BackgroundAs a number of commentators have noted, SARS exposed the vulnerabilities of our health care systems and governance structures. Health care professionals (HCPs) and hospital systems that bore the brunt of the SARS outbreak continue to struggle with the aftermath of the crisis. Indeed, HCPs – both in clinical care and in public health – were severely tested by SARS. Unprecedented demands were placed on their skills and expertise, and their personal commitment to their profession was severely tried. Many were (...) exposed to serious risk of morbidity and mortality, as evidenced by the World Health Organization figures showing that approximately 30% of reported cases were among HCPs, some of whom died from the infection. Despite this challenge, professional codes of ethics are silent on the issue of duty to care during communicable disease outbreaks, thus providing no guidance on what is expected of HCPs or how they ought to approach their duty to care in the face of risk.DiscussionIn the aftermath of SARS and with the spectre of a pandemic avian influenza, it is imperative that we (re)consider the obligations of HCPs for patients with severe infectious diseases, particularly diseases that pose risks to those providing care. It is of pressing importance that organizations representing HCPs give clear indication of what standard of care is expected of their members in the event of a pandemic. In this paper, we address the issue of special obligations of HCPs during an infectious disease outbreak. We argue that there is a pressing need to clarify the rights and responsibilities of HCPs in the current context of pandemic flu preparedness, and that these rights and responsibilities ought to be codified in professional codes of ethics. Finally, we present a brief historical accounting of the treatment of the duty to care in professional health care codes of ethics.SummaryAn honest and critical examination of the role of HCPs during communicable disease outbreaks is needed in order to provide guidelines regarding professional rights and responsibilities, as well as ethical duties and obligations. With this paper, we hope to open the social dialogue and advance the public debate on this increasingly urgent issue. (shrink)

Perhaps the greatest impediment to a viable libertarianism is the provision of a satisfactory explanation of how actions that are undetermined by an agent's character can still be under the control of, or ‘up to’, the agent. The ‘luck problem’ has been most assiduously examined by Robert Kane who supplies a detailed account of how this problem can be resolved. Although Kane's theory is innovative, insightful, and more resourceful than most of his critics believe, it ultimately cannot account for the (...) type of control that moral responsibility and (ultimate) agency legitimately require. (shrink)

Historically, scientific and engineering expertise has been key in shaping research and innovation policies, with benefits presumed to accrue to society more broadly over time. But there is persistent and growing concern about whether and how ethical and societal values are integrated into R&I policies and governance, as we confront public disbelief in science and political suspicion toward evidence-based policy-making. Erosion of such a social contract with science limits the ability of democratic societies to deal with challenges presented by new, (...) disruptive technologies, such as synthetic biology, nanotechnology, genetic engineering, automation and robotics, and artificial intelligence. Many policy efforts have emerged in response to such concerns, one prominent example being Europe's Eighth Framework Programme, Horizon 2020, whose focus on “Responsible Research and Innovation” provides a case study for the translation of such normative perspectives into concrete policy action and implementation. Our analysis of this H2020 RRI approach suggests a lack of consistent integration of elements such as ethics, open access, open innovation, and public engagement. On the basis of our evaluation, we suggest possible pathways for strengthening efforts to deliver R&I policies that deepen mutually beneficial science and society relationships. (shrink)

We argue that critiques of political process theory are beginning to coalesce into new approach to social movements--a "multi-institutional politics" approach. While the political process model assumes that domination is organized by and around one source of power, the alternative perspective views domination as organized around multiple sources of power, each of which is simultaneously material and symbolic. We examine the conceptions of social movements, politics, actors, goals, and strategies supported by each model, demonstrating that the view of society and (...) power underlying the political process model is too narrow to encompass the diversity of contemporary change efforts. Through empirical examples, we demonstrate that the alternative approach provides powerful analytical tools for the analysis of a wide variety of contemporary change efforts. (shrink)

McCradden and colleagues' argues that machine learning in health care poses new challenges to appropriate evaluation for safe use in clinical care. It also claims that “the longstanding syst...

Various approaches have emerged over the last several decades to meet the challenges and complexities of anticipating and responding to the potential impacts of emerging technologies. Although many of the existing approaches share similarities, they each have shortfalls. This paper takes as the object of its study Anticipatory Ethics for Emerging Technologies (ATE) to technology assessment, given that it was formatted to address many of the privations characterising parallel approaches. The ATE approach, also in practice, presents certain areas for retooling, (...) such as how it characterises levels and objects of analysis. This paper results from the work done with the TechEthos Horizon 2020 project in evaluating the ethical, legal, and social impacts of climate engineering, digital extended reality, and neurotechnologies. To meet the challenges these technology families present, this paper aims to enhance the ATE framework to encompass the variety of human processes and material forms, functions, and applications that comprise the socio-technical systems in which these technologies are embedded. (shrink)

Advances in neuromodulation and an improved understanding of the anatomy and circuitry of psychopathology have led to a resurgence of interest in surgery for psychiatric disease. Clinical trials exploring deep brain stimulation (DBS), a focally targeted, adjustable and reversible form of neurosurgery, are being developed to address the use of this technology in highly selected patient populations. Psychiatric patients deemed eligible for surgical intervention, such as DBS, typically meet stringent inclusion criteria, including demonstrated severity, chronicity and a failure of conventional (...) therapy. Although a humanitarian device exemption by the US Food and Drug Administration exists for its use in obsessive-compulsive disorder, DBS remains a largely experimental treatment in the psychiatric context, with its use currently limited to clinical trials and investigative studies. The combination of a patient population at the limits of conventional therapy and a novel technology in a new indication poses interesting challenges to the informed consent process as it relates to clinical trial enrollment. These challenges can be divided into those that relate to the patient, their disease and the technology, with each illustrating how traditional conceptualisations of research consent may be inadequate in the surgical psychiatry context. With specific reference to risk analysis, patient autonomy, voluntariness and the duty of the clinician-researcher, this paper will discuss the unique challenges that clinical trials of surgery for refractory psychiatric disease present to the consent process. Recommendations are also made for an ethical approach to clinical trial consent acquisition in this unique patient population. (shrink)

We are continually trying to make sense of our world through the stories we tell and are told, but in our search for coherence, we often sacrifice our freedom and the rich randomness of life. In this passionate and lucid book, Michael André Bernstein challenges our practice of "foreshadowing," in which we see our lives as moving toward a predetermined goal or as controlled by fate. Foreshadowing, he argues, demeans the variety and openness that exist in even the most ordinary (...) moments of life. And it is precisely ordinary life, with its random, haphazard, and contradictory choices, that Bernstein celebrates in his call for "sideshadowing"—an alternative practice that reminds us that every present is dense with possible futures. Bernstein sees the Holocaust as the prime example of how our tendency to "foreshadow" and "backshadow" misrepresents history. He argues eloquently against politicians and theologians who posit the Holocaust as foreordained and who depict its victims as somehow complicit with a fate that they should have been able to foresee. Instead, Bernstein proposes a radically new understanding of the relationship between the Holocaust and earlier Jewish experience, transforming how we read and write both individual and communal history. Foregone Conclusions is an extraordinarily wide-ranging book, both in its scope and in its broader intellectual and moral implications. From the latest biographies of Kafka to the peace accords between Israel and the PLO, from the role of cultural diversity in universities to the Crown Heights riots, Bernstein warns us against passively accepting our identities as being shaped primarily by historical or personal victimization. His book liberates us from stereotyped patterns of understanding the relationship between our lives as individuals and as members of racial, sexual, and historic/ethnic communities. Berstein ultimately opens a powerful new way to understand the principles governing how we read and write narratives--whether historical, personal, or literary. In striking original juxtapositions and critical evaluations of Marcel Proust, Robert Musil, and Aharon Appelfeld, Bernstein sugests the need for a new literary model based on the prosaics of daily life. Bernstein speaks directly and persuasively to many of the most pressing issues in Jewish history, Holocaust studies, literary criticism, and cultural history. Foregone Conclusions is a provocative and poignant attempt to find coherence in our world without accepting either ineluctable destiny of pure coincidence. (shrink)

Some carnivores defend the position that the opportunistic consumption of meat is morally permissible even under the assumption that it is morally wrong to act in ways that ause unnecessary suffering to sentient beings. Ordering and consuming chicken once a week, they argue, will not increase the numbers of chickens suffering or slaughtered, since the system of purchasing and farming chickens is not sufficiently fine‐tuned to register differences at margin. We argue that, insensitivity of the market notwithstanding, consistent consequentialists are (...) morally prohibited from each additional purchase and consumption of meat. (shrink)

In this paper, we introduce the Societal Readiness Thinking Tool to aid researchers and innovators in developing research projects with greater responsiveness to societal values, needs, and expectations. The need for societally-focused approaches to research and innovation—complementary to Technology Readiness frameworks—is presented. Insights from responsible research and innovation concepts and practice, organized across critical stages of project-life cycles are discussed with reference to the development of the SR Thinking Tool. The tool is designed to complement not only shortfalls in TR (...) approaches, but also improve upon other efforts to integrate RRI, sustainability, and design thinking in research and innovation cycles. Operationalization and early-stage user tests of the Tool are reported, along with discussion of potential future iterations and applications. (shrink)

McCradden and colleagues' (2022) argues that machine learning in health care poses new challenges to appropriate evaluation for safe use in clinical care. It also claims that “the longstanding syst...

Received opinion has it that humans are morally superior to non-human animals; human interests matter more than the like interests of animals and the value of human lives is alleged to be greater than the value of nonhuman animal lives. Since this belief causes mayhem and murder, its de-mythologizing requires urgent attention.

Recent developments in the field of neurosurgery, specifically those dealing with the modification of mood and affect as part of psychiatric disease, have led some researchers to discuss the ethical implications of surgery to alter personality and personal identity. As knowledge and technology advance, discussions of surgery to alter undesirable traits, or possibly the enhancement of normal traits, will play an increasingly larger role in the ethical literature. So far, identity and enhancement have yet to be explored in a neurosurgical (...) context, despite the fact that 1) neurological disease and treatment both potentially alter identity, and 2) that neurosurgeons will likely be the purveyors of future enhancement implantable technology. Here, we use interviews with neurosurgical patients to shed light on the ethical issues and challenges that surround identity and enhancement in neurosurgery. The results provide insight into how patients approach their identity prior to potentially identity-altering procedures and what future ethical challenges lay ahead for clinicians and researchers in the field of neurotherapeutics. (shrink)

The principle of gratuitous suffering -- The value of humans and the value of animals -- The holocaust of factory farming -- Hunting -- Animal experimentation -- The law and animals -- Women and animals.

It has become virtually a matter of dogma—among both philosophers and laypersons—that human lives are more valuable than animal lives. One argument for this claim dominates the philosophical literature and, despite its employment by a host of philosophers, should be found wanting. I try to show that this line of reasoning, as well as one that is less popular but still with significant appeal, are faulty. The errors in each argument seem fatal: the pervasive argument begs the question, and the (...) more selective is, at bottom, unintelligible. We should judge that the lives of humans and animals are equally valuable, an assessment that should be accompanied by major changes in some of our fundamental practices. (shrink)

Helping scientists and engineers challenge received assumptions about how science, engineering, and society relate is a critical cornerstone for macroethics education. Scientific and engineering research are frequently framed as first steps of a value-free linear model that inexorably leads to societal benefit. Social studies of science and assessments of scientific and engineering research speak to the need for a more critical approach to the noble intentions underlying these assumptions. “Science Outside the Lab” is a program designed to help early-career scientists (...) and engineers understand the complexities of science and engineering policy. Assessment of the program entailed a pre-, post-, and 1 year follow up survey to gauge student perspectives on relationships between science and society, as well as a pre–post concept map exercise to elicit student conceptualizations of science policy. Students leave Science Outside the Lab with greater humility about the role of scientific expertise in science and engineering policy; greater skepticism toward linear notions of scientific advances benefiting society; a deeper, more nuanced understanding of the actors involved in shaping science policy; and a continued appreciation of the contributions of science and engineering to society. The study presents an efficacious program that helps scientists and engineers make inroads into macroethical debates, reframe the ways in which they think about values of science and engineering in society, and more thoughtfully engage with critical mediators of science and society relationships: policy makers and policy processes. (shrink)

Physical environmental factors – or ‘artifacts’ – are linked to healthcare outcomes in the field of social psychology. However, the role of artifacts remains rarely examined in the burgeoning discipline of placebo studies. In this paper, we argue that a careful consideration of artifacts – such as provider clothing and office décor – may carry significant potential in eliciting placebo effects in clinical settings. We discuss three potential mechanisms by which artifacts may enhance or diminish placebo (or nocebo) effects: classical (...) conditioning, response expectancy, and mindsets. We propose testable hypotheses and conclude by providing innovative research designs that might help to better advance this novel research agendum. (shrink)

It is undeniable that many human practices are detrimental to the well-being of non-human animals. Among other things, we trap and hunt them, experiment upon them, and kill them to use their flesh for food. We cause pain and suffering, and so a moral justification for these activities is required. Traditionally such a justification has taken the form of claiming that humans have some property–intelligence, ability to morally deliberate, etc.–which is both morally significant and missing in non-humans. However, once we (...) recall the existence of marginal or deficient humans, those who suffer from senility, retardation, Alzheimer disease, etc., this appeal loses much of its force. I investigate whether loyalty appeals can be used to support our treatment of non-humans as resources. That is, can we legitimately appeal to the fact that an individual is a fellow human to ground inferior moral behaviors toward non-human animals. I conclude that, concerning any of the major uses of animals, including the experimenting upon them in the hopes of finding cures and treatments of human diseases, loyalty appeals have no efficacy. (shrink)

The decision to initiate invasive, first-in-human trials involving Parkinson’s disease presents a vexing ethical challenge. Such studies present significant surgical risks, and high degrees of uncertainty about intervention risks and biological effects. We argue that maintaining a favorable riskbenefit balance in such circumstances requires a higher than usual degree of confidence that protocols will lead to significant direct and/or social benefits. One critical way of promoting such confidence is through the application of stringent evidentiary standards for preclinical studies. We close (...) with a series of recommendations for strengthening the internal and external validity of preclinical studies, reducing their tendency toward optimism and publication biases, and improving the knowledge base used to design and evaluate preclinical studies. (shrink)

One tolerably clear statement of Determinism has it that all events are caused. Expanded upon, this thesis has been taken as the claim that the existence of any event E1, has a set of events, E2 … En which antedate E1, and which are causally sufficient for the occurrence of E1. That is, given the occurrence of E2 … En, E1 is causally necessary. I would hardly wish to claim that this is the only plausible statement of the doctrine of (...) Determinism; nonetheless it is a common one, and the one that I’ll use as definitive. Some have believed both that this premise is true and that it inevitably leads to a denial of free actions. While remaining neutral as to the merits of the Hard Determinist position, what I wish to show is that the consequences of the argumentation that has led them to such a position have been neither fully nor adequately understood. (shrink)

In "Size Matters" in this issue, Joel MacClellan argues for three claims: according to utilitarianism, faced with a choice of eating large or small animals, we should eat the large; utilitarianism may ground obligations to eat meat; and we justifiably attract greater moral responsibility for the "direct" killing of our food animals than we do for "indirect" killing. MacClellan tends to underestimate the resources available even to hedonistic utilitarianism and oversimplifies the conditions in the food industry. His second claim has (...) merit but is merely an instance of utilitarianism’s problem with providing a satisfying account of justice. (shrink)

A commentary on the Case Study “Bad Words,” in the March‐April 2014 issue.