Bioethical Theory Research Articles

O-232 New principles for the use of artificial intelligence in human reproduction: leave everything as it is?

Abstract Study question Which fundamental principles in bioethics ought to be reinforced in the face of the novel introduction of artificial intelligence (AI) into in vitro fertilization (IVF)? Summary answer Contrary to recent arguments, there is no need for new ethical principles to address moral worries regarding AI-based IVF. What is known already Several AI-based technologies are currently introduced into various stages of the IVF process. These include, for instance, the prediction of success rates, automation of sperm selection and cryopreservation, and optimization of embryo evaluation. The anticipated benefits of such automation are couched with high hopes of improving efficiency, accessibility and consistency in ART. However, it is an open question which ethical principles are fit to address introduction of AI in the IVF lab. In the field of assisted reproduction, like in other medical contexts, arguments abound that the current set of ethical principles cannot adequately deal with anticipated moral issues. Study design, size, duration A literature study was performed to map principles formulated by international organizations and professional organizations. These are mostly formulated echoing the four leading principles of medical ethics–respect for autonomy, beneficence, non-maleficence, and justice—yet, with the addition of a new principle: explicability. The latter can be understood in terms of intelligibility (viz. ‘how does it work?’) and in terms of accountability (viz. who is responsible for the way it works?). Participants/materials, setting, methods Literature study, conceptual analysis, and ethical analysis. Main results and the role of chance One can expect that AI-driven reproductive medicine will bring new ethical challenges and potential harms that compound the anticipated benefits. The black-box character of many possible AI applications in IVF is a special challenge for informed consent as algorithms are becoming exponentially more complex in contrast to the relatively linear technological improvements of machines traditionally used in the profession. This opacity problem could undermine trust in the output of the systems. With such challenges at stake, how can we understand the justification for explicability as a separate principle? Based on the methodological criterion of simplicity, there are good reasons to avoid expanding the number of principles. Explicability can be subsumed under the four existing principles, which is morally relevant if bioethics is to retain a hands-on element. The contrary would have an unnecessary watering down effect on the separate, well-established principles, paradoxically making it more complex to follow their interactions. Furthermore, setting a high threshold of explicability could be perplexing for IVF patients (morally relevant in terms of autonomy) and doctors (morally relevant in terms of accountability and contextual factors of for example workload), possibly reopening discussion about paternalism in reproductive medicine. Limitations, reasons for caution This normative analysis does not presume to offer a complete bioethical theory. Rather, we take a pragmatic and principle-based approach which is crucial given the embryonic stage of AI technologies and to better understand the novel digital setting before us. Wider implications of the findings These findings instigate reflection about (bio)ethical analysis of AI by accentuating the importance of specification and contextualization of principles on a topic that will gradually mature. This analysis also connects with questions on how technological developments in the reproductive realm can contribute to moral progress. Trial registration number Not Applicable

Intersectionality as a tool for clinical ethics consultation in mental healthcare

Bioethics increasingly recognizes the impact of discriminatory practices based on social categories such as race, gender, sexual orientation or ability on clinical practice. Accordingly, major bioethics associations have stressed that identifying and countering structural discrimination in clinical ethics consultations is a professional obligation of clinical ethics consultants. Yet, it is still unclear how clinical ethics consultants can fulfill this obligation. More specifically, clinical ethics needs both theoretical tools to analyze and practical strategies to address structural discrimination within clinical ethics consultations. Intersectionality, a concept developed in Black feminist scholarship, is increasingly considered in bioethical theory. It stresses how social structures and practices determine social positions of privilege and disadvantage in multiple, mutually co-constitutive systems of oppression. This article aims to investigate how intersectionality can contribute to addressing structural discrimination in clinical ethics consultations with a particular focus on mental healthcare. To this end, we critically review existing approaches for clinical ethics consultants to address structural racism in clinical ethics consultations and extend them by intersectional considerations. We argue that intersectionality is a suitable tool to address structural discrimination within clinical ethics consultations and show that it can be practically implemented in two complementary ways: 1) as an analytic approach and 2) as a critical practice.

An empirical ethics study of the coherence of NICE technology appraisal policy and its implications for moral justification

BackgroundAs the UK’s main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE’s decisions. In this study we adopt a complementary approach, based on the proposition that a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system. This study is the first to empirically assess the coherence of NICE’s formal approach and in doing so to generate evidence-based conclusions about the extent to which this approach is morally justified.MethodsThe study is grounded in the theory, methods and standards of empirical bioethics. Twenty NICE policy documents were coded to identify and classify the normative commitments contained within NICE technology appraisal policy as of 31 December 2021. Coherence was systematically assessed by attempting to bring these commitments into narrow reflective equilibrium (NRE) and by identifying sources of dissonance.FindingsMuch of NICE policy rests on coherent values that provide a strong foundation for morally justified decision-making. However, NICE’s formal approach also contains several instances of dissonance which undermine coherence and prevent NRE from being fully established. Dissonance arises primarily from four sources: i) NICE’s specification of the principle of cost-effectiveness; ii) its approach to prioritising the needs of particular groups; iii) its conception of reasonableness in the context of uncertainty, and iv) its concern for innovation as an independent value.ConclusionAt the time of analysis, the level of coherence across NICE policy provides reason to question the extent to which its formal approach to technology appraisal is morally justified. Some thoughts are offered on why, given these findings, NICE has been able to maintain its legitimacy as a healthcare priority-setter and on what could be done to enhance coherence.

A Theory of Bioethics by David DeGrazia and Joseph Millum (review)

A Theory of Bioethics by David DeGrazia and Joseph Millum (review)

Relational approaches in bioethics: A guide to their differences.

Contemporary critical approaches to bioethics increasingly present themselves as "relational," though the meaning of relationality and its implications for bioethics seem to be many and varying. I argue that this confusion is due to a multiplicity of relational approaches originating from distinct theoretical lineages. In this article, I identify four key differences among commonly referenced relational approaches: the scope and nature of relationships considered, the extent of the determining influence on individual selfhood, and the integrity of individual selfhood. Importantly, these four differences carry consequences for the usage of relational approaches within academic and clinical bioethics. I show that these differences attach to multiple objects of critique within mainstream bioethics and imply distinct metaethical commitments. Although I issue a cautionary note about combining relational approaches from distinct lineages, I close by suggesting that many such approaches may have their use, drawing on Susan Sherwin's sense of bioethical theories as lenses.

Twelve Tips for Integrating Bioethics and Palliative Care in Medical Education

It is important to integrate bioethics and palliative care (PC) in addition to providing the appropriate teaching of end-oflife care to future doctors. This article presents an evaluation of the updated literature and thus proposes to integrate the principles of bioethics with PC in medical schools. Accordingly, these 12 tips aim to highlight the necessary key points to help facilitate the teaching of PC and bioethics to medical students. These points are: addressing of bioethical theories according to the context experienced; supporting shared decisions; encouraging the development of a care plan based on beneficence, non-maleficence, and dignity; relieving uncomfortable physical symptoms and the avoidance of dysthanasia; promoting comfort through palliative sedation; understanding vulnerabilities and promoting the patient’s autonomy; taking care of those who care; integratingspirituality and the respect of religious practices; taking care of family members and informal caregivers; understanding and respecting research participants; developing awareness of medically assisted death and ethical-legal limits; and including PC and bioethics themes in all student experiences related to terminality during medical school.

Empathic care as a command of a new clinical bioethics

The current context of healthcare, which perpetuates the subordinate position of the patient and the violation of patients’ rights, demands the construction of a bioethical theory based on the ethical commitment to change this reality. Consequently, Principialism, the hegemonic line of Clinical Bioethics, needs to be overcome, and another framework needs to be formulated, such as what is now proposed based on clinical empathy and empathic care. This new framework for Clinical Bioethics conforms to an innovative aspect called “Healthcare Bioethics,” which has been the subject of a series of studies. These studies aimed at the theoretical structure of Healthcare Bioethics but did not focus on empathic care as an ethical structuring of this new theoretical-normative proposition. This article proposes theoretical contributions to Healthcare Bioethics based on clinical empathy and, specifically, by formulating the empathic care concept as a constituent and structuring command of this new aspect of Clinical Bioethics. Empathic care is a central ethical command of the further reference of clinical practice, Healthcare Bioethics. However, as seen, empathy is a motivational phenomenon conditioned to subjective factors that concern the individuals themselves and the context in which they find themselves. Although empathy is essential to our well-being, self-esteem, sense of belonging, and positive emotions, often, the choice is not to be empathic, given the costs of being so. This is also true in healthcare. Thus, health institutions and systems must adopt training, continuing education of health professionals, and other motivational interventions to drive empathic choice. It is an illusion to expect this choice to be made predominantly without creating factors that motivate empathic care, which must be an ethical substrate for constructing these motivational interventions. Therefore, empathic care should be incorporated into the health area as a new paradigm that founds institutions and health systems centered on the patient and the quality of care.

The Invisibility of the Asian American Identity in North American Bioethics

This Perspective sheds light on the major barriers behind Asian American invisibility in bioethics, such as the inconsistencies in defining a coherent identity in North American society, the systemic mechanisms of invisibility from history to healthcare based on immigration status, and scarcity of bioethics literature about their perspectives. The consequences of Asian American invisibility in bioethics and healthcare practises are also discussed, including a reflection of the interconnected mechanisms between academic bioethical theory and healthcare practises that perpetuate Asian American invisibility. Finally, recommendations are provided to begin a critical reflection of bioethical theory with Asian Americans in mind. This serves as the stepping-stone for future discussions on Asian American bioethics, to highlight a missing perspective in North American race-based activism regarding the equity, diversity, and inclusion of an underrepresented demographic.

The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery: a preliminary theory model

ObjectivesEthical dilemmas at both the individual and structural level are part of the daily work of midwives and gender inequality and injustice can affect women’s sexual and reproductive health. Mainstream bioethical theory has been criticized for neglecting women’s issues. To ensure women’s experiences are addressed, a gender lens on ethics is crucial.AimThis study develops a theory model by exploring ethical dilemmas related to gender in the context of maternity care from the perspective of midwifery science and feminist ethics.MethodsThe research strategy followed a coherent stepwise approach: literature search, thematic analysis, elaboration of a gender ethics protocol, and the integration of various components into a preliminary gender ethics model for midwifery.FindingsA literature search was performed using Scopus and Web of Science to identify ethical dilemmas in maternity care linked to gender and power. The search of articles published between 1996 and 2019 returned 61 abstracts. These abstracts were screened and assigned one of the following themes: The Midwifery Profession, The Rights of the Woman, Fetal Rights Dominate, and Medicalization of Pregnancy and Childbirth. A tentative gender ethics frame was developed and tested on two articles on abortion, one from Denmark and one from Japan. The protocol facilitated the gender analysis of ethical dilemmas related to abortion, which were related to the imbalance of power relations in health care. In the final step, we synthesized the dimensions of gender and power in a gender ethics model for midwifery.DiscussionThe gender ethics protocol developed revealed gendered dimensions of ethical dilemmas in midwifery. This gender analysis adds to the understanding of the “do no harm” principle by revealing assumptions and stereotypes that promote unequal power relations. The gender ethics model is an innovative approach that envisions and exposes power imbalance at the micro, meso, and macro levels.ConclusionsThe protocol could improve gender competence among researchers, midwives/professionals, and midwifery students throughout the world.

What is the contemporary role of second-generation philosophical bioethicists?

Bioethics originated in the 1970s and has now been around for half a century. During that half-century, brilliant achievements have been made, especially in the West. Basic bioethics theories have been developed that have proved useful in solving many bioethical issues including policies. Moreover, ethics committees and clinical ethics consultations have been implemented in the medical field. However, there seems to be a pessimistic discourse in bioethics in developed countries. For example, mid-career researchers from the world's leading bioethics centres in the UK and North America, Blumenthal-Barby et al, expressed concern and frustration about the current situation of philosophy in bioethics in their 2021 paper "The Place of Philosophy in Bioethics Today" [1]. The authors pessimistically say that.

Bio-ethical issues in oncology during the first wave of the COVID-19 epidemic:A qualitative study in a French hospital.

BackgroundUsing a specific bioethical theory (=global bioethics) and method (=a posteriori), we try here to identify and evaluate the bio‐ethical issues raised by the COVID‐19 pandemic, and possible solutions, to improve the management of cancer patients at the hospital in future pandemics, before the emergence of vaccines or scientifically validated treatments.Materials & MethodsOur work is based primarily on the clinical experience of three oncologists from the oncology department of Foch Hospital in France, who were on the frontline during the first wave of the epidemic. We compared their perceptions with published findings, to complete or nuance their views.ResultsThree bio‐ethical issues were identified, and possible solutions to these problems were evaluated: (1) scientific evidence versus lack of time → the creation of emergency multidisciplinary team meetings (MTM); (2) healthcare equality versus lack of resources → the development of telemedicine; (3) individual liberties versus risk of contamination → role of cancer patients' associations, psychologists and bioethicists.ConclusionWe consider the creation of an emergency MTM, in particular, in addition to a true ethics committee with real competence in bioethics, to be a first solution that would be easy to implement in hospitals in many countries.

Engaging Diversity

Engaging Diversity

Rethinking Theory in Bioethics

AbstractThis book review essay points to some of the more novel and controversial contributions of A Theory of Bioethics, by Joseph Millum and David DeGrazia (Cambridge University Press, 2021), such as their account of moral status. With a remarkable breadth of topics, the book is characterized by philosophical care and nuance and by spelling out the implications of the authors’ theorizing for real‐world, pressing questions, for instance, about the implications of Millum and DeGrazia's theoretical work on moral status for embryo research, animal research with mice and apes, and human‐brain organoids.

Latinx Bioethics: Toward a Braver, Broader, and More Just Bioethics.

In recognizing that overcoming anti-Blackness and structural racism requires a collective effort, Latinx bioethics has emerged as a space in the larger field of bioethics where Latino scholars, researchers, artists, and other bioethics professionals are contributing to deconstructing anti-Blackness. With attention to race and ethnocultural perspectives, Latinx bioethics draws from bioethical theories and conceptual frameworks to address ethical and moral issues affecting Latino communities. This essay aims to explain how Latinx bioethics aids in centering the Latinx voice and eradicating anti-Blackness in bioethics. After introducing the Latinx bioethics framework and mission, the essay explores the overlap between Black bioethics and Latinx bioethics and discusses why this overlap calls for cross-examination and collaboration in the field. The essay concludes with a summary of recommendations and reflections that bioethics can adopt to begin progressing toward a more inclusive and racially equitable field.

Intersections and Methods in Disability Theology: Bioethics and Critical Studies as Dialogue Partners

Disability theology has been a small but growing field over the past thirty years. This paper reviews the current methods used in the discipline and proposes ways to move the field forward. Two intersections between disability studies and Christian theological ethics are explored in particular: bioethics and critical theory. Bioethics helps to address the material health and wellbeing concerns of people with disabilities and the discriminatory attitudes about disability that stem from the medical field. Critical theory on the other hand, examines disability through cultural productions that shape our ableist imaginary. Critical theory offers resources for countering or “disciplining” our imaginations. Both bioethics and critical theory offer unique entry points into disability, but each also contains limitations that reveal why disability theology must continue to engage multiple methods and discourses.

Rethinking individual autonomy in medical decision-making for young adults reliant on caregiver support: A case report and analysis

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity.

Design Bioethics: A Theoretical Framework and Argument for Innovation in Bioethics Research

Empirical research in bioethics has developed rapidly over the past decade, but has largely eschewed the use of technology-driven methodologies. We propose “design bioethics” as an area of conjoined theoretical and methodological innovation in the field, working across bioethics, health sciences and human-centred technological design. We demonstrate the potential of digital tools, particularly purpose-built digital games, to align with theoretical frameworks in bioethics for empirical research, integrating context, narrative and embodiment in moral decision-making. Purpose-built digital tools can engender situated engagement with bioethical questions; can achieve such engagement at scale; and can access groups traditionally under-represented in bioethics research and theory. If developed and used with appropriate rigor, tools motivated by “design bioethics” could offer unique insights into new and familiar normative and empirical issues in the field.

Preferential Option for the Poor and Critical Race Theory in Bioethics

The preferential option for the poor is a concept and set of ideas in Catholic social teaching that is highly relevant to bioethics scholarship and practice. The option for the poor is mentioned frequently in the bioethics literature but with little specification of its history and implications for ethical and theological analysis. This article examines the origins and implications of the preferential option; compares it to critical race theory, which dominates current debates about discrimination and oppression; and proposes a set of principles for further application in bioethical scholarship and discussion.

Un enfoque personalista ontológico de los dilemas surgidos en la pandemia COVID-19

La pandemia COVID-19 ha dejado al descubierto, en forma dramática, la falta de inversión y gestión en el sistema de salud y las debilidades estructurales del sistema de protección social. El análisis de los dilemas que surgen como secuencia de la toma de decisiones para lidiar contra los efectos de la pandemia puede dejar de lado la protección y promoción del bienestar de la persona como centro de la organización de la sociedad, y centrarse solo en el bienestar colectivo e institucional. El personalismo ontológico como teoría bioética permite un análisis profundo de estos dilemas, ya que su base filosófica se centraliza en la defensa y promoción de la persona, y en la búsqueda del bien común. En este artículo se analizarán los fundamentos de esta corriente bioética y las respuestas que puede aportar a los dilemas morales expuestos en forma intempestiva por la pandemia COVID-19.

Principlism's Balancing Act: Why the Principles of Biomedical Ethics Need a Theory of the Good.

Principlism, the bioethical theory championed by Tom Beauchamp and James Childress, is centered on the four moral principles of beneficence, non-maleficence, respect for autonomy, and justice. Two key processes related to these principles are specification-adding specific content to general principles-and balancing-determining the relative weight of conflicting principles. I argue that both of these processes necessarily involve an appeal to human goods and evils, and therefore require a theory of the good. A significant problem with principlism is that it lacks a theory of the good and consequently does not have an adequate solution to the problems of specification and balancing. My conclusion is that principlism must adopt some account of human well-being in order to be a satisfactory bioethical framework.