The review by De Bie et al. (2023) provides an overview of the current ethical literature on artificial womb technology (AWT). Two characteristics stand out, and provide the basis for our commentar...

The general and deep dissatisfaction with the present-day status of health care is of such intensity that one speaks of a health care crisis. What is most disturbing to the physicians is that society directs its accusation mainly at the health care professional for being responsible for this crisis. If we want to abolish the crisis we must try to get a renewed look at its source, i.e., to answer the questions where did health care go wrong primarily? and with (...) whom lies the ultimate responsibility for health care?. In the following discourse these questions are discussed. Based on the assumption that every human being is a free rational agent the ultimate health care responsibility is assigned to the citizen. Of course, whether such an approach will in fact solve the problems inherent in present-day health systems cannot be predicted. (shrink)

Recently, the attitude and performance of the physician have been questioned and new codes of medical ethics have been introduced. Any ethics proposed for the future is a scenario reflecting the composer''s selectivity. Envisaged ethics of truthful, non-paternalistic, responsible physician-patient interaction will have far-reaching implications for autopsy, euthanasia, abortion, suicide, genetic engineering, transplantation, clinical trials, status of the psychiatric patient, physician immunity and liability. Conflicts between personal and societal medical ethics may continue to be insoluble. A possible projection of the (...) physician''s ethics on that of the politician is discussed. A new medical ethics should encompass principles of different creeds and be supranational. (shrink)

Background: The banking of biological samples raises a number of ethical issues in relation to the storage,export and re-use of samples. Whilst there is a growing body of literature exploringparticipant perspectives in North America and Europe, hardly any studies have been reportedin Africa. This is problematic in particular in light of the growing amount of research takingplace in Africa, and with the rise of biobanking practices also on the African continent. Inorder to investigate the perspectives of African research participants, we (...) conducted a studywith research participants in a TB study in the Western Cape, South Africa. Methods: Semi-structured interviews were conducted using an interview guide which drew on the mostprominent themes expressed in current literature on sample storage, re-use and exportation.Interviews were conducted in Afrikaans and subsequently translated into English by the sameinterviewer. Interviews were transcribed verbatim and analysed qualitatively. Results: The results of our study indicate that the majority of participants were supportive of givingone-time consent to the storage and re-use of their samples. The concept of research being fora "good cause" was a central prerequisite. Additionally, a significant minority requested thatthey be re-contacted if a future use was not stipulated on the original consent. There was alsoconsiderable variation in how participants understood the concept of a 'good cause', withparticipants describing three distinct categories of research, of which two were generallythought to constitute 'good cause' research. Research that was for-profit was considered tofall outside the spectrum of 'good cause' research. Participants displayed confidence in theabilities of the researchers to make future decisions regarding sample use, but seemedunaware of the role of ethics committees in either this process or more generally. Conclusions: Participants expressed a wide and complex range of views about issues of sample storage andre-use, and they showed a great deal of trust in researchers. Participants' willingness to havetheir samples stored and re-used is consistent with findings from existing studies. However,in contrast to existing literature, participants were generally not in favour of for-profitresearch. Further research needs to be done to explore these ideas in other communities, bothin South Africa and other countries. (shrink)

We appreciate that the theme “ethics of ethics conferences” that we introduced in 2023 (Van der Graaf et al. 2023) was echoed by the previous and current presidents of the International Association...

ABSTRACT In ethics, the use of empirical data has become more and more popular, leading to a distinct form of applied ethics, namely empirical ethics. This ‘empirical turn’ is especially visible in bioethics. There are various ways of combining empirical research and ethical reflection. In this paper we discuss the use of empirical data in a special form of Reflective Equilibrium (RE), namely the Network Model with Third Person Moral Experiences. In this model, the empirical data consist of the moral (...) experiences of people in a practice. Although inclusion of these moral experiences in this specific model of RE can be well defended, their use in the application of the model still raises important questions. What precisely are moral experiences? How to determine relevance of experiences, in other words: should there be a selection of the moral experiences that are eventually used in the RE? How much weight should the empirical data have in the RE? And the key question: can the use of RE by empirical ethicists really produce answers to practical moral questions? In this paper we start to answer the above questions by giving examples taken from our research project on understanding the norm of informed consent in the field of pediatric oncology. We especially emphasize that incorporation of empirical data in a network model can reduce the risk of self‐justification and bias and can increase the credibility of the RE reached. (shrink)

This book examines the role of new technologies and the way social practices are influenced by them, creating all sorts of new challenges for maintaining a coherent practice without clashed between norms.

In a bid to boost fertility levels, Iran and Japan have recently launched their own dating apps, with more countries likely to follow. The aim of this article is to consider whether state-run dating apps are morally desirable, which is a question that has not received any scholarly attention. It finds that such apps have at least two benefits that collectively, if not individually, render their introduction to be welcomed provided certain conditions are met. These benefits are that they are (...) better placed than commercial dating apps such as Tinder, Bumble, and Badoo to (i) help people find lasting love and to (ii) protect individuals from spending too much money and/or time on online dating. Several objections are discussed and shown to be unconvincing as arguments against state-run dating apps tout court, including the objection that for states to offer their own dating apps is unduly expensive; the objection that it gives them too much power; and the objection that they should invest in creating offline opportunities for meeting potential partners instead. (shrink)

The introduction of genomics and biobanking methodologies to the African research context has also introduced novel ways of doing science, based on values of sharing and reuse of data and samples. This shift raises ethical challenges that need to be considered when research is reviewed by ethics committees, relating for instance to broad consent, the feedback of individual genetic findings, and regulation of secondary sample access and use. Yet existing ethics guidelines and regulations in Africa do not successfully regulate research (...) based on sharing, causing confusion about what is allowed, where and when. In order to understand better the ethics regulatory landscape around genomic research and biobanking, we conducted a comprehensive analysis of existing ethics guidelines, policies and other similar sources. We sourced 30 ethics regulatory documents from 22 African countries. We used software that assists with qualitative data analysis to conduct a thematic analysis of these documents. Surprisingly considering how contentious broad consent is in Africa, we found that most countries allow the use of this consent model, with its use banned in only three of the countries we investigated. In a likely response to fears about exploitation, the export of samples outside of the continent is strictly regulated, sometimes in conjunction with regulations around international collaboration. We also found that whilst an essential and critical component of ensuring ethical best practice in genomics research relates to the governance framework that accompanies sample and data sharing, this was most sparingly covered in the guidelines. There is a need for ethics guidelines in African countries to be adapted to the changing science policy landscape, which increasingly supports principles of openness, storage, sharing and secondary use. Current guidelines are not pertinent to the ethical challenges that such a new orientation raises, and therefore fail to provide accurate guidance to ethics committees and researchers. (shrink)

The works of the early Greek philosophers are not only a fundamental source for understanding archaic Greek culture and the whole of ancient philosophy, but also a perennially fresh resource that has stimulated Western thought until the present day. This nine-volume edition presents all the major fragments from the sixth to the fourth centuries BC.

In this issue of The Journal of Clinical Ethics, we offer a variety of perspectives on the moral and medical responsibilities of professionals with regard to a woman’s choice of where she will birth her baby. The articles in this special issue focus on place of birth, but they have larger resonance for clinicians whose decisions about providing the best possible care require them to sort through evidence, consider their own possible biases and the limitations of their training, and balance (...) the wishes of their patients with the demands of colleagues, hospitals, and insurers. The articles published in this special issue of The Journal of Clinical Ethics will help those who wrestle with such dilemmas in everyday clinical decision making. (shrink)

The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We (...) first introduce several different conceptions of justice and decolonisation in relation to knowledge, purposefully drawing on work emanating from the global South as well as the global North. We then apply those conceptions to the global health ethics context to generate a tripartite account of the layers of epistemic justice in the field: who is producing ethics knowledge; what theories and concepts are being applied to produce ethics knowledge; and whose voices are sought, recorded and used to generate ethics knowledge. These layers reflect that the field spans conceptual and empirical research. We conclude by proposing that, going forward, three avenues are key to achieve greater epistemic justice at each layer and to help decolonise global health ethics: namely, understanding the problem, dialogue and structural change. (shrink)

It is held by many philosophers that it is a consequence of epistemic contextualism that speakers are typically semantically blind, that is, typically unaware of the propositions semantically expressed by knowledge attributions. In his ?Contextualism, Invariantism and Semantic Blindness? (this journal, 2009), Martin Montminy argues that semantic blindness is widespread in language, and not restricted to knowledge attributions, so it should not be considered problematic. I will argue that Montminy might be right about this, but that contextualists still face a (...) serious and related problem: that it is a consequence of epistemic contextualism that subjects are typically unaware of contents conveyed by knowledge attributions, independently of whether these are semantic or non-semantic contents. Even if semantic blindness is widespread in language, it does not seem that content unawareness of this sort is. (shrink)

Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in (...) global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs. (shrink)

In a recent paper, Erasmus et al. (2021) defend the idea that the ambiguity of the term “explanation” in explainable AI (XAI) can be solved by adopting any of four different extant accounts of explanation in the philosophy of science: the Deductive Nomological, Inductive Statistical, Causal Mechanical, and New Mechanist models. In this chapter, I show that the authors’ claim that these accounts can be applied to deep neural networks as they would to any natural phenomenon is mistaken. I also (...) provide a more general argument as to why the notion of explainability as it is currently used in the XAI literature bears little resemblance to the traditional concept of scientific explanation. It would be more fruitful to use the label “understandable AI” to avoid the confusion that surrounds the goal and purposes of XAI. In the second half of the chapter, I argue for a pragmatic conception of understanding that is better suited to play the central role attributed to explanation in XAI. Following De Regt (2017) and Kuorikoski and Ylikoski (2015), the conditions of satisfaction for understanding an ML system are fleshed out in terms of an agent’s success in using the system. (shrink)

Okay, Professor Turner is not Rodney King. He is not responding to bioethicists and social scientists running amuck, setting automobiles aflame, and pelting each other with rocks and broken bottles. He does not come right out and ask, “Why can't we all just get along?” But in its academic way, Turner's essay is an effort to negotiate a truce in the interdisciplinary squabbles that plague bioethics, a plea to move bioethics beyond the “misleading” and “unhelpful” “demarcation of disciplinary goals” that (...) leads to “dichotomous thinking” and “polemical accusations.”. (shrink)

The philosophy problem of identity and the related problem of change go back to the ancient Greek philosophers and fascinated later figures including Leibniz, Locke and Hume. Heraclitus argued that one could not swim in the same river twice because new waters were ever flowing in. When is a river not the same river? If one removes one plank at a time when is a ship no longer a ship? What is the basic nature of identity and persistence? This book (...) introduces and asseses the philosophical puzzles posed by things persisting through time. Beginning with essential historical background to the problem it explores the following key topics and debates: mereology and identity, including 'Leibniz's Law' the constitution view of identity the 'relative identity' argument concerning identity temporary identity four-dimensionalism, counterpart and mulitiple counterpart theory supervenience the problem of temporary intrinsics the necessity of identity presentism ontological and epistemological criteria for persistence and the difference between them. Including chapter summaries, annotated further reading and a glossary this book is essential reading for anyone seeking a clear and informative introduction to and assessement of the metaphysics of identity. (shrink)

Rendre hommage à un auteur, ce n'est pas seulement célébrer ce qu'il fut mais c'est aussi alerter sur ce que son oeuvre apporte au présent et à l'avenir de la connaissance. C'est bien le sens donné à cet hommage à André-Jean Arnaud. Repenser le droit, c'était pou r cet auteur érudit : repenser les lieux, les conditions et les façons de l'étudier en dépassant les frontières géographiques en même temps que les frontières disciplinaires. En montrant en quoi André-Jean Arnaud fut, (...) hors des sentiers battus et des orthodoxies de la production et de la transmission des savoirs en la matière, un exceptionnel précurseur et l'infatigable artisan d'un nouveau régime de connaissance sur le droit, le présent ouvrage s'adresse à toutes celles et à tous ceux, enseignants, chercheurs, étudiants ou simples citoyens, pou r qui l'étude du droit permet de mieux comprendre ce que sont et ce que sont susceptibles de devenir nos sociétés. (shrink)

Recent attempts to develop and apply digital ethics principles to address the challenges of the digital transformation leave organisations with an operationalisation gap. To successfully implement such guidance, they must find ways to translate high-level ethics frameworks into practical methods and tools that match their specific workflows and needs. Here, we describe the development of a standardised risk assessment tool, the Principle-at-Risk Analysis (PaRA), as a means to close this operationalisation gap for a key level of the ethics infrastructure at (...) many organisations – the work of an interdisciplinary ethics panel. The PaRA tool serves to guide and harmonise the work of the Digital Ethics Advisory Panel at the multinational science and technology company Merck KGaA in alignment with the principles outlined in the company’s Code of Digital Ethics. We examine how such a tool can be used as part of a multifaceted approach to operationalise high-level principles at an organisational level and provide general requirements for its implementation. We showcase its application in an example case dealing with the comprehensibility of consent forms in a data-sharing context at Syntropy, a collaborative technology platform for clinical research. (shrink)

The field of bioethics continues to struggle with the problem of cultural diversity: can universal principles guide ethical decision making, regardless of the culture in which those decisions take place? Or should bioethical principles be derived from the moral traditions of local cultures? Ten Have and Gordijn and Bracanovic defend the universalist position, arguing that respect for cultural diversity in matters ethical will lead to a dangerous cultural relativity where vulnerable patients and research subjects will be harmed. We challenge the (...) premises of moral universalism, showing how this approach imports and imposes moral notions of Western society and leads to harm in non-western cultures. (shrink)

BackgroundFor many decades, the debate on children’s competence to give informed consent in medical settings concentrated on ethical and legal aspects, with little empirical underpinnings. Recently, data from empirical research became available to advance the discussion. It was shown that children’s competence to consent to clinical research could be accurately assessed by the modified MacArthur Competence Assessment Tool for Clinical Research. Age limits for children to be deemed competent to decide on research participation have been studied: generally children of 11.2 (...) years and above were decision-making competent, while children of 9.6 years and younger were not. Age was pointed out to be the key determining factor in children’s competence. In this article we reflect on policy implications of these findings, considering legal, ethical, developmental and clinical perspectives.DiscussionAlthough assessment of children’s competence has a normative character, ethics, law and clinical practice can benefit from research data. The findings may help to do justice to the capacities children possess and challenges they may face when deciding about treatment and research options. We discuss advantages and drawbacks of standardized competence assessment in children on a case-by-case basis compared to application of a fixed age limit, and conclude that a selective implementation of case-by-case competence assessment in specific populations is preferable. We recommend the implementation of age limits based on empirical evidence. Furthermore, we elaborate on a suitable model for informed consent involving children and parents that would do justice to developmental aspects of children and the specific characteristics of the parent-child dyad.SummaryPrevious research outcomes showed that children’s medical decision-making capacities could be operationalized into a standardized assessment instrument. Recommendations for policies include a dual consent procedure, including both child as well as parents, for children from the age of 12 until they reach majority. For children between 10 and 12 years of age, and in case of children older than 12 years in special research populations of mentally compromised patients, we suggest a case-by-case assessment of children’s competence to consent. Since such a dual consent procedure is fundamentally different from a procedure of parental permission and child assent, and would imply a considerable shift regarding some current legislations, practical implications are elaborated. (shrink)