Ethical Debate Research Articles

Clearing the Fog: A Scoping Literature Review on the Ethical Issues Surrounding Artificial Intelligence-Based Medical Devices.

The use of AI in healthcare has sparked much debate among philosophers, ethicists, regulators and policymakers who raised concerns about the implications of such technologies. The presented scoping review captures the progression of the ethical and legal debate and the proposed ethical frameworks available concerning the use of AI-based medical technologies, capturing key themes across a wide range of medical contexts. The ethical dimensions are synthesised in order to produce a coherent ethical framework for AI-based medical technologies, highlighting how transparency, accountability, confidentiality, autonomy, trust and fairness are the top six recurrent ethical issues. The literature also highlighted how it is essential to increase ethical awareness through interdisciplinary research, such that researchers, AI developers and regulators have the necessary education/competence or networks and tools to ensure proper consideration of ethical matters in the conception and design of new AI technologies and their norms. Interdisciplinarity throughout research, regulation and implementation will help ensure AI-based medical devices are ethical, clinically effective and safe. Achieving these goals will facilitate successful translation of AI into healthcare systems, which currently is lagging behind other sectors, to ensure timely achievement of health benefits to patients and the public.

Moral persuasion for value-laden objections to human papillomavirus vaccination

The martial art of jiu jitsu capitalizes on the strength of a sparring partner by redirecting their momentum. Jiu jitsu persuasion similarly redirects the concerns motivating an objection in a manner that undermines the objection. This method of persuasion effectively addresses criticisms that motivate vaccine hesitancy, including moral criticisms. Critics argue that human papillomavirus vaccination causes young women to become more promiscuous. Evidence undermines this objection, but such evidence fails to persuade many objectors because of countervailing moral concerns regarding promiscuity. Healthcare professionals, therefore, need to consider supplementing evidence with moral arguments against the objection, using a framework that appeals to the core values motivating vaccine objections. A jiu jitsu model of persuasion is one such framework. By employing a jiu jitsu model healthcare professionals can facilitate collaborative, normative discussion that persuades more objectors and fulfills healthcare professionals’ obligations with respect to patient care vis-à-vis vaccination.

Stewardship according to context: Justifications for coercive antimicrobial stewardship policies in agriculture and their limitations.

Antimicrobial resistance (AMR) is an urgent, global threat to public health. The development and implementation of effective measures to address AMR is vitally important but presents important ethical questions. This is a policy area requiring further sustained attention to ensure that policies proposed in National Action Plans on AMR are ethically acceptableand preferable to alternatives that might be fairer or more effective, for instance. By ethically analysing case studies of coercive actions to address AMR across countries, we can better inform policy in a context-specific manner. In this article, I consider an example of coercive antimicrobial stewardship policy in Canada, namely restrictions on livestock farmers' access to certain antibiotics for animal use without a vet's prescription. I introduce and analyse two ethical arguments that might plausibly justify coercive action in this case: the harm principle and a duty of collective easy rescue. In addition, I consider the factors that might generally limit the application of those ethical concepts, such as challenges in establishing causation or evidencing the scale of the harm to be averted. I also consider specifics of the Canadian context in contrast to the UK and Botswana as example settings, to demonstrate how context-specific factors might mean a coercive policy that is ethically justified in one country is not so in another.

Continuous palliative sedation until death: a qualitative study of palliative care clinicians' experiences.

The practice of continuous palliative sedation until death is the subject of much medical and ethical debate, which is reflected in the inconsistency that persists in the literature regarding the definition and indications of palliative sedation. This study aims to gain a better understanding of palliative care clinicians' experiences with continuous palliative sedation. We conducted a qualitative study based on focus group discussions. We conducted six focus groups with a total of 28 palliative care clinicians (i.e., 15 nurses, 12 physicians, and 1 end-of-life doula) from diverse care settings across Canada, where assisted dying has recently been legalized. An interpretative phenomenological analysis was used to consolidate the data into six key themes: responding to suffering; grappling with uncertainty; adapting care to ensure ongoing quality; grounding clinical practice in ethics; combining medical expertise, relational tact, and reflexivity; and offering an alternative to assisted death. Interaction with the patient's family, uncertainty about the patient's prognosis, the concurrent practice of assisted dying, and the treatment of existential suffering influence the quality of sedation and indicate a lack of clear palliative care guidelines. Nevertheless, clinicians exhibit a reflective and adaptive capacity that can facilitate good practice.

Debunking robot rights metaphysically, ethically, and legally

In this work we challenge the argument for robot rights on metaphysical, ethical and legal grounds. Metaphysically, we argue that machines are not the kinds of things that may be denied or granted rights. Building on theories of phenomenology and post-Cartesian approaches to cognitive science, we ground our position in the lived reality of actual humans in an increasingly ubiquitously connected, controlled, digitized, and surveilled society. Ethically, we argue that, given machines’ current and potential harms to the most marginalized in society, limits on (rather than rights for) machines should be at the centre of current AI ethics debate. From a legal perspective, the best analogy to robot rights is not human rights but corporate rights, a highly controversial concept whose most important effect has been the undermining of worker, consumer, and voter rights by advancing the power of capital to exercise outsized influence on politics and law. The idea of robot rights, we conclude, acts as a smoke screen, allowing theorists and futurists to fantasize about benevolently sentient machines with unalterable needs and desires protected by law. While such fantasies have motivated fascinating fiction and art, once they influence legal theory and practice articulating the scope of rights claims, they threaten to immunize from legal accountability the current AI and robotics that is fuelling surveillance capitalism, accelerating environmental destruction, and entrenching injustice and human suffering.

Advances and Challenges of Sensing in Water Using CRISPR-Cas Technology.

The groundbreaking gene-editing mechanism, CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats), paired with the protein Cas9, has significantly advanced the realms of biology, medicine, and agriculture. Through its precision in modifying genetic sequences, CRISPR holds the potential to alter the trajectory of genetic disorders and accelerate advancements in agriculture. While its therapeutic potential is profound, the technology also invites ethical debates centered on responsible use and equity in access. Parallelly, in the environmental monitoring sphere and sensing in water, especially biosensors have been instrumental in evaluating natural water sources' quality. These biosensors, integrating biological components with detection techniques, have the potential to revolutionize healthcare by providing rapid and minimally invasive diagnostic methods. However, the design and application of these sensors bring forth challenges, especially in ensuring sensitivity, selectivity, and ethical data handling. This article delves into the prospective use of CRISPR-Cas technology for sensing in water, exploring its capabilities in detecting diverse biomarkers, hazardous substances, and varied reactions in water and wastewater systems.

The American ‘doc fix’: Incremental policy change and the growth of US healthcare spending

The extraordinary growth of healthcare spending in the United States necessitates an incremental model of institutional change. Efforts to reduce social spending in the 1980s introduced strict cost controls on healthcare, yet this regulation was annually abated with temporary legislation known as ‘doc fixes’. We show that the institutions set up to control spending were slowly undermined through three mechanisms: the transformation of wider political and economic problems into technical ones, the ‘layering’ effect of repeated budgetary appropriations, and the moral arguments that sustained incremental spending growth. This case illustrates how creative responses to budget constraints may produce incremental change, driven by ideas about how markets and welfare should work.

Too many rules

ABSTRACT The main thesis of Scott Hershovitz's recent book is in its title: Law is a Moral Practice. By this, Hershovitz means that legal practices aim to adjust people's moral relationships (and generally succeed in doing so). He further thinks that lawyers' arguments in court concern the precise moral effect of legal practices on the moral relationships of the parties. They are, in other words, moral arguments that aim to identify the parties' moral relationships, which implies that the rights and duties contested in court are moral rights and duties. To defend the thesis, Hershovitz focuses on cases or phenomena that seem best to fit the competing, nonmoral view, and show that, in spite of initial appearances, these too can be better accounted for by the moral practice view. This is a risky strategy for it does not allow for presenting the view at its strongest, and may encourage confusion over what the final position is. Indeed, it seems to me that Hershovitz ends up leaving an opening, an exit for his opponent that I think survives Hershovitz's arguments in favour of the moral practice view, and indicates that, in the end, the opponent has the better, more nuanced view.

An ethical dilemma: the role of the psychiatrist in physician assisted suicide and/or euthanasia

IntroductionQuestions regarding death have generated debates and art since the dawn of civilization. These themes permeate through various areas of study, including religion, philosophy, ethics, medicine and humanities. Various countries have been revising their laws regarding the end of life, especially on the right to aid and choice in the end in the context of medical and phychological suffering. Physician-Assisted Suicide (PAS) and euthanasia are methods by which people, mostly terminal patients, seek to end their lives with the help of medical professionals. PAS and euthanasia have been the target of heated debates in politics and in medicine, with the question of ethics centering most of these.ObjectivesThe authors aim to explore PAS and euthanasia in the context of the ethical debate. Based on the pillars of ethics, based on the principal of do no harm and beneficence, the authors explore the role of the Psychiatrist, if any, in these end of life issues.MethodsThe authors performed a brief narrative review of the available literature, with recourse to various databases such as PubMed and Scopus. The search terms utilized in isolation or combination included: physician assisted suicide, euthanasia, psychiatry, mental illness and ethical issues. Taking into consideration the widespread discussion of these themes in the public forum, news articles were included based on their merit and relevance to the explored topic.Results The ethical debate appears to rest between the pillars of first, do no harm, the principles of beneficence and nonmaleficence and aut. Here, the conflict between the first and last appear, where the killing of any patient, whether directly or indirectly is clearly contrary to the principle of primum non nocere. However, the prolonging of suffering in a terminal patient, appears to contradict the principles of nonmaleficence. The Psychiatrist is called to evaluate competence to choose, which is allied to autonomy. Other sources explore the role of the Psychiatrist in permitting a suicide to occur, when the profession is dedicated to the prevention of suicide. From the literature, the psychiatric evaluation is rarely regularly carried out, usually being solicited in cases where mental illness which might compromise the capacity to choose is suspected.Conclusions In ethical debates, clear cut answers are rarely every developed, with the nuance and greyscale of difficult topics usually dividing those that ferverantly champion each cause. Psychiatric evaluation is usually invoked when patient autonomy, especially in terms of capacity, is called into question. Questions remain as to whether the presence of the psychiatrist should be a regular one in these procedures or if it should be carried out in a selective manner. There is little consensus in regards to this role, which merits further conversation in the various forums of medical and ethical communication.Disclosure of InterestNone Declared

Suicide across time and cultures: from a philosophical debate to network analysis

Introduction Suicide is a multifaceted subject that encompasses a broad spectrum of perspectives, spanning philosophy, the arts, social sciences, neuroscience, neuropsychiatry, and public health. The history of suicide is intricately intertwined with the history of humanity itself, and examining the shifting attitudes towards suicide holds significant implications for the field of suicide prevention.ObjectivesThe objective of this paper is to offer a timeline of the social perspectives about suicidal behavior throughout history in order to showcase the influence of cultural and contextual factors.MethodsThis poster is based on the Massive Open Online Course (MOOC) “Focus on Suicidal Behaviour” provided by the European Psychiatric Association. We performed a brief overview of the chapter on history of suicide and updated data on this topic with recent literature findings.ResultsIn antiquity, suicide was sometimes regarded as justifiable, whether to preserve honor or protest injustices. However, during the Middle Ages, suicide was primarily seen as a criminal act, violating the rules of the Christian religion. The Renaissance brought about a shift in the perception of suicide, as it began to be depicted in art as a heroic or philosophical act. Moving into the Romantic period, suicide took on a tragic and noble connotation, often seen as an escape from unbearable suffering.The 19th century marked a significant turning point when the social context started being recognized as a crucial factor in the development of suicidal behavior. In the 20th century, suicide was increasingly considered a public health problem. In the 21st century, the discourse on suicide has become multifaceted. On one hand, network analysis has enabled the development of an integrated model of suicide, emphasizing the complex interactions among various risk and protective factors. On the other hand, ethical and moral debates persist regarding assisted suicide and its indications.This summary primarily centers on the historical context of suicide within Europe. However, attitudes toward suicide vary significantly across cultures. For instance, in China, suicide rates are higher for women than for men, while Japan has historically displayed a relatively tolerant attitude toward suicide, particularly within the military. In contrast, Islamic countries consider suicide a major sin and implicitly associate it with stigma.Conclusions The understanding of suicide evolves over time and is deeply influenced by cultural contexts. Familiarizing ourselves with the historical perspectives on suicide is essential for comprehending this complex social and personal phenomenon. Such knowledge forms the foundation for the creation of effective prevention strategies.Disclosure of InterestNone Declared

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

The relationship between personal and professional goals and emotional state in academia: a study on unethical use of artificial intelligence.

Artificial Intelligence (AI) is a concept that has been a subfield of computer science since the 1950s. In recent years, with its growing development power, AI technologies have made significant progress and are now being used in many fields. Like in all areas, the use of AI technologies in academia has provided convenience to academics while also bringing ethical debates. In the literature part of the study, concepts such as AI, academia, academics and academic progress, ethics, ethical theories, academic ethics, and emotional states have been thoroughly examined and defined. In this study, starting from AI and scientific ethics, ethical issues arising from emotional states in academic research have been identified, and concrete solutions to these ethical issues have been proposed. The aim is to discuss the views of academics in order to determine what types of scientific ethical violations and prevention methods are involved. In this context, the semi-structured interview technique, which is one of the qualitative research methods, was preferred as the method. In the study, in-depth semi-structured interviews were conducted with 4 ethics experts and 4 psychology experts selected through snowball sampling technique. The data obtained through semi-structured in-depth interviews will be analyzed using content analysis. Within the context of the literature review and interviews: Ethics is based on the foundation of acting correctly. In this context, scientific ethics can be summarized as acting truthfully and honestly, not distorting data, and not trying to progress unfairly. The use of AI in academia is becoming increasingly widespread. From a positive perspective, this usage significantly contributes to making studies more practical. However, it can lead to problems such as unfair authorship, devaluation of human authorship, and incorrect data. The connection between academics' professional advancement goals and emotional states becomes prominent in this context. The potential of AI to facilitate progression can lead to unethical use. To prevent such situations, it is recommended to organize training sessions to increase professional awareness, internalize ethics personally, establish ethical committees specific to the field of AI, conduct more effective audits by academic publication and promotion committees, and implement specific regulations for AI. Finally, for future academic studies, it is suggested that the usage of AI in academic research be measured and evaluated by ethics experts. For psychologists, conducting surveys with academics to explore how they use AI in the context of their emotional states and professional advancement goals is recommended.

The Psychological Process Underlying Attitudes Toward Human-Animal Chimeric Brain Research: An Empirical Investigation

This study adopted an empirical method to investigate lay people’s attitudes toward the bioethical issues of human-animal chimeric brains. The results of online surveys showed that (1) people did not entirely reject chimeric brain research, but showed slightly more negative responses than ordinary animal testing; and that (2) their ethical concerns arose in connection with the perception that chimerism in the brain would humanize the animal. This means that people’s psychology was consistent with the ethical argument that crossing the human-animal boundary would bring moral confusion to our society. Meanwhile, it was not in line with another argument that moral status depended on having high capacities, and that chimerism would cause a problem if it enhanced animals’ capacities. Furthermore, this study analyzed additional psychological factors related to people’s moral judgment and the relationship among those factors. Several psychological factors, such as the perception that chimeric brain research is unnatural, were identified as mediating the relationship between perception of animal humanization and ethical concerns about creating and using chimeric brains. Introducing an empirical approach to the ethics of human-animal chimeric brains brought two findings: (1) this study informed us of socially shared intuition regarding this novel technology; and (2) it unveiled the psychological processes behind people’s ethical concerns in more detail than they spontaneously mentioned. These findings will help to build normative arguments and future policies that are understandable and acceptable to society.

A paradigm shift?-On the ethics of medical large language models.

After a wave of breakthroughs in image-based medical diagnostics and risk prediction models, machine learning (ML) has turned into a normal science. However, prominent researchers are claiming that another paradigm shift in medical ML is imminent-due to most recent staggering successes of large language models-from single-purpose applications toward generalist models, driven by natural language. This articleinvestigates the implications of this paradigm shift for the ethical debate. Focusing on issues like trust, transparency, threats of patient autonomy, responsibility issues in the collaboration of clinicians and ML models, fairness, and privacy, it will be argued that the main problems will be continuous with the current debate. However, due to functioning of large language models, the complexity of all these problems increases. In addition, the articlediscusses some profound challenges for the clinical evaluation of large language models and threats to the reproducibility and replicability of studies about large language models in medicine due to corporate interests.

Fuel for revolt – moral arguments as delegitimation practices in Swedish fuel protests

ABSTRACT This article examines the role of moral arguments in the delegitimation of transition policies. Previous research has highlighted attitudes and arguments that explain resistance against transition policies, including perceptions of unfairness; inefficiency and effectiveness; lack of trust; and ideology. This article provides further understanding of resistance to climate policies by zooming in on how social movements implicitly and explicitly use moral arguments to delegitimise low-carbon transition policies. Through a qualitative interview study with members of a Swedish social media movement against low-carbon transport policies, we analyse central arguments against policies; how moral considerations figure in them; and how these strengthen argumentative delegitimation practices against transition policies in the transport sector. We show how moral arguments serve to legitimise protests both by instilling an urgency in the cause and generalising the demands to delegitimise mainstream transition policies, and suggest that recognition of this may contribute to both better analysis and policies.

Co-designing AI Education Curriculum with Cross-Disciplinary High School Teachers

High school teachers from many disciplines have growing interests in teaching about artificial intelligence (AI). This cross-disciplinary interest reflects the prevalence of AI tools across society, such as Generative AI tools built upon Large Language Models (LLM). However, high school classes are unique and complex environments, led by teachers with limited time and resources with priorities that vary by class and the students they serve. Therefore, developing curricula about AI for classes that span many disciplines (e.g. history, art, math) must involve centering the expertise of cross-disciplinary teachers. In this study, we conducted five collaborative curricular co-design sessions with eight teachers who taught high school humanities and STEM classes. We sought to understand how teachers considered AI when it was taught in art, math, and social studies contexts, as well as opportunities and challenges they identified with incorporating AI tools into their instruction. We found that teachers considered technical skills and ethical debates around AI, opportunities for "dual exploration" between AI and disciplinary learning, and limitations of AI tools as supporting engagement and reflection but also potentially distracting. We interpreted our findings relative to co-designing adaptable AI curricula to support teaching about and with AI across high school disciplines.

An analysis of some ethical argumentation about genetically modified food

We present an analysis of ethical argumentation and rhetorical elements in an article on the debate about growing genetically modified food (GMF), an issue of current interest in environmental ethics. Ethical argumentation is argumentation that a certain action is permissible, forbidden, or obligatory in terms of ethical intuitions, principles, or theories. Based on analysis of argumentation in the article, we propose several argumentation schemes for descriptive modeling of utilitarian arguments as an alternative to using more general schemes such as practical reasoning and argument from consequences. We also show how the article promoted its pro-GMF stance using rhetorical elements such as quotation, argument from expert opinion, and ad hominem attacks. Pedagogical and computational implications of the analysis of argumentation and rhetoric are discussed.

The ethically significant difference between dual use and slippery slope arguments, in relation to CRISPR-Cas9: philosophical considerations and ethical challenges

Biomedical research, on the one hand, contributes to important goals from generation of knowledge about the human body to the development and testing of therapeutics of all kinds. On the other hand, it can produce serious and sometimes unforeseeable consequences. In the ethical analysis of these two aspects of biomedical research, two important argumentative strategies play a major role. First, slippery slope arguments are used to warn of potential risks and to highlight knowledge-based limitations. Second, a dual-use problem describes the challenge that already established techniques can be used for both morally wrong and morally right purposes. These two argumentative strategies appear to share several similarities, which will be investigated in this article. For this purpose, the article will first provide clear working definitions for both types of argument. This lays the foundation for the further ethical analysis. In a second step, and in order to investigate the similarities and differences of the argumentative strategies with an example from current ethical debates, CRISPR-Cas9, a currently very promising tool of genome editing, will be examined. The extent to which the possible applications of this genome editing tool can be addressed by slippery slope arguments or the dual use problem will be investigated. For this purpose, selected studies involving the use of CRISPR-Cas9 will be examined. Based on this two-step, analytic and example-based comparison of slippery-slope argumentation and dual-use considerations, the article will detail the ethically relevant difference between the two argumentative strategies and at the same time contribute to the ongoing ethical debate about CRISPR-Cas9.

Persons with mental disorders and assisted dying practices in Spain: In response to Ramos et al.

Ramos et al. paper offers a narrative review of Spanish Organic Law 3/2021, which regulates euthanasia, focusing on its application to individuals with mental disorders. Ramos et al. examine the application of legal prerequisites from an ethical-legal perspective to ascertain the conditions under which psychiatric euthanasia might be considered legitimate and compliant with legal stipulations. Nevertheless, it is apparent that the core ethical inquiries linked to this matter have not been exhaustively investigated. The criteria laid out are, in our assessment, still open to further debate and broader deliberation. Our article emphasizes the need for a comprehensive ethical and legal debate in Spain regarding psychiatric euthanasia. Competency assessment is central to the legislation, but there are concerns about the validity of assessment tools and the subjective nature of interviews. Furthermore, defining irreversible suffering in mental health contexts poses challenges. The article advocates for a deeper understanding of the needs of individuals with mental disorders before considering euthanasia and emphasizes the importance of comprehensive care and psychosocial interventions in reducing the desire for euthanasia. Ultimately, it underscores the ethical complexities of euthanasia in mental health and the necessity of prioritizing comprehensive care in addressing these complexities.

Thoraco-abdominal normothermic regional perfusion for thoracic transplantation in the United States: current state and future directions.

To provide an update regarding the state of thoracoabdominal normothermic regional perfusion (taNRP) when used for thoracic organ recovery. taNRP is growing in its utilization for thoracic organ recovery from donation after circulatory death donors, partly because of its cost effectiveness. taNRP has been shown to yield cardiac allograft recipient outcomes similar to those of brain-dead donors. Regarding the use of taNRP to recover donor lungs, United Network for Organ Sharing (UNOS) analysis shows that taNRP recovered lungs are noninferior, and taNRP has been used to consistently recover excellent lungs at high volume centers. Despite its growth, ethical debate regarding taNRP continues, though clinical data now supports the notion that there is no meaningful brain perfusion after clamping the aortic arch vessels. taNRP is an excellent method for recovering both heart and lungs from donation after circulatory death donors and yields satisfactory recipient outcomes in a cost-effective manner. taNRP is now endorsed by the American Society of Transplant Surgeons, though ethical debate continues.