. We also outline the role of employees’ technology frames in this process. We then use an illustrative example to demonstrate how this multilevel normative background helps to inform the content of individuals’ PCs in the context of working with AI technologies. (shrink)

Abstract:Adam Smith argues that virtue falls into two broad categories: “justice,” which he calls a “negative” virtue because it principally comprises restraint from harming or injuring others; and “beneficence,” which he calls “positive” because it comprises the actions we ought to take to improve others’ situations. Smith’s conception of justice is thus quite “thin,” and some critics argue that it is indeed too thin, since it fails to incorporate substantive concerns for the well-being of others. In this essay, I (...) lay out Smith’s conception of justice and offer a way to understand it that attempts to comprehend the various things he says about it. I then offer a cluster of objections drawing on criticisms that might fall under the heading of “social justice.” Finally, I suggest how Smith might respond to the criticisms by outlining a Smithian conception of what I call “ultimate justice.”. (shrink)

We discuss the crucial, but easily missed, link between paternalism and incarceration. Legal paternalists believe law should be used to help individuals stay healthy or moral or become healthier or morally better. Criminal laws are paternalistic if they make it illegal to perform some action that would be bad for the actor to do, regardless of effects on others. Yet, one result of such laws is the punishment, including incarceration, of the very same actors—also clearly bad for them even if (...) meant to be rehabilitative. Therein lies an oddity: paternalist criminal law—and thepresumably rehabilitativepunishments that serve as responses to infringements of such laws—is meant to help the actor but in fact has the opposite effect on net. Incarceration is particularly problematic on this front as it harms the alleged criminal in ways that go beyond the harm they would have caused themselves. Incarceration also may undermine the actor’s ability to improve his decision-making abilities or his moral character. The effects of the punishment also drift to others—family and friends, as well as business associates, of the punished. Paternalists, inasmuch as they are motivated by beneficence or concern about moral character, must account for all of these costs as threats to well-being and the conditions for acting morally. Given the link between paternalism and incarceration, we propose that if we are to take seriously the problem of over-incarceration in the U.S., we must reconsider the use of paternalism in criminal law; we sketch several alternatives. We believe paternalists should support our resistance to incarceration and seriously consider these alternatives. (shrink)

Artificially intelligent (AI) technologies are increasingly being used in many workplaces. It is recognised that there are ethical dimensions to the ways in which organisations implement AI alongside, or substituting for, their human workforces. How will these technologically driven disruptions impact the employee–employer exchange? We provide one way to explore this question by drawing on scholarship linking Integrative Social Contracts Theory (ISCT) to the psychological contract (PC). Using ISCT, we show that the macrosocial contract’s ethical AI norms of (...) class='Hi'>beneficence, non-maleficence, autonomy, justice, and explicability can feed into national- and organisational-level microsocial contracts. We also outline the role of employees’ technology frames in this process. We then use an illustrative example to demonstrate how this multilevel normative background helps to inform the content of individuals’ PCs in the context of working with AI technologies. (shrink)

Principles of procreative beneficence (PPBs) hold that parents have good reasons to select the child with the best life prospects. Sparrow (2010) claims that PPBs imply that we should select only female children, unlesswe attach normative significance to “normal” human capacities. We argue that this claim fails on both empirical and logical grounds. Empirically, Sparrow’s argument for greater female wellbeing rests on a selective reading of the evidence and the incorrect assumption that an advantage for females would persist even (...) when a serious gender imbalance is obtained. Logically, PPBs cite only pro tanto reasons and allow that the good of an individual child could be outweighed by other morally relevant considerations, such as those which take collectively suboptimal outcomes into account. There is thus no need to attach value to the “normal.”. (shrink)

The purpose of this article is to illuminate the conceptualisations and applications of the Belmont Report’s key ethical principles of respect for persons, beneficence, and justice based on a document analysis of five of the most relevant disciplinary guidelines on internet research in the social sciences. These seminal documents are meant to provide discipline-specific guidance for research design and implementation and are regarded as key references when conducting research online. Our analysis revealed that the principles of respect and (...) beneficence were explicitly conveyed in the documents analysed, offering nuanced interpretations on issues of informed consent, privacy, and benefits and risks as well as providing recommendations for modifying traditional practices to fit the online setting. However, the invocations of the principle of justice were rather implicit and reflect an important shift from the Belmont Report’s protectionist ethical position towards more situational and dialogic approaches. With the rapidly evolving nature of internet technologies, this analysis is projected to contribute to the ongoing developments in research ethics in the social sciences by outlining the tensions and implications of the use of the internet as a methodological tool. We also seek to provide recommendations on how disciplinary associations can proceed to facilitate ethically sensitive internet research. (shrink)

Mitochondrial/nuclear transfer (M/NT) to avoid the transmission of serious mitochondrial disease raises complex and challenging ethical, legal and social issues (ELSI). In February 2015, the United Kingdom became the first country in the world to legalize M/NT, making the heated debate surrounding this technology even more relevant. This critical interpretive review identified 95 relevant papers discussing the ELSI of M/NT, including original research articles, government-commissioned reports, editorials, letters to editors and research news. The review presents and synthesizes the arguments (...) present in the literature in relation to the most commonly raised themes: terminology; identity, relationships and parenthood; potential harm; reproductive autonomy; available alternatives; consent; impact on specific interest groups; resources; “slippery slope”; creation, use and destruction of human embryos; and beneficence. The review concludes by identifying those ELSI that are specific to M/NT and by calling for follow-up longitudinal clinical and psychosocial research in order to equip future ELSI debate with empirical evidence. (shrink)

_GPs serve in a double role of treatment provider and expert in certain social insurance systems, such as the Norwegian one. Some physicians assert that the ethical obligations of the two roles conflict with each other. The objective of this article is to show that social insurance medical ethics, which are based on recognised principles of medical ethics, unite the physicians’ obligations associated with these roles. The method applied is a medical ethics conceptual analysis. The material consists of (...) literature on normative SIME. The study shows that SIME expands the role of the treatment provider to a wider societal context. Here, physicians should attempt to balance the perspectives of sympathy with empathy, as treatment providers, with the impartiality in their role as experts. Five principles of medical ethics are fundamental. Respect for human dignity is the overarching principle of medical ethics. The four others are nonmaleficence, beneficence, autonomy, and social justice. The article discusses two areas where it is asserted that the roles of treatment provider and expert conflict with each other: the application of beneficence and justice, and the duty of confidentiality versus the duty to provide information to the National Insurance service. The study concludes that there are no basic ethical conflicts between the two roles. The ethical problems that may arise when exercising this duality should be viewed in the same way as other ethical problems in medicine. Actual application and balancing of the principles may necessitate negotiations between patients and physicians. _ _Keywords_: dual roles, professionalism, deliberation, impartiality, medical principle ethics, values of welfare state. (shrink)

The Covid-19 pandemic has presented major challenges to society, exposing preexisting ethical weaknesses in the modern social fabric’s ability to respond. Distrust in government and a lessened authority of science to determine facts have both been exacerbated by the polarization and disinformation enhanced by social media. These have impaired society’s willingness to comply with and persevere with social distancing, which has been the most powerful initial response to mitigate the pandemic. These preexisting weaknesses also threaten the future (...) acceptance of vaccination and contact tracing, two other tools needed to combat epidemics. Medical ethicists might best help in this situation by promoting truth-telling, encouraging the rational adjudication of facts, providing transparent decision-making and advocating the virtue of cooperation to maximize the common good. Those interventions should be aimed at the social level. The same elements of emphasizing cooperation and beneficence also apply to the design of triage protocols for when resources are overwhelmed. A life-stages approach increases beneficence and reduces harms. Triage should be kept as simple and straightforward as reasonably possible to avoid unwieldly application during a pandemic. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)