Ethical Questions Research Articles

On Disquieting Ground

This article focuses on attempts by inhabitants of the island of Samothraki, in North-Eastern Greece, to make sense of rapid soil erosion and degradation. Through the use of ethnographic vignettes, collected during my first fieldwork on the island in August of 2022, and broader ethnographic material, I show the imbrication of landscape perception with questions of collective ethics as well as the specific forms of social uncertainty which emerge from soil instability. The article highlights specific and local discursive attempts to make sense of broader processes, including weather events, as prompts used by Samothracians to think about their ways of inhabiting their own island.

The ethical dimensions of utilizing Artificial Intelligence in palliative care

Palliative care aims to improve the quality of life for seriously ill individuals and their caregivers by addressing their holistic care needs through a person- and family-centered approach. While there have been growing efforts to integrate Artificial Intelligence (AI) into palliative care practice and research, it remains unclear whether the use of AI can facilitate the goals of palliative care. In this paper, we present three hypothetical case examples of using AI in the palliative care context, covering machine learning algorithms that predict patient mortality, natural language processing models that detect psychological symptoms, and AI chatbots addressing caregivers’ unmet needs. Using these cases, we examine the ethical dimensions of utilizing AI in palliative care by applying five widely accepted moral principles that guide ethical deliberations in AI: beneficence, nonmaleficence, autonomy, justice, and explicability. We address key ethical questions arising from these five core moral principles and analyze the potential impact the use of AI can have on palliative care stakeholders. Applying a critical lens, we assess whether AI can facilitate the primary aim of palliative care to support seriously ill individuals and their families. We conclude by discussing the gaps that need to be further addressed in order to promote ethical and responsible AI usage in palliative care.

Communicative Responsibility in an Age of Fragmented Connectivity

In the face of technological advances, questions of communicative ethics seem to become more important than ever. This paper first introduces the notion of fragmented connectivity to explain major structural aspects of how public discourse can be seen to unfold today. Then we summarize two distinct studies, focusing on (i) the political weaponization of free speech, and (ii) academic complicity in politically driven historiography. Both point at the need to re-emphasize attention to communicative responsibility.

"I think all of us should have […] much better training in ethics." Ethical challenges in policy making during the COVID-19 pandemic: Results from an interview study with Swiss policy makers and scientists.

The COVID-19 pandemic posed many unprecedented challenges to health care systems and public health efforts worldwide. Policy making and science were deeply intertwined, in particular with regard to the justification of health policy measures. In this context, ethical considerations were often at the core of decision-making trade-offs. However, not much is known about the actual ethical challenges encountered by policy makers and scientists involved in policy advice. With this study, we therefore aim to explore the ethical challenges during COVID-19-related political decision-making in Switzerland as perceived by policy makers and scientists involved in policy making. We also explore the role ethics advice had during the pandemic response and what can be learned for future public health crises. We conducted thirteen qualitative expert interviews with policy makers and scientists involved in decision-making on COVID-19 policy responses in Switzerland on the regional and national level. We used inductive content analysis to analyse the interviews. Among the multitude of ethical challenges highlighted, interviewees perceived making trade-offs between the common good vs. the individual good and between economic welfare vs. health of the population, as well as proportionality of the policy measures, and the capacity of the public to accept uncertainty as central. Interviewees had diverging opinions on whether ethical considerations were sufficiently raised and discussed on the Swiss policy level during the COVID-19 pandemic. Among the reasons why ethics was not sufficiently discussed, they mentioned a lack of time in the fast-paced dynamic of the pandemic, ethics as a complex subject area, the interconnectedness between ethics and law, too much focus on few topics (mostly on vaccination-related ethical questions), and power relationships, such as dominance of medical professionals over ethicists. They evaluated ethics support to have been adequately present in the decision-making process, but wished for ethics training, involvement of the public in the discourse and for accompanying communication to build trust among the population for the future. The study provides empirical insights into the ethical considerations of COVID-19 policy making in practice in Switzerland. It can help to develop ethics assistance for future crises and inform ethical health policy and decision-making not only in Switzerland, but also in other countries.

Medicaid Waivers to Address Homelessness: Political Development and Policy Trajectories.

This article reviews the role of Medicaid Waivers in homeless policy, and their emerging role as a mechanism to address homelessness. We evaluate the political development of Waivers in housing and homeless policy over the past thirty years, and investigate the status of current and approved Waivers targeting homelessness. We then consider how Waivers may shape homeless policy governance going forward, including the success of existing systems, and ethical questions related to the role of healthcare payers in solutions to homelessness. We find that the scope of Medicaid Waivers to address homelessness has always been present, but significantly expanded post Affordable Care Act (ACA) and more notably following the COVID-19 pandemic. These expansions brought new opportunities for states to fund responses to homelessness through Medicaid social determinants of health (SDoH) provisions providing wrap-around medical services for populations at-risk of or experiencing homelessness, and now through time-limited direct housing costs paired with essential medical services. Over one third of states have an 1115 Waiver specifically targeting homelessness, with nearly one in five states including provisions that cover direct housing costs (e.g., rent). Going forward, Medicaid's involvement in homeless policy has the potential to reshape state and local responses to homelessness.

Wish to die trying to live: unwise or incapacitous? The case of University Hospitals Birmingham NHS Foundation Trust versus ‘ST’

The recent legal dispute about medical treatment for a 19-year-old patient, Sudiksha Thirumalesh, (known initially by the Court of Protection as ‘ST’) in A NHS Trust versus ST & Ors...

The effect of social media engagement on telemedicine adoption: an empirical study

Purpose This study aims to assess the collective impact of social media engagement and anxiety due to COVID-19 on telemedicine adoption intentions with other constructs of the Technology Acceptance Model (TAM) concerning anxiety linked to COVID-19 and the influence of privacy concerns on TAM constructs. These constructs encompass the perception of ease of use, perceived usefulness, one’s attitude toward telemedicine and the intention to utilize telemedicine. Design/methodology/approach A total of 178 comprehensive responses were gathered over a six-month period from residents in Mumbai, India, to examine the proposed model. The data was analyzed using software tools, including SPSS version 23 and IBM AMOS 21, to compute factor loadings, assess model fit, estimate path relationships and conduct hypothesis testing. Findings Privacy concerns with telemedicine usage had a significant negative impact on behavioral engagement (B = −0.20, SE = 0.08, p < 0.05) and positively impacted affective engagement (B = 0.25, SE = 0.06, p < 0.01). Similarly, anxiety due to COVID-19 had a negative impact on the perceived usefulness of telemedicine (B = −0.10, SE = 0.03, p < 0.05). Research limitations/implications This research addresses a void in the existing literature by merging the TAM and the Social Media engagement theory. This study reaffirms the impact of past and relevant experiences, privacy concerns and COVID-19-induced anxiety on various components of TAM, thus expanding and enriching the TAM model. Practical implications Healthcare administrators should implement strategies to alleviate privacy-related apprehensions associated with telemedicine platforms. Additionally, they should promote existing users to create and disseminate positive content to mitigate COVID-19-induced anxiety and foster meaningful engagement, thereby enhancing the willingness to adopt telemedicine. Social implications Providers and promoters of telemedicine platforms and services may lean toward employing digital marketing campaigns that rely on emotional persuasion, including tapping into the fear factor to boost subscription and service sales. Such practices raise ethical questions, underscoring the need for well-defined advertising standards to govern the marketing of these products. Originality/value This article is among the relatively rare studies that document the favorable influence of emotional engagement on the intention to utilize telemedicine, underscoring the significant role of emotions in shaping telemedicine adoption Intentions.

A review of clinical ethics consultations in a regional healthcare system over a two-year timeframe

BackgroundClinical Ethics Consultations (CECs) are used by healthcare systems to offer healthcare practitioners a structured level of support to approach ethical questions. The objective of this study was to detail the elements of surveyed CECs and offer guidance in the approach to future ethics consultations at a regional healthcare system.MethodsThis cohort study has a qualitative and quantitative retrospective approach, surveying ethics consultations through the dates of 4/27/22 to 4/26/24. A documentary sheet was created, and information was entered via online data-gathering forms. The cases are from a range of specialties within a regional healthcare system servicing Minnesota, Wisconsin, and North Dakota.Results103 CECs were performed within the study period across the regional healthcare system. Consultations were identified through retrospective review of the internal CEC database, and patient information was collected through the medical record. Decision-making was often performed by a substitute decision-maker (N = 54), occurring in 70.1% of cases with known decision makers. CECs were documented in an ethics-specific note in the patient medical record in 37 of 82 (45.1%) documented patient cases. It was common for physicians to mention the ethics consultation in their patient notes, occuring in 51 of 82 (62.2%) of documented patient cases. Age was recorded in 92.0% (N = 91) of unique patient cases; the median age was 62 years. Ethical questions concerning end-of-life care were the most common cause for consultation (N = 35, 34%), and CECs were most commonly requested in general medicine or hospitalist departments (N = 38, 45.2%). Most consultations resulted in resolution at time of initial consultation with the ethics call team.ConclusionsRecommendations for increased frequency and timing of policy review are given based on the results of the data presented. Using interpretation of the CECs in this study, we offer recommendations towards the use and documentation of ethics consultations in the era of open notes, open the door towards areas of future research, and ultimately promote use of CECs for more favorable patient outcomes.

Transformations and transitions: The social and political life of the dead

Death is often considered the end of the story, and indeed the end of politics. The papers in this special issue demonstrate however that this is far from the case. They probe the transformations and transitions of the dead across varying cultural and social contexts, and time periods, and reckon with how human remains are repurposed, mobilized, represented, and integrated into larger narratives, including evidentiary, memorial, political, and emotional. They also understand the dead as complex and lively actors in the various ways they provoke the living and impact the way we think about larger political, cultural, and ethical questions. Collectively, the papers raise critical questions about how we understand the social, cultural, communal, religious, and political significance of human remains and of what remains in the aftermath of violence.

Drosophila melanogaster experimental model to test new antimicrobials: a methodological approach

Given the increasing concern about antimicrobial resistance among the microorganisms that cause infections in our society, there is an urgent need for new drug discovery. Currently, this process involves testing many low-quality compounds, resulting from the in vivo testing, on mammal models, which not only wastes time, resources, and money, but also raises ethical questions. In this review, we have discussed the potential of D. melanogaster as an intermediary experimental model in this drug discovery timeline. We have tackled the topic from a methodological perspective, providing recommendations regarding the range of drug concentrations to test based on the mechanism of action of each compound; how to treat D. melanogaster, how to monitor that treatment, and what parameters we should consider when designing a drug screening protocol to maximize the study’s benefits. We also discuss the necessary improvements needed to establish the D. melanogaster model of infection as a standard technique in the drug screening process. Overall, D. melanogaster has been demonstrated to be a manageable model for studying broad-spectrum infection treatment. It allows us to obtain valuable information in a cost-effective manner, which can improve the drug screening process and provide insights into our current major concern. This approach is also in line with the 3R policy in biomedical research, in particular on the replacement and reduce the use of vertebrates in preclinical development.

Corporate Governance and Business Resilience in the Banking Industry

The unstable banking business environment and ethical questions that bedeviled the industry have opened new windows for researchers and policymakers on how best to tackle the menace. But as researchers keep pace on how best banking institutions can remain unperturbed with preparation for future adversities and bearing in mind the shareholders' wealth, the concept of resilience becomes the beacon of hope for managers and directors alike. 139 participants drawn from ten interest-deposit money banks in south-eastern Nigeria were selected for this inquiry. The result of this study demonstrated that corporate governance predicted business resilience positively. It was concluded that corporate governance that is predicated on board independence, board size, board effectiveness, leadership quality, and accountability would strengthen the resilience of interest deposit money banks. This study recommends that managing directors of interest deposit money can leverage corporate governance measures utilized in this study to strengthen the resilience capability of their organisations.

An exploratory study of blind spot bias in psychiatrists: The value of mindfulness and ethical skills’

IntroductionPsychiatry is an area of medicine that is particularly exposed to the risks of cognitive bias, notably because diagnosis is subjective. However, psychiatrists may develop psycho-cognitive skills that protect against bias, as the reflective approach to their patients favors the activation of system 2 (logical) as opposed to system 1 (intuitive) processes. Furthermore, the collegial practices found in psychiatry, a consequence of the ethical questions psychiatrists must address, can also mitigate the impact of bias. On the other hand, clinical ethics committees have adopted structured deliberation practices that aim to improve collective decision-making and limit the cognitive biases associated with groupthink. ObjectiveThe primary aim was to compare blind spot bias in a group of psychiatrists and a group of ‘ethicists’, experts in group deliberation. The secondary objective was to study the distribution of skills influencing the balance between systems 1 and 2 (notably, ethical deliberation, feeling of efficacy, mindfulness, and values) in both groups. The general hypothesis is that psychiatrists are less prone to blind spot bias and are more competent in the skills studied. MethodsThis descriptive, cross-sectional study was conducted from April 2022 to May 2023. Thirty-two psychiatrists were recruited from several French hospitals, along with 20 ‘ethicists’. All participants completed the following self-administered questionnaires: the Bias Blind Spot Scale (French version), the Euro Moral Case Deliberation (Euro-MCD, ethical skills), Bandura's self-efficacy scale (self and collective efficacy), the Freiburg Mindfulness Inventory (mindfulness), and the Schwartz Value Survey (values). ResultsThe ratio of self/other blind spot bias was lower in the ‘ethicists’ group than the psychiatrists’ group (P<0.001). Euro-MCD scores were higher (P<0.001) and psychiatrists tended to have a better sense of collective efficacy (P=0.08). No significant difference was found between the two groups for total mindfulness or presence and acceptance sub-scores. Scores for hedonic value were higher among psychiatrists (P<0.02). ConclusionThe results do not confirm our hypotheses. There is less evidence of blind spot bias among our sample of ‘ethicists’, who are experts in group deliberation, than psychiatrists, who have experience of the patient/physician dyad. The ethical skills that are developed within the formal deliberation process seem particularly interesting in terms of reducing cognitive bias.

From televangelism to “tele-exorcism”: a socio-ethical perspective on Christian television broadcast in Cameroon and Nigeria

ABSTRACT Thanks to the forces of globalisation and localisation, televangelism has spread across the world and become so revolutionised that there presently exist a variety of televisual genres questionably classified under it. Indeed, the explosion and tropicalisation of televangelism have given birth to a myriad of televisual cultures relatable only nominally to the original American televangelism. This diversity and complexity raise definitional, epistemological and ethical questions, three of which include: what should genuine televangelism be? How ‘televangelical’ are the versions of the concept observed in African neo-Pentecostal and charismatic movements? And how are these African versions subtle perversions or entirely hybrid televisual genres? Using secondary sources and a critical exploration of Christian televisions in Cameroon and Nigeria, this paper attempts answers to the aforementioned under-researched questions. In the first place, the paper makes a brief incursion into the history of televangelism and its importation into Africa. In the second place, it examines how specific Nigerian and Cameroonian neo-Pentecostal movements have sought to revolutionise this televisual genre. In the last instance, the paper shows how specific Cameroonian and Nigerian church leaders’ apparent perversion of the concept has given birth to tele-exorcism which, besides being confused with televangelism, is questionable in a media ethics sense.

The 2024 Olympics: Confronting Human Rights Violations , Global Tensions , and Trans Athlete Participation.

As we anticipate the 2024 Paris Olympics, it is imperative to examine the multifaceted consequences of human rights abuses in host nations, particularly in relation to the treatment of migrant workers involved in the construction and preparation for the Games. These workers often endure exploitative conditions, including insufficient wages, prolonged working hours, and hazardous work environments. This raises significant ethical questions about the obligations of the International Olympic Committee (IOC) and host nations in ensuring that the Games not only promote athletic excellence but also safeguard the fundamental rights and dignity of all individuals involved.

Whose Side Are We On? Toward an Emancipatory Ethic in Critical Arts-Based Research

The renowned U.S. sociologist Howard S. Becker, writing in 1969, posed the ethical question: Whose side are we on? In the context of continued structural inequalities in the distribution of power and wealth and individual and institutional oppression, in terms of class, race, gender, disability, and sexual orientation, this question remains as important as ever. The article, in advocating a robustly partisan approach, offers an emancipatory ethical framework continuum and an empirical example, from the authors’ critical arts-based research with undocumented Mexican Americans, to support and inform critical researchers, committed to working with oppressed groups against discrimination and for social justice.

Narrating Disruptive Encounters in the Forest: Hunting, Animal Lives, and Ecology

Over the last century, three popular writers and media personalities have written bestsellers and created TV programs in order to alert the general public to the suffering of wild animals as well as the deleterious effects on young trees caused directly or indirectly by hunting and forestry practices. Austrian journalist and writer Felix Salten published Bambi: A Story of Life in the Woods (1923), using a baby deer’s perspective. German journalist and literary author Horst Stern shocked the nation with his TV program Remarks about the Stag (1971), which shows the brutality of hunting; his 1989 Jagdnovelle (The Last Hunt) weaves together a hunter’s perspective with his prey animal’s experience. In recent years, German forester Peter Wohlleben has shifted the focus from animals to plants by publishing a series of popular books about the forest, starting with The Hidden Life of Trees (2015). This essay examines how Salten, Stern, and Wohlleben all humanize their animal and plant characters, including through a form of “critical anthromorphism” (Mossner)—and are criticized for it. They also incorporate ethology, i.e. observations of animal behavior and the forest environment, as well as scientific knowledge, as they attempt to evoke their audience’s empathy for their nonhuman characters. Hunting pressure and the violent disruption of the lives of the animals leads to an “ecology of fear” instead of an “ecology of subjects” that would align better with changing perceptions of “nature” (Soentgen). Ethical questions concerning the mass killing of Europe’s largest mammals remain as it does not succeed in reducing deer overpopulation or damage to the forest ecosystem, perpetuing Germany’s forest/game conflict.

Exploring the synergy between generative AI and software engineering: Automating code optimization and bug fixing

As applied to software engineering, generative AI is quickly transitioning from a zero-sum industry game changer into the primary automation tool for code optimization, bug identification, and problem-solving. This technology takes advantage of artificial intelligence algorithms within machine learning models to analyze and write code, resulting in improved quality and speed of an application development process. The generative AI replenishes productivity in development work and enhances centralization between development work teams through code handling and intelligent suggestions for essential codes. However, the integration of AI in software engineering poses the following problems and ethical questions: the question of accuracy, bias, and data. This paper will review the existing knowledge on generative AI in software engineering regarding its current use, future evolutions and advancements, issues and limitations, and ethical factors in using this technology. This paper considers these aspects to give a global outlook on how generative AI will transform software development in the future and how responsible AI should be employed.

Extending Child Protection Law to the Unborn: Maternal Liability for Unborn Injury in Malaysia

The debate about the value of life is very important in discussions about abortion rights, with one side arguing that unborn children should be completely protected from harm. This view enhances with the widely held belief that pregnant women need strong legal protections to keep both of them and their unborn children safe. In Malaysia, the rights of unborn children are not clearly defined by law. The current laws try to protect pregnant women from harm caused by others but not from their own actions that could harm the unborn child. This lack of clarity leads to many legal, ethical, and social questions, especially concerning the rights of unborn children in cases of criminal acts. This article suggests a detailed legal approach that considers both scientific and medical perspectives. It argues that unborn children should be recognised as victims of crime, even when the crime is committed by their mothers.

Ethical Dilemmas in Home Palliative Care

Abstract Background In the past two decades, there has been a noticeable shift towards home-based care, reflecting the broader trend among OECD countries to prioritize a comprehensive approach to health and well-being. This approach emphasizes preventive and proactive measures, often relying on home-based care delivered by multidisciplinary teams providing both curative and palliative care. However, the unique nature of providing care in a home environment raises ethical questions among healthcare providers, necessitating high levels of attentiveness and sensitivity from the caregiving team to address them effectively. Research Objectives This study aims to identify ethical challenges encountered by a multidisciplinary team, as perceived by managers of an organization offering home palliative services in Israel. Methods A qualitative study was conducted, involving interviews with nine key managers to explore prevalent ethical issues in delivering home-based care. Findings Thematic analysis unveiled common ethical dilemmas in providing Home Palliative Care. These dilemmas include balancing patient preferences with professional obligations, addressing the needs of both patients and their families, navigating caregiver-patient relationships, understanding patients’ cultural backgrounds, and advocating for home care as the preferred option while considering alternative treatment approaches. Conclusions Home palliative care poses ethical dilemmas for caregiving teams. It’s imperative for organizations in the home care sector to devise strategies aimed at assisting teams in navigating these challenges while upholding the autonomy and dignity of patients within their home environment. Key messages • Home-based care faces ethical challenges, requiring strategies to balance patient preferences and professional duties. • Ethical home hospice care needs strategies that respect patient autonomy and dignity.

Keeping viewers hooked: Netflix’s innovative strategies for reducing churn

Netflix’s digital disruption in the entertainment industry has been significantly enhanced by digital nudging, which refers to using behavioural science techniques to subtly influence user decisions (Thaler and Sunstein, 2008). By leveraging data analytics, Netflix personalises the viewing experience, guiding users toward content they are likely to enjoy, which increases engagement and encourages binge-watching. The platform employs sophisticated algorithms to recommend titles, effectively nudging viewers to explore new genres or original content based on their viewing history (Lobato, 2019). This strategy has been pivotal in fostering a binge-watching culture, contrasting sharply with traditional broadcasting schedules offering weekly instalments. Netflix’s ability to analyse user data allows it to create content that aligns with viewer preferences, further enhancing its appeal. By understanding what resonates with audiences, Netflix can produce targeted original content that captures attention and retains subscribers. Digital nudging plays a crucial role in Netflix’s strategy, reinforcing its position as a leader in the streaming market while reshaping consumption habits across the industry. However, digital nudging presents both opportunities and challenges for customer churn management, raising critical ethical questions about autonomy and manipulation. Finding the right balance between effective customer retention strategies and ethical considerations will be vital for fostering trust and enhancing the overall user experience on the platform.