Experimental Philosophy: Bioethics

In a recent study, Lantian and colleagues (2024) measured public attitudestoward the use of ‘love drugs’ as introduced through the work of Earp,Savulescu, and their collaborators. Use of a “revolutionary pill” (described as“100% reliable”) to bring about love is seen as less morally acceptable thanpsychological therapy toward the same end, and this is partly explained byperceptions that the pill-induced love is less authentic. However, the “pill” inquestion bears little resemblance to the real-world uses of love drugs discussedby Earp and Savulescu, (...) such as MDMA-assisted couples therapy. In this partialreplication and extension study, we show that more ecologically valid ‘lovedrugs’ scenarios lead to much higher ratings of moral acceptability and perceived authenticity of the resulting love. (shrink)

In recent decades, many jurisdictions have moved toward legalizing euthanasia and assisted suicide—together with a growing recognition of the moral right to a medically assisted death. Herewe draw on a comprehensive quantitative review of existing laws on assisted dying, experimental survey evidence, and four decades of time-series data to explore the relationship between these legislative transitions and changing moral attitudes. Our analysis reveals that existing laws on medical aid in dying impose a common set of eligibility restrictions, based on the (...) patient’s age, decision-making capacity, prognosis and the nature of their illness. These eligibility restrictions shape public moral approval of physician-assisted death, equally in countries where euthanasia is legal (i.e., Spain) and illegal (i.e., the United Kingdom). Additionally, records of public attitudes toward euthanasia across numerous countries over a forty-year period uncovered anticipatory growth in moral approval leading up to legalization, but no accelerated growth thereafter. Collectively, our findings suggest that legal frameworks for medical aid in dying crystallize patterns of moral intuition. (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate whether health and (...) disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

Background Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders’ perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), (...) deep brain stimulation (DBS), and adaptive brain implants (ABI). Methods We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs. Results Participants’ ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies. Conclusions To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs. (shrink)

Background Whether patients' life-style should involve lower priority for treatment is a controversial question in bioethics. Less is known about clinicians' views. Aim To study how clinical doctors' attitudes to questions of patient responsibility and priority vary over time. Method Surveys of doctors in Norway in 2008, 2014, 2021. Questionnaires included statements about patients' lifestyle's significance for priority to care, and vignettes of priority cases (only in 2014). Results Attitudes were fairly stable between 2008 and 2021. 17%/14% agreed that patients' (...) lifestyle should count, while 19%/22% agreed that it should involve lower priority to scarce organs. 42/44% agreed that smokers should have lower priority. Substantially more agreed in 2014. Regression analyses showed that being male, working in hospital, and younger age increased the likelihood of agreeing. Conclusion A substantial minority of doctors agreed that lifestyle should be a priority criterion, possibly contrary to Norwegian legislation and professional ethics. The finding might be explained by the unspecified meaning of priority, increased scarcity-awareness, or socio-cultural trends towards individualism. The 2014 results indicate a framing effect; the vignettes may have primed the respondents towards accepting lifestyle as a criterion. We conclude that attitudes to normative questions are unstable and depend on context. A substantial minority of doctors seems to be positive to deprioritizing patients allegedly responsible for their illness. However, what deprioritization implies in practice is not clear. (shrink)

Background Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals’ judgments of stigma, empathy, and compassion. Methods We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, (...) empathy, and compassion. Results Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists. Conclusions The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others. (shrink)

In this paper, we report the results from an experimental reproductive ethics study exploring questions about reproduction and parenthood. The main finding in our study is that, while we may assume that everyone understands these concepts and their relationship in the same way, this assumption may be unwarranted. For example, we may assume that if ‘x is y’s father’, it follows that ‘y is x’s child’. However, the participants in our study did not necessarily agree that it does follow. This (...) means, at the very least, that we need to make sure all parties in a debate have the same relationships in mind when talking about reproduction and parenthood. Moreover, it gives us reason to explore more carefully the conditions which support or undermine the connections between these concepts. This cannot come from purely theoretical reasoning, nor from empirical research alone, but from the alliance between the two. (shrink)

Motivational enhancement of any kind can be conceived of either as a way to reduce the need for effort, or as a change in the subjective perception of effort. However, in both cases, effort is not all that matters. In the evaluation of praiseworthy conduct, the practical goals pursued by the subject, their dedication, and the discernment they exercise are equally important. I further argue that not only in terms of the general purpose, but also in terms of the means (...) employed for human enhancement, we cannot, in fact, establish significant differences between the traditional technology of the self and biomedical technologies for enhancing motivation. There are two key features they all share. The traditional techniques of the self also aim at the gradual reduction of effort through their steady practice, and they are all mental conditioning and self-conditioning techniques based on repetition and training. (shrink)

Many bioliberals endorse broadly consequentialist frameworks in normative ethics, implying that a progressive stance on matters of bioethical controversy could stem from outcome-based reasoning. This raises an intriguing empirical prediction: encouraging outcome-based reflection could yield a shift toward bioliberal views among nonexperts as well. To evaluate this hypothesis, we identified empirical premises that underlie moral disagreements on seven divisive issues (e.g., vaccines, abortion, or genetically modified organisms). In exploratory and confirmatory experiments, we assessed whether people spontaneously engage in outcome-based reasoning (...) by asking how their moral views change after momentarily reflecting on the underlying empirical questions. Our findings indicate that momentary reflection had no overall treatment effect on the central tendency or the dispersion in moral attitudes when compared to prereflection measures collected 1 week prior. Autoregressive models provided evidence that participants engaged in consequentialist moral reasoning, but this self-guided reflection produced neither moral “progress” (shifts in the distributions’ central tendency) nor moral “consensus” (reductions in their dispersion). These results imply that flexibility in people's search for empirical answers may limit the potential for outcome-based reflection to foster moral consensus. (shrink)

Background In the context of discussions between supporters and opponents of euthanasia, and legal regulations regarding this type of practices, the attitude of young people with respect to this phenomenon is a very interesting issue. According to Polish law, euthanasia is prohibited. The aim of this study was to determine the degree of acceptance of euthanasia among students from Polish universities across three different fields of study: psychology, medicine, and economic-technical disciplines, and to identify the factors associated with the acceptance (...) of this phenomenon. Methods The study included 627 persons studying in Lublin, Poland: medicine (280), psychology (170), and economic-technical studies (177). The study was conducted as a survey using questionnaire containing items concerning students’ attitudes towards euthanasia. The analysis of the collected data was conducted using the SPSS software (version 29) with the following methods: Chi2, Student’s t-test, Phi test, Cramer’s V test, Kolmogorov-Smirnov test, one-way ANOVA with Dunnett’s post hoc test, linear regression analysis, and categorical regression analysis using optimal scaling (CATREG). Results Nearly half of the students participating in the study (45.9%) rated the practice of euthanasia as decidedly negative. The highest number of strongly negative evaluations was found among psychology students, and the least among students of economic-technical disciplines. The level of acceptance of euthanasia is significantly associated with religious involvement and studying psychology. Being religious and being a psychology student both contribute to lower acceptance of euthanasia and a lower willingness to consent to euthanasia. Consent to euthanasia is more commonly declared by individuals with experience of living with elderly people. Conclusions Although nearly half of the respondents expressed a negative attitude towards euthanasia, considering the secularization process among Polish youth, it can be assumed that the level of acceptance of euthanasia in this social group will increase. The lower level of acceptance of euthanasia among psychology and medical students compared to students of economic-technical disciplines suggests that the curricula of these studies present alternative solutions to the problems of terminally ill patients other than euthanasia. (shrink)

New technologies regularly bring about profound changes in our daily lives. Romantic relationships are no exception to these transformations. Some philosophers expect the emergence in the near future of love drugs: a theoretically achievable biotechnological intervention that could be designed to strengthen and maintain love in romantic relationships. We investigated laypeople’s resistance to the use of such technologies and its sources. Across two studies (Study 1, French and Peruvian university students, N after exclusion = 186; Study 2, Amazon Mechanical Turk (...) sample, N after exclusion = 693, pre-registered), we found that the use of love drugs designed to strengthen and maintain love in romantic relationships are considered as more morally problematic than psychological therapy with the same aim. In Study 2, we show that this last effect is partially due to the fact that the love resulting from the use of love drugs is perceived as less authentic, intense, and durable. We discuss the specific role of authenticity in the relative moral disapproval of love drugs. (shrink)

Bioethicists influence practices and policies in medicine, science, and public health. However, little is known about bioethicists’ views. We recently surveyed 824 U.S. bioethicists on a wide range of ethical issues, including topics related to abortion, medical aid in dying, and resource allocation, among others. We also asked bioethicists about their demographic, religious, academic, and professional backgrounds. We find that bioethicists’ normative commitments predict their views on bioethical issues. We also find that, in important ways, bioethicists’ views do not align (...) with those of the U.S. public: for instance, bioethicists are more likely than members of the public to think abortion is ethically permissible but are less likely to believe compensating organ donors is. Our demographic results indicate the field of bioethics is far less diverse than the U.S. population—less diverse even than other academic disciplines—suggesting far more work needs to be done to build an inclusive field. (shrink)

Sacrificial dilemmas such as the trolley problem play an important role in experimental philosophy (x-phi). But it is increasingly argued that, since we are not likely to encounter runaway trolleys in our daily life, the usefulness of such thought experiments for understanding moral judgments in more ecologically valid contexts may be limited. However, similar sacrificial dilemmas are experienced in real life by animal research decision makers. As part of their job, they must make decisions about the suffering, and often the (...) death, of many non-human animals. For this reason, a context-specific investigation of so-called “3R dilemmas” (i.e., dilemmas where there is a conflict between the principles of replacement, reduction, and refinement of the use of animals in research) is essential to improve the situation of both non-human animals and human stakeholders. An approach well suited for such investigation is experimental philosophical bioethics (“bioxphi”), which draws on methods similar to x-phi to probe more realistic, practical scenarios with an eye to informing normative debates and ethical policy. In this article, we argue for a need to investigate 3R dilemmas among professional decision-makers using the tools of bioxphi. In a first step, we define 3R dilemmas and discuss previous investigations of professionals’ attitudes in such cases. In a second step, we show how bioxphi is a promising method to investigate the whys and hows of professional decision-making in 3R dilemmas. In a last step, we provide a bioxphi template for 3R dilemmas, give recommendations on its use, explore the normative relevance of data collected by such means, and discuss important limitations. (shrink)

Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics remain underexplored in both research and practice. It is argued that pragmatism can make a distinctive contribution to bioethics through its concept, developed by Charles S. Peirce and John Dewey, that ethical issues can be resolved through experimental inquiry. Dewey’s proposal that policies can be confirmed or disconfirmed through experimentation is developed by comparing it to the confirmation of scientific (...) hypotheses, with a focus on the objection that the consequences of following a moral view or policy do not provide guidance on choosing among competing ethical perspectives. As confirmation of scientific hypotheses typically relies on evidence gathered from observation, the possibility of ethically relevant observation is then explored based on Peirce’s views on feelings as emotional interpretants. Finally, the connection between Dewey’s experimental ethics and democracy is outlined and compared to unfettered ethical progressivism. (shrink)

Background Advance healthcare decision-making presumes that a prior treatment preference expressed with sufficient mental capacity (“T1 preference”) should trump a contrary preference expressed after significant cognitive decline (“T2 preference”). This assumption is much debated in normative bioethics, but little is known about lay judgments in this domain. This study investigated participants’ judgments about which preference should be followed, and whether these judgments differed depending on a first-person (deciding for one’s future self) versus third-person (deciding for a friend or stranger) perspective. (...) -/- Methods A vignette-based survey was conducted (N = 1445 US Americans; gender-balanced sample), in a 3 (relationship: self, best friend, stranger) × 2 (T1 preference: treat, do not treat) × 2 (T2 contrary preference: ambiguous, unambiguous) design. -/- Results Participants were more likely to defer to the incapacitated T2 preference of a third-party, while being more likely to insist on following their own T1 capacitated preference. Further, participants were more likely to conclude that others with substantial cognitive decline were still their “true selves,” which correlated with increased deference to their T2 preferences. -/- Conclusions These findings add to the growing evidence that lay intuitions concerning the ethical entitlement to have decisions respected are not only a function of cognition, as would be expected under many traditional bioethical accounts, but also depend on the relationship of the decision to the decision-maker’s true self. (shrink)

Jennifer Hawkins (2024) offers two cases that challenge traditional accounts of decision-making capacity, according to which respect for a medical decision turns on an individual’s cognitive capacities at the time the decision is made (Hawkins 2024; Appelbaum and Grisso 1988). In each of her described cases (involving anorexia nervosa and grief, respectively), a patient makes a decision that—although instrumentally rational at the time—does not reflect the patient’s longer-term values due to being in a particular psychological state. Importantly, this state does (...) not impair the patient’s cognition, but rather predisposes them to make a decision that conflicts with their own broader values, beliefs, or desires. (shrink)

This volume presents new research on the use of experimental methodologies in moral and social philosophy. The contributions reflect the growing plurality of methodologies and strategies for implementing experimental work on morality to new domains, problems, and topics. Philosophers are exploring the ways in which empirical approaches can transform our idea of the good, our understanding of the social nature of norms and morality, as well as our methods of fulfilling ethical goals. The chapters in this volume extend experimental work (...) on morality to previously underexplored areas. The contributions in Part 1 explore the methods and foundations of experimental work in areas such as folk moral judgments, metaethical beliefs, moral explanations, and reflective equilibrium. Part 2 focuses on issues in normative ethics, legal, and political philosophy such as virtue ethics, utilitarianism, theories of justice, and criminal responsibility. Finally, the chapters in Part 3 tackle various applied ethical issues including feminist X-Phi, animal welfare, experimental bioethics, and self-driving cars. Experiments in Moral and Political Philosophy will be of interest to scholars and advanced students working in ethics, applied ethics, experimental philosophy, social and political philosophy, and philosophy of law. (shrink)

Philosophers have been particularly interested in providing an analysis of the concept of mental disorder that could accommodate and guide psychiatric practices (for example diagnostics, therapy, epidemiology, etc.). One of the most discussed propositions is Jerome Wakefield’s “Harmful Dysfunction Analysis” (henceforth HDA). Inspired by Wakefield’s own foray into experimental philosophy, we propose in this paper to test folk people’s intuitions on a wider number of mental disorders than he did as well as in different condition in which the symptoms could (...) be understand as the result of an evolved mechanism. (shrink)

Safeguarding the rights of minorities is crucial for just societies. However, there are conceivable situations where minority rights might seriously impede the rights of the majority. Favoring the minority in such cases constitutes a violation of utilitarian principles. To explore the emotional, cognitive, and punitive responses of observers of such utilitarian rule transgressions, we conducted an online study with 1004 participants. Two moral scenarios (vaccine policy and epidemic) were rephrased in the third-party perspective. In both public health-related scenarios, the protagonist (...) opted against the utilitarian option, which resulted in more fatalities in total, but avoided harm to a minority. Importantly, in vaccine policy, members of the minority cannot be identified beforehand and thus harm to them would have been rather accidental. Contrariwise, in epidemic, minority members are identifiable and would have needed to be deliberately selected. While the majority of participants chose not to punish the scenarios’ protagonists at all, 30.1% judged that protecting the minority over the interests of the majority when only accidental harm would have occurred (vaccine policy) was worthy of punishment. In comparison, only 11.2% opted to punish a protagonist whose decision avoided deliberately selecting (and thus harming) a minority at the cost of the majority (epidemic). Emotional responses and appropriateness ratings paralleled these results. Furthermore, complex personality × situation interactions revealed the influence of personality features, i.e., trait psychopathy, empathy, altruism, authoritarianism, need for cognition and faith in intuition, on participants’ responses. The results further underscore the need to consider the interaction of situational features and inter-individual differences in moral decisions and sense of justice. (shrink)

Evaluative judgments imply positive or negative regard. But there are different ways in which something can be positive or negative. How do we tell them apart? According to Evaluative Sentimentalism, different evaluations (e.g., dangerousness vs. offensiveness) are grounded on different emotions (e.g., fear vs. anger). If this is the case, evaluation differentiation requires emotional awareness. Here, we test this hypothesis by looking at alexithymia, a deficit in emotional awareness consisting of problems identifying, describing, and thinking about emotions. The results of (...) Study 1 suggest that high alexithymia is not only related to problems distinguishing emotions, but also to problems distinguishing evaluations. Study 2 replicated this latter effect after controlling for individual differences in attentional impulsiveness and reflective reasoning, and found that reasoning makes an independent contribution to evaluation differentiation. These results suggest that emotional sensibilities play an irreducible role in evaluative judgment while affording a role for reasoning. (shrink)

In the present chapter, we seek to better understand how lay people reason about the “true self” of a person with advancing dementia. We are also interested in how such reasoning bears on laypeople’s views about the validity or invalidity of an advance directive (AD) regarding that person’s treatment. Toward that end, we will report the results of two empirical studies we undertook to gain insights into this relationship: namely, between judgments about the true self and whether to follow an (...) AD. We find that many participants judge that a hypothetical person with dementia, stipulated to be non-autonomous with respect to her healthcare decision-making, is nevertheless still her “true self” and that her current apparent preference (to be treated) should be honored despite conflicting with the autonomous preference (not to be treated) previously recorded in her AD. We discuss potential normative implications of our findings, drawing on arguments from the emerging literature on experimental philosophical bioethics, also known experimental bioethics or “bioxphi.”. (shrink)

In health communication, metaphor can be considered as a reasoning device to let people understand an abstract concept in terms of a concrete one (Lakoff and Johnson 1980; Bowdle and Gentner 2005). Both the positive and negative communicative effects of metaphors have been largely pointed out in a variety of medical fields, from oncology (Semino et al. 2016, 2018) to mental health (Frezza and Zoccolotti 2019). The use of metaphors in vaccine communication has been less considered, though it might be (...) crucial to let people understand vaccination as an important collective health phenomenon. A previous study (Scherer et al. 2015) focused on the communicative effects of conventional metaphors for vaccination, but not specifically on novel metaphors deliberately used to explain the concept of population immunity in vaccination. We hypothesized that metaphors used to explain vaccination as a collective phenomenon could improve the communicative aims of pro-vaccination texts in many respects, ranging from understandability to trust in expertise. We designed a study to test the hypothesis: two groups of participants were presented with a text about vaccination as a collective phenomenon, described in either literal or metaphorical terms. They were asked to evaluate the text on different communicative aspects from both an individual and a collective point of view. The results confirmed the hypothesis that metaphor is an effective reasoning device and that it also enhances the overall communicative effects of the message, in terms of understandability, persuasion, feeling of control over the health situation, trust in expertise, and uptake of experts’ advice. However, the results show that this effect is significantly nuanced in the individual vs. collective response type. (shrink)

In this chapter we consider the tension between how pain researchers today typically define pain and the dominant, ordinary conception of pain. While both philosophers and pain scientists define pains as experiences, taking this to correspond with the ordinary understanding, recent empirical evidence indicates that laypeople tend to think of pains as qualities of bodily states. How did this divide come about? To answer, we sketch the historical origins of the concept of pain in Western medicine, providing evidence that during (...) large swaths of this history, medical experts characterized pains as laypeople tend to today—that is, as qualities of bodily states. The conception of pains as experiences that we find in contemporary definitions seems to be a relatively recent development corresponding with changes in the diagnostic tools available to doctors. We argue that this history is important and suggests that the most prominent current scientific definition of pain (IASP) is partly stipulative and fails to match how laypeople most often think of pain. We suggest that either we should acknowledge this stipulative character, or else should amend the IASP definition in a pluralistic fashion that notes both bodily and experiential conceptions of pain. (shrink)

How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that (...) public values would straightforwardly decide the ethical question of how resources should be distributed. On the other hand, in a democratic society, it seems equally unreasonable that they would be considered irrelevant for this question. In this paper we draw on the notion of reflective equilibrium and discuss the relevance and roles that empirical studies may plausibly have for justification in priority setting ethics. We develop a framework for analysing how different kinds of empirical results may have different kinds of implications for justification. (shrink)

This open access collection brings together a team of leading scholars and rising stars to consider what experimental philosophy of medicine is and can be. While experimental philosophy of science is an established field, attempts to tackle issues in philosophy of medicine from an experimental angle are still surprisingly scarce. A team of interdisciplinary scholars demonstrate how we can make progress by integrating a variety of methods from experimental philosophy, including experiments, sociological surveys, simulations, as well as history and philosophy (...) of science, in order to yield meaningful results about the core questions in medicine. They focus on concepts central to philosophy of medicine and medical practice, such as death, pain, disease and disorder, advance directives, medical explanation, disability and informed consent. Presenting empirical findings and providing a crucial foundation for future work in this dynamic field, this collection explores new ways for philosophers to cooperate with scientists and reveals the value of these collaborations for both philosophy and medicine. The eBook editions of this book are available open access under a CC BY-NC-ND 4.0 licence on bloomsburycollections[dot]com. Open access was funded by the European Research Council Starting Grant. (shrink)

This chapter describes the field of philosophy of medicine and its methods. We discuss the history and potential of experimental approaches in philosophy of medicine. We give an overview of the chapters in the book.

For Van Rensselaer Potter (1911–2001), Global Bio-Ethics is about building on the legacy of Aldo Leopold (1887–1948), one of the most notable forest managers of the twentieth century who brought to light the importance of pragmatism in the sciences and showed us a new way to proceed with environmental ethics. Following Richard Huxtable and Jonathan Ives's methodological 'Framework for Empirical Bioethics Research Projects' called 'Mapping, framing, shaping,' published in BMC Medicine Ethics (2019)), we propose operationalizing a framework for Global Bio-Ethics (...) by hybridizing approaches in empirical bioethics and ecosystem management. We explain this framework using the metaphor of forest management. This mixed approach is articulated through three phases: (1) mapping the “landscape” to build a working theory, (2) framing the “scene” to prepare the fieldwork, and (3) shaping bioethics “tools” to stimulate cooperation. Applying this methodology, an adaptive management cycle is outlined to help ensure that political processes are sustainable and socially acceptable, still based on strategic and ethical thinking, but also capable of reshaping failing policies. (shrink)

Research ethics committees and institutional review boards spend considerable time developing, scrutinising, and revising specific consent processes and materials for survey-based studies conducted on crowdsourcing and online recruitment platforms such as MTurk and Prolific. However, there is evidence to suggest that many users of ICT services do not read the information provided as part of the consent process and they habitually provide or refuse their consent without adequate reflection. In principle, these practices call into question the validity of their consent. (...) In this paper we argue that although the ‘no read problem’ and the routinisation of consent may apply to research participants’ consent practices for studies on crowdsourcing platforms, this is not a serious problem. Furthermore, given that the informational requirements for informed consent in these contexts are minimal, we argue that these participants are, nevertheless, sufficiently informed to give valid consent. We conclude that research ethics committees and institutional review boards should only agonise over the precise details of the informed consent process and materials in those rare cases where appreciable risks to research participants need to be managed. (shrink)

Background Over the last decades, the neurosciences, behavioral sciences, and the social sciences have all seen a rapid development of innovative research methods. The field of bioethics, however, has trailed behind in methodological innovation. Despite the so-called “empirical turn” in bioethics, research methodology for project development, data collection and analysis, and dissemination has remained largely restricted to surveys, interviews, and research papers. We have previously argued for a “Design Bioethics” approach to empirical bioethics methodology, which develops purpose-built methods for investigation (...) of bioethical concerns. In this paper we compare a research tool created using a design bioethics approach to a “methods-as-usual” approach in empirical bioethics. Methods Our study compared dimensions of engagement with a digital game we created, called “Tracing Tomorrow,” to a standard vignette survey. The two tools investigated the same subject matter, digital phenotyping for mental health, in a sample of 301 UK adolescents. Results Participants who played the game reported a greater sense of presence, emotional engagement, cognitive absorption, and mental health ethics insight, compared to participants who completed the vignette survey. Perceived authenticity and curiosity/motivation to learn more was equivalent for both methods. Conclusion The results of this study highlights the importance of purpose-built methodology for empirical bioethics research. (shrink)

This chapter examines the folk concept of disease by assessing (1) whether disease judgments are influenced by whether a condition is typical, dysfunctional, and disvalued and (2) whether they are influenced by the causes and symptoms of a condition. Results tentatively suggest that the folk concept of disease is naturalistic (i.e., value judgments don’t seem to matter) and perhaps not essentially causal (symptoms are sufficient for a condition to be a disease) and that gender and disgust sensitivity influence disease judgment.

There is little debate regarding the acceptability of providing medical care to restore physical or mental health that has deteriorated below what is considered typical due to disease or disorder (i.e., providing “treatment”—for example, administering psychostimulant medication to sustain attention in the case of attention deficit disorder). When asked whether a healthy individual may undergo the same intervention for the purpose of enhancing their capacities (i.e., “enhancement”—for example, use of a psychostimulant as a “study drug”), people often express greater hesitation. (...) Building on prior research in moral philosophy and cognitive science, in this work, we ask why people draw a moral distinction between treatment and enhancement. In two experiments, we provide evidence that the accessibility of health-related interventions determines their perceived descriptive or statistical normality (Experiment 1), and that gains in descriptive normality for such interventions weaken the moral distinction between treatment and enhancement (Experiment 2). In short, our findings suggest that the tendency to draw a moral distinction between treatment and enhancement is driven, in part, by assumptions about descriptive abnormality; and raise the possibility that normalizing novel biomedical interventions by promoting access could undermine people’s selective opposition toward enhancement, rendering it morally comparable to treatment. (shrink)

The Non-Identity Problem, first discussed by Derek Parfit in the 1970s, continues to inspire and trouble many philosophers across various disciplines. Ongoing debates in procreative ethics show its relevance in philosophy of medicine. This chapter reports an experimental philosophy study that aims to investigate whether the central role of the problem is justified given lay people’s intuitions about related vignettes. The study focuses on two assumptions underlying the typical use of the Non-Identity Problem. Firstly, I investigate whether a diverse sample (...) of non-philosophers shares Parfit’s No-Difference View. This view entails that there is no moral difference between choices that affect who comes into existence and choices that merely affect already existing people. I found that the non-philosophers in my sample do not hold a No-Difference View. Instead, they attach more moral import to identity-affecting, pre-conception choices than to those made by a woman who is already pregnant. Secondly, this study looks at people’s intuitions about disability and the ways in which those might have an inappropriate impact on their judgements about identity-affecting decisions. I found that aspects of the stories which Parfit seems to deem morally irrelevant are actually considered to be relevant by other people. The participants were most outspoken in their moral judgments about the woman described in the vignettes when those vignettes mentioned disability in general or deafness in particular. The reactions on a vignette in which neither deafness nor disability was mention were less outspoken. particular, I found that both vignettes about disability in general and vignettes about deafness as a particular disability are associated with lower scores than the Pure vignette, in which neither deafness nor disability was mentioned. This chapter concludes with an call for philosophers of medicine to critically investigate their own assumptions about disability and its relation to issues such as quality of life, cure and procreative beneficence. (shrink)

When a terminally ill patient kills herself, using a drug prescribed by a physician for this purpose, in bioethical literature this would be described as a case of physician-assisted suicide. This would also be a case of suicide according to the standard account of suicide in the philosophical literature. However, in recent years, some authors have argued that terminally ill self-killing in fact should not be considered suicide. In this paper, we don’t try to address the philosophical merits of such (...) arguments. Instead, we ask whether these considerations align with the way non-philosophers think about suicide. We present empirical evidence from four studies that address different concerns raised about terminally ill self-killing being a suicide. We conclude that the raised concerns cannot be supported by the folk understanding of suicide. (shrink)

The present chapter explores conceptual links in folk cognition between death, existence and personal identity. There is some evidence that people’s judgments about death determination differ relatively widely (Dranseika and Neiders 2018, Neiders and Dranseika 2020). If folk judgements about death differ between people, however, can those differences at least in some degree be driven by people’s beliefs about what we are, when we cease to exist and whether ceasing to exist is identical to death (so-called Termination Thesis)? In order (...) to answer these questions, we conducted two studies. The first study looks into how people think about when they begin and cease to exist as well as when they are born and die. The second study replicates the findings of the first study in a different language and country and also extends these results by also looking at what people think about ‘what we are’, and whether their position on the latter issue is associated to their thinking about when they begin and cease to exist as well as when they are born and die. The studies presented in this chapter show that, first, people seem to hold a considerable variety of different views about death, coming into existence, ceasing to exist and what we are. The studies also recovered a number of conceptual links between these concepts. These results potentially bear on a number of issues in bioethics, i.e., not only discussions on death determination, but also on abortion or embryonic research. As for death determination, the results can be taken to provide further support for the so-called pluralist proposal. Second, study results provide little evidence for the claim that people’s beliefs about death are driven by their assumptions about personal identity, i.e., their understanding of ‘what we are’. In particular, there is little evidence that differences among people on death result from differences among people on personal identity. Finally, the studies show that people don’t reason in accordance with the Termination Thesis. The link between folk ascriptions of death and cessation of existence, while present, is weak. (shrink)

The COVID-19 pandemic created enormously difficult decisions for individuals trying to navigate both the risks of the pandemic and the demands of everyday life. Good decision making in such scenarios can have life and death consequences. For this reason, it is important to understand what drives risk assessments during a pandemic, and to investigate the ways that these assessments might deviate from ideal risk assessments. In a preregistered online study of U.S. residents (N = 841) using two blocks of vignettes (...) about potential COVID exposure scenarios, we investigated the effects of moral judgment, importance, and intentionality on COVID infection risk assessments. Results demonstrate that risk judgments are sensitive to factors unrelated to the objective risks of infection. Specifically, activities that are morally justified are perceived as safer while those that might subject people to blame or culpability, are seen as riskier, even when holding objective risk fixed. Similarly, unintentional COVID exposures are judged as safer than intentional COVID exposures. While the effect sizes are small, these findings may have implications for public health and risk communications, particularly if public health officials are themselves subject to these biases. (shrink)

During the COVID-19 pandemic, healthcare professionals have often faced moral challenges, which required them to choose between endorsing self- or other-sacrifice for the greater good. Drawing on the altruistic rationalization hypothesis and trait-activation theory, this study investigates (a) whether healthcare students’ endorsement of utilitarian solutions to sacrificial moral dilemmas varies when they are confronted with the minority group, majority group, or third-person perspective on the given dilemma and (b) whether individual differences in utilitarian thinking, as measured by the Oxford Utilitarianism (...) Scale (both instrumental harm and impartial beneficence), predict endorsement of utilitarian solutions to moral dilemmas. The study population was divided into a group of healthcare students and a group of non-healthcare students. It was found that the members of both groups expressed a stronger pro-utilitarian position when making moral dilemma judgments from a majority perspective than from the two other perspectives. However, a difference was observed with healthcare students being more reluctant to endorse the utilitarian action than their non-healthcare counterparts in the self-in-majority context. The instrumental harm component was a significant predictor of utilitarian judgments in the healthcare group, but impartial beneficence significantly predicted utilitarian judgments in the non-healthcare group in the self-in-majority context. -/- . (shrink)

Background Despite the bourgeoning of digital tools for bioethics research, education, and engagement, little research has empirically investigated the impact of interactive visualizations as a way to translate ethical frameworks and guidelines. To date, most frameworks take the format of text-only documents that outline and offer ethical guidance on specific contexts. This study’s goal was to determine whether an interactive-visual format supports frameworks in transferring ethical knowledge by improving learning, deliberation, and user experience.Methods An experimental comparative study was conducted with (...) a pre-, mid-, and post-test design using the online survey platform Qualtrics. Participants were university based early-stage health researchers who were randomly assigned to either the control condition (text-only document) or the experimental condition (interactive-visual). The primary outcome variables were learning, (measured using a questionnaire), deliberation (using cases studies) and user experience (measured using the SED/UD Scale). Analysis was conducted using descriptive statistics and mixed-effects linear regression.Results Of the 80 participants, 44 (55%) used the text-only document and 36 (45%) used the interactive-visual. Results of the knowledge-test scores showed a statistically significant difference between participants’ post-test scores, indicating that the interactive-visual format better supported understanding, acquisition, and application of the framework’s knowledge. Findings from the case studies showed both formats supported ethical deliberation. Results further indicated the interactive-visual provided an overall better episodic and remembered user experience compared with the text-only document.Conclusions Our findings show that ethical frameworks formatted with interactive and visual qualities provide a more pleasing user experience and are effective formats for ethics learning and deliberation. These findings have implications for practitioners developing and deploying ethical frameworks and guidelines (e.g., in educational or employee-onboarding settings), in that the knowledge generated can lead to more effective dissemination practices of normative guidelines and health data ethics concepts. (shrink)

Purpose: There is a widespread recognition that biomedical explanations offer benefits to those diagnosed with a mental disorder. Recent research points out that such explanations may nevertheless have stigmatizing effects. In this study, this ‘mixed blessing’ account of biomedical explanations is investigated in a case of philosophical interest: Tourette Syndrome. Method: We conducted a vignette survey with 221 participants in which we first assessed quantitative attributions of blame as well as the desire for social distance for behavior associated with Tourette (...) Syndrome. Results: In our study, it is confirmed that in the case of biomedical explanations, less blame is attributed than in the case of psychosocial explanations. When presented with a mixed explanation stressing an entanglement of biological and psychosocial factors this did not increase blame attribution. The desire for social distance is unaffected by the type of explanation but the participants’ free text feedback indicates this might obfuscate an underlying dilemma between stigma and blame revealed in recent research. Conclusion: There seems to be potential for blame reduction in explanations where biological and psychosocial factors are entangled. However, dynamic, ‘epigenetic’, explanations require further qualitative research to be performed as well as a philosophical framework to account for the ‘mixed blessings’ account. (shrink)

Topic modeling—a text‐mining technique often used to uncover thematic structures in large collections of texts—has been increasingly frequently used in the context of the analysis of scholarly output. In this study, we construct a corpus of 19,488 texts published since 1971 in seven leading journals in the field of bioethics and philosophy of medicine, and we use a machine learning algorithm to identify almost 100 topics representing distinct themes of interest in the field. On the basis of intertopic correlations, we (...) group the content‐based topics into eight clusters, thus providing a novel, fine‐grained intellectual map of bioethics and philosophy of medicine. Moreover, we conduct a number of diachronic analyses, examining how the “prominence” of different topics has changed across time. In this way, we are able to observe the distinct patterns in which bioethics and philosophy of medicine have evolved and changed their focus over the past half a century. (shrink)

Blumenthal-Barby and her colleagues (2022) situate their discussion of philosophy and bioethics in the context of (reportedly) widely held assumption that, when compared to the early days of bioethics, the role of philosophy is now diminished across the field – the assumption we call the Disconnection Thesis. This assumption can be summarized, to use the authors’ own words, by the phrase “philosophy’s glory days in bioethics are over“. While in no place of the article they explicitly endorse the Disconnection Thesis, (...) at least some of the authors had previously endorsed it in print (Savulescu 2015). Such expressions of collective expert wisdom might be a valuable source of information on the discipline's history, but they should not be accepted uncritically. Given the explosion in the size and scope of bioethical research in recent decades, any scholar’s familiarity with the area is necessarily based on selective reading and might be biased. Hence, in this commentary, we examine what kind of more rigorous evidence could corroborate the Disconnection Thesis. In other words, if the role of philosophy in bioethics has been indeed diminishing, what kind of observable patterns should we expect to see? Drawing on our previous research (Bystranowski, Dranseika, Żuradzki 2022), here we focus on two useful perspectives: citation analysis and topic modeling. While the first approach allows us to indirectly measure the level of engagement of bioethicists with philosophical literature (by measuring the proportion of references from articles published in journals in bioethics that cite philosophy journals), the latter provides a window into the content and argumentative style of bioethical texts. (shrink)

Significant advancements towards a future of big data genomic medicine, associated with large-scale public dataset repositories, intensify dilemmas of genomic privacy. To resolve dilemmas adequately, we need to understand the relative force of the competing considerations that make them up. Attitudes towards genomic privacy are complex and not well understood; understanding is further complicated by the vague claim of ‘genetic exceptionalism’. In this paper, we distinguish between consequentialist and non-consequentialist privacy interests: while the former are concerned with harms secondary to (...) exposure, the latter represent the interest in a private sphere for its own sake, as an essential component of human dignity. Empirical studies of attitudes towards genomic privacy have almost never targeted specifically this important dignitary component of the privacy interest. In this paper we first articulate the question of a non-consequentialist genomic privacy interest, and then present results of an empirical study that probed people’s attitudes towards that interest. This was done via comparison to other non-consequentialist privacy interests, which are more tangible and can be more easily assessed. Our results indicate that the non-consequentialist genomic privacy interest is rather weak. This insight can assist in adjudicating dilemmas involving genomic privacy. (shrink)

Consent governs innumerable everyday social interactions, including sex, medical exams, the use of property, and economic transactions. Yet little is known about how ordinary people reason about the validity of consent. Across the domains of sex, medicine, and police entry, Study 1 showed that when agents lack autonomous decision-making capacities, participants are less likely to view their consent as valid; however, failing to exercise this capacity and deciding in a nonautonomous way did not reduce consent judgments. Study 2 found that (...) specific and concrete incapacities reduced judgments of valid consent, but failing to exercise these specific capacities did not, even when the consenter makes an irrational and inauthentic decision. Finally, Study 3 showed that the effect of autonomy on judgments of valid consent carries important downstream consequences for moral reasoning about the rights and obligations of third parties, even when the consented-to action is morally wrong. Overall, these findings suggest that laypeople embrace a normative, domain-general concept of valid consent that depends consistently on the possession of autonomous capacities, but not on the exercise of these capacities. Autonomous decisions and autonomous capacities thus play divergent roles in moral reasoning about consent interactions: while the former appears relevant for assessing the wrongfulness of consented-to acts, the latter plays a role in whether consent is regarded as authoritative and therefore as transforming moral rights. (shrink)

In their target article, titled “The Place of Philosophy in Bioethics Today” (Blumenthal-Barby et al. 2022), Jennifer Blumenthal-Barby and colleagues provide a powerful argument for the role of phi...

The question of what makes someone the same person through time and change has long been a preoccupation of philosophers. In recent years, the question of what makes ordinary or lay people judge that someone is—or isn’t—the same person has caught the interest of experimental psychologists. These latter, empirically oriented researchers have sought to understand the cognitive processes and eliciting factors that shape ordinary people’s judgments about personal identity and the self. Still more recently, practitioners within an emerging discipline, experimental (...) philosophical bioethics or “bioxphi”—the focus of this chapter—have adopted a similar aim and employed similar methodologies, but with two distinctive features: (a) a special concern for enhanced ecological validity in the examples and populations studied; and (b) an interest in contributing to substantive normative debates within the wider field of bioethics. Our aim in this chapter is to sample illustrative work on personal identity in bioxphi, explore how it relates to studies in psychology covering similar terrain, and draw out the implications of this work for matters of bioethical concern. In pursuing these issues, we highlight recent work in bioxphi that includes the perceived validity of advance directives following neurodegeneration, the right of psychologically altered study participants to withdraw from research, how drug addiction may cause one to be regarded by others as “a completely different person,” the effect of deep-brain stimulation on perceptions of the self, and the potential influence of moral enhancement interventions on intuitive impressions of a person’s character. (shrink)

BackgroundImplicit prejudice can lead to disparities in treatment. The effects of specialty and experience on implicit obesity and mental illness prejudice had not been explored. The main objective was to examine how specializing in psychiatry/general medicine and years of experience moderated implicit obesity and mental illness prejudice among Swiss physicians. Secondary outcomes included examining the malleability of implicit bias via two video interventions and a condition of cognitive load, correlations of implicit bias with responses to a clinical vignette, and correlations (...) with explicit prejudice. MethodsIn stage 1, participants completed an online questionnaire including a clinical vignette. In stage 2, implicit prejudice pre- and post- intervention was tested using a 4 × 4 between-subject design including a control group. In stage 3, explicit prejudice was tested with feeling thermometers and participants were debriefed. Participants were 133 psychiatrists and internists working in Geneva, hospital-based and private practice. Implicit prejudice was assessed using a Weight IAT and a Mental Illness IAT. Explicit feelings towards the obese and the mentally ill were measured using Feeling Thermometers. A clinical vignette assessed the level of concern felt for a fictional patient under four conditions: control, obese, depression, obese and depression. Linear regression was conducted to test for association of gender, experience, and specialty with responses to vignettes, pre-intervention IATs and explicit attitudes, and to test for association of interventions with post-intervention IATs and explicit attitudes. Reported effect sizes were computed using Cohen’s d. Two-tailed p < 0.05 was selected as the significance threshold. ResultsCompared to internists, psychiatrists showed significantly less implicit bias against mentally vs. physically ill people than internists and warmer explicit feelings towards the mentally ill. More experienced physicians displayed warmer explicit feelings towards the mentally ill and a greater level of concern for the fictional patients in the vignette than the less experienced, except when the patient was described as obese. ConclusionsSpecialty moderates both implicit and explicit mental illness prejudice. Experience moderates explicit mental illness bias and concern for patients. The effect of specialty on implicit prejudice seems to be based principally on self-selection. (shrink)

Aim: Streamlining consent for low-risk comparative effectiveness research (CER) could facilitate research, while safeguarding patients' rights. Materials & methods: 2618 adults were randomized to one of seven consent approaches (six streamlined and one traditional) for a hypothetical, low-risk CER study. A survey measured understanding, voluntariness, and feelings of respect. Results: Participants in all arms had a high understanding of the trial and positive attitudes toward the consent interaction. Highest satisfaction was with a streamlined approach showing a video before the medical (...) appointment. Participants in streamlined were more likely to mistakenly think a signature was required. Conclusion: Streamlined consent was no less acceptable than traditional, signed consent. Streamlined and traditional approaches achieved similar levels of understanding, voluntariness and a feeling that the doctor–patient interaction was respectful. (shrink)