Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare (...) context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

The primary intention of Ren and Canavero's article (2017) is to respond to various criticisms raised by their proposal of the head anastomosis venture (HEAVEN) procedure. Before we launch a deeper analysis of Ren and Canavero's article, I would like to draw attention to a sentence, “Unfortunately, humility is not a part of medical lore,” where they refer to the arrogance and unsuccessfulness of medical science to recognize the importance and breakthrough of the HEAVEN procedure. Interestingly, with this repeated citation, (...) they acknowledge a familiar criticism of medical lore, so that we would expect that they provide a good example of the appreciation of humility in their present article. (shrink)

Within the domain of public health, vector-borne diseases are among the most vehemently discussed issues. Recent scientific breakthroughs in genome editing technology provided a solution to this issue in the form of a gene drive that might decrease and even eradicate vector-borne diseases. Gene drives are engineered, and designed genes that can break typical inheritance rules and be passed to almost all of the carrier’s offspring. This genome editing and gene drive technology has become a powerful tool for ecological and (...) environmental engineering, through which man can manipulate his surroundings, adjusting it to himself and directly mastering evolution and the ecosystem. Although the gene drive technology has been perceived as promising in the public health domain, ecological implications of its use are not to be underestimated. The primary aim of this paper is to overcome the ongoing discussion which mostly focuses on whether priority should be given to the environment or to public health, and to find an adequate answer and solution. In this quest to find the proper answer and solution, Pierre Teilhard de Chardin’s thought might be useful, especially his concepts of the biosphere and the noosphere which may provide some clarifications as to why we are at the moment so cautious with gene drive technology and how we need to move towards a better common future on earth. (shrink)

Digital phenotyping represents an avenue of consideration in patients' self-management. This scoping review aims to explore the trends in the body of literature on ethical, legal, and social challenges relevant to the implementation of digital phenotyping technologies in healthcare. The study followed the PRISMA-ScR methodology :467–473, 2018. https://doi.org/10.7326/M18-0850). The review systematically identified relevant literature, characterised the discussed technology, explored its impacts and the proposed solutions to identified challenges. Overall, the literature, perhaps unsurprisingly, concentrates on technical rather than ethical, legal, and (...) social perspectives, which limits understanding of the more complex cultural and social factors in which digital phenotyping technologies are embedded. ELS issues mostly concern privacy, security, consent, lack of regulation, and issues of adoptability, and seldom expand to more complex ethical issues. Trust was chosen as an umbrella theme of a continuum of major ELS and technical issues. Sustained critical analysis of digital phenotyping showed to be sparse and geographically exclusive. There is a continuum and overlap between ELS issues, suggesting the need for a holistic, interdisciplinary approach to each of the challenges posed by the various technologies of digital phenotyping. (shrink)

Eilers Miriam, Gru¨ber Katrin, and Rehmann-Sutter Christoph’s latest edited volume, The Human Enhancement Debate and Disability: New Bodies for a Better Life, may at first seem to be just another book about human enhancement, on which there is a significant detailed literature. But, in fact, this book provides a novel16 perspective to the human enhancement debate by observing it through the disability lens, even as it gathers contributions from various experts from diverse fields. This interdisciplinary approach shows how disability and (...) human enhancement are tightly correlated in the debate on the latter. (shrink)

In this position paper, we have used Alan Cooper’s persona technique to illustrate the utility of audio- and video-based AAL technologies. Therefore, two primary examples of potential audio- and video-based AAL users, Anna and Irakli, serve as reference points for describing salient ethical, legal and social challenges related to use of AAL. These challenges are presented on three levels: individual, societal, and regulatory. For each challenge, a set of policy recommendations is suggested.

Ambient assisted living technologies are increasingly presented and sold as essential smart additions to daily life and home environments that will radically transform the healthcare and wellness markets of the future. An ethical approach and a thorough understanding of all ethics in surveillance/monitoring architectures are therefore pressing. AAL poses many ethical challenges raising questions that will affect immediate acceptance and long-term usage. Furthermore, ethical issues emerge from social inequalities and their potential exacerbation by AAL, accentuating the existing access gap between (...) high-income countries and low and middle-income countries. Legal aspects mainly refer to the adherence to existing legal frameworks and cover issues related to product safety, data protection, cybersecurity, intellectual property, and access to data by public, private, and government bodies. Successful privacy-friendly AAL applications are needed, as the pressure to bring Internet of Things devices and ones equipped with artificial intelligence quickly to market cannot overlook the fact that the environments in which AAL will operate are mostly private. The social issues focus on the impact of AAL technologies before and after their adoption. Future AAL technologies need to consider all aspects of equality such as gender, race, age and social disadvantages and avoid increasing loneliness and isolation among, e.g. older and frail people. Finally, the current power asymmetries between the target and general populations should not be underestimated nor should the discrepant needs and motivations of the target group and those developing and deploying AAL systems. Whilst AAL technologies provide promising solutions for the health and social care challenges, they are not exempt from ethical, legal and social issues. A set of ELSI guidelines is needed to integrate these factors at the research and development stage. (shrink)

It is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred (...) to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters. Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals. Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely lifelogging and self-monitoring, remote monitoring of vital signs, emotional state recognition, food intake monitoring, activity and behaviour recognition, activity and personal assistance, gesture recognition, fall detection and prevention, mobility assessment and frailty recognition, and cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed. (shrink)

We review different conceptions of the set-theoretic multiverse and evaluate their features and strengths. In Sect. 1, we set the stage by briefly discussing the opposition between the ‘universe view’ and the ‘multiverse view’. Furthermore, we propose to classify multiverse conceptions in terms of their adherence to some form of mathematical realism. In Sect. 2, we use this classification to review four major conceptions. Finally, in Sect. 3, we focus on the distinction between actualism and potentialism with regard to the (...) universe of sets, then we discuss the Zermelian view, featuring a ‘vertical’ multiverse, and give special attention to this multiverse conception in light of the hyperuniverse programme introduced in Arrigoni and Friedman (2013). We argue that the distinctive feature of the multiverse conception chosen for the hyperuniverse programme is its utility for finding new candidates for axioms of set theory. (shrink)

A central area of current philosophical debate in the foundations of mathematics concerns whether or not there is a single, maximal, universe of set theory. Universists maintain that there is such a universe, while Multiversists argue that there are many universes, no one of which is ontologically privileged. Often model-theoretic constructions that add sets to models are cited as evidence in favour of the latter. This paper informs this debate by developing a way for a Universist to interpret talk that (...) seems to necessitate the addition of sets to V. We argue that, despite the prima facie incoherence of such talk for the Universist, she nonetheless has reason to try and provide interpretation of this discourse. We present a method of interpreting extension-talk (V-logic), and show how it captures satisfaction in `ideal' outer models and relates to impredicative class theories. We provide some reasons to regard the technique as philosophically virtuous, and argue that it opens new doors to philosophical and mathematical discussions for the Universist. (shrink)

Many authors have already observed that the Tractatus Theologico-Politicus of Baruch Spinoza was, in its time, the most discussed and most vehemently refuted book. Indeed, at the dawn of the Enlightenment, and almost until the end of the nineteenth century, Spinoza's Theological-Political Treatise was an assertive and powerful appeal to freedom of expression and thought, a bold claim of religious tolerance and freedom of conscience in a Europe that was unaccustomed to the exercise of free thought. But, what is after (...) all the subject of the Theological-Political Treatise, a book maligned for so long and by so many as ultra pestilential and immoral? The present volume, collecting essays by notable European scholars, attempts to address some of the problems created by the broad spectrum of topics included in Spinoza's Theological-Political Treatise. (shrink)

We review different conceptions of the set-theoretic multiverse and evaluate their features and strengths. In Sect. 1, we set the stage by briefly discussing the opposition between the ‘universe view’ and the ‘multiverse view’. Furthermore, we propose to classify multiverse conceptions in terms of their adherence to some form of mathematical realism. In Sect. 2, we use this classification to review four major conceptions. Finally, in Sect. 3, we focus on the distinction between actualism and potentialism with regard to the (...) universe of sets, then we discuss the Zermelian view, featuring a ‘vertical’ multiverse, and give special attention to this multiverse conception in light of the hyperuniverse programme introduced in Arrigoni-Friedman :77–96, 2013). We argue that the distinctive feature of the multiverse conception chosen for the hyperuniverse programme is its utility for finding new candidates for axioms of set theory. (shrink)

In this article we show that Morse-Kelley class theory provides us with an adequate framework for class forcing. We give a rigorous definition of class forcing in a model \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $$$$ \end{document} of MK, the main result being that the Definability Lemma can be proven without restricting the notion of forcing. Furthermore we show under which conditions the axioms are preserved. We conclude by proving that Laver’s Theorem does not hold for (...) class forcings. (shrink)

This collection documents the work of the Hyperuniverse Project which is a new approach to set-theoretic truth based on justifiable principles and which leads to the resolution of many questions independent from ZFC. The contributions give an overview of the program, illustrate its mathematical content and implications, and also discuss its philosophical assumptions. It will thus be of wide appeal among mathematicians and philosophers with an interest in the foundations of set theory. The Hyperuniverse Project was supported by the John (...) Templeton Foundation from January 2013 until September 2015. (shrink)

It is often assumed that concepts from the formal sciences, such as mathematics and logic, have to be treated differently from concepts from non-formal sciences. This is especially relevant in cases of concept defectiveness, as in the empirical sciences defectiveness is an essential component of lager disruptive or transformative processes such as concept change or concept fragmentation. However, it is still unclear what role defectiveness plays for concepts in the formal sciences. On the one hand, a common view sees formal (...) concepts to be protected against defects because of their precise and stable nature. On the other, studies going back as far as Lakatos (1963) showcase the changeability of such concepts. -/- In this paper, I will investigate if and how defectiveness based on the occurrence of inconsistencies can appear with formal concepts. To make the case as strong as possible, I employ a strict notion of formal concept that assumes the concept to have a fixed and definite extension. I will show that there are indeed certain types of defectiveness that cannot occur with such concepts; but that there are other types of defectiveness that do occur. This means that while formal concepts have to be treated differently than non-formal concepts, questions about defectiveness---as raised in the conceptual engineering debate and philosophy of science---can still be applied to them. I will highlight this point by showing how formal sciences have special strategies available to them that allow them to resolve defectiveness of their concepts in a flexible and informative manner. (shrink)

This article addresses the question of fundamental entities in set theory. It takes up J. Hamkins’ claim that models of set theory are such fundamental entities and investigates it using the methodology of P. Maddy’s naturalism, Second Philosophy. In accordance with this methodology, I investigate the historical case study of the use of models in the introduction of forcing, compare this case to contemporary practice and give a systematic account of how set-theoretic practice can be said to introduce models as (...) new entities. In conclusion, I argue for a view that takes both sets and models to be fundamental entities in set theory. (shrink)