Digital contact tracing, in combination with widespread testing, has been a focal point for many plans to “reopen” economies while containing the spread of Covid‐19. Most digital contact tracing projects in the United States and Europe have prioritized privacy protections in the form of local storage of data on smartphones and the deidentification of information. However, in the prioritization of privacy in this narrow form, there is not sufficient attention given to weighing ethical trade‐offs within the context of a public (...) health pandemic or to the need to evaluate safety and effectiveness of software‐based technology applied to public health. (shrink)

McCradden et al. propose to close the “AI chasm” between algorithms and clinically meaningful application using the norms of evidence-based medicine and clinical research, with the rat...

Sedlakova and Trachsel (2023) advocate for a holistic approach to assessing ethical application of conversational artificial intelligence (CAI) in mental health therapy. They first describe CAI as...

Design bioethics, as defined by Pavarini et al. is “purpose-built, technology-driven research tools” that provide “the chance to leverage technological advances at the interface of engin...

After the November 2020 U.S. presidential election, many political analysts looked at the voting patterns of Latinx communities with consternation and surprise. Some analysts noted that “Latinx” ha...

Digital mental health technologies have been promoted with the promise of delivering wide-scale access to more efficient and effective mental health diagnosis and care. During the pandemic, the rap...

Big data and artificial intelligence (“AI”) promise to transform virtually all aspects of biomedical research and health care (Matheny et al. 2019), through facilitation of drug development, diagno...

Volume 20, Issue 10, October 2020, Page 79-81.

Jecker and colleagues open (2024) a critical and needed dialogue about the ethics of international conferencing. In particular, they focus on proposing a set of principles in selecting the location...

Advances in neurotechnologies, artificial intelligence (AI) and Big Data analytics are allowing interpretation of patterns from brain data to identify and even predict and manipulate mental states. Furthermore, there are avenues through which brain data can move into the consumer sphere, be reidentified and brokered. In response to these developments, there have been a number of approaches proposed to strengthen protections of brain data. To better understand the landscape of brain data protection discussions, we conducted a scoping review to identify (...) the rationales for establishing brain data protections and the proposals for protecting brain data offered in the ethics and neuroscience literature. To draw comparisons, we also surveyed the rationales given in the literature for the protection of sensitive behavioral inferences drawn from other types of personal data and associated approaches to achieving protection. This systematic examination of the rationale behind heightened protection for brain data should be useful to clarify the functional and conceptual bases given for brain data protection and to provide a better grounding for evaluating how the different approaches to brain data protection address these concerns. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)

Multiple studies have been performed to identify the most common ethical dilemmas encountered by ethics consultation services. However, limited data exists comparing the content of ethics consultations requested by specific hospital specialties. It remains unclear whether the scope of ethical dilemmas prompting an ethics consultation differ between specialties and if there are types of ethics consultations that are more or less frequently called based on the specialty initiating the ethics consult. This study retrospectively assessed the incidence and content of ethics (...) consultations called by surgical vs. non-surgical specialties between January 1, 2013 to December 31, 2018 using our RedCap Database and information collected through the EMR via our Clinical and Translational Science Center. 548 total ethics consultations were analyzed. Our results demonstrate that more surgical consults originated from the ICU, as opposed to lower acuity units, and surgical patients were more likely to have a DNR in place. Surgical specialties were more likely to call about issues relating to withholding/withdrawing life-sustaining treatment, while non-surgical specialties were more likely to call about issues related to discharge planning. There appear to be morally relevant differences between consults classified as the “same” that are not entirely captured by the usual ethics consultations classification system. In conclusion, this study highlights the unique ethical issues experienced by surgical vs. non-surgical specialties. Ultimately, our data can help ethics consultation services determine how best to educate various hospital specialties to approach ethical issues commonly experienced within their field. (shrink)

Essa pesquisa é um estudo de caso em que foram avaliadas as habilidades cognitivas de um idoso com queixa de memória e de sintomas depressivos. Foram aplicados testes cognitivos, escalas para avaliar as funções cognitivas e realizadas análise qualitativa e quantitativa dos resultados com objetivo de..

Several psychosocial models have been proposed to explain the etiology of eating disorders and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth from 41 schools in the Ottawa region, Canada. (...) Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Designer Biology: The Ethics of Intensively Engineering Biological and Ecological Systems consists of thirteen chapters that address the ethical issues raised by technological intervention and design across a broad range of biological and ecological systems. Among the technologies addressed are geoengineering, human enhancement, sex selection, genetic modification, and synthetic biology.

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)

Commercialiser des produits de beauté, c’est d’abord vendre – on le sait – l’idée même de « beauté ». Ce que l’on réalise moins, c’est que cette idée, comme ses véhicules publicitaires, moraux, médicaux et artistiques, a une histoire et que cette production socio-culturelle, pour être comprise et n’être jamais séparée de l’ensemble de ses incidences économiques, doit être appréhendée de façon genrée, racialisée et politisée. Soumise à des ruptures temporelles qui sont bien plus que des modes,...

Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

PurposeChildhood onset speech fluency disorder is possibly related to dopaminergic dysfunction. Mesencephalic hyperechogenicity detected by transcranial ultrasound might be seen as an indirect marker of dopaminergic dysfunction. We here determined whether adults who stutter since childhood show ME.MethodsWe performed TCS in ten AWS and ten matched adults who never stuttered. We also assessed motor performance in finger tapping and in the 25 Foot Walking test.ResultsCompared to controls, AWS showed enlarged ME on either side. Finger tapping was slower in AWS. Walking (...) cadence, i.e., the ratio of number of steps by time, tended to be higher in AWS than in control participants.DiscussionThe results demonstrate a motor deficit in AWS linked to dopaminergic dysfunction and extending beyond speech. Since iron deposits evolve in childhood and shrink thereafter, ME might serve as an easily quantifiable biomarker helping to predict the risk of persistency in children who stutter. (shrink)

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

This book is a rich blend of analyses by leading experts from various cultures and disciplines. A compact introduction to a complex field, it illustrates biotechnology's profound impact upon the environment and society. Moreover, it underscores the vital relevance of cultural values. This book empowers readers to more critically assess biotechnology's value and effectiveness within both specific cultural and global contexts.

I analyse Drenthen's article 'Ecological restoration and place attachment: emplacing non-places?' (Environmental Values 18(3): 285-312), focusing in particular on his use of the notions of 'appropriation' and 'estrangement' from the perspective of meaningfulness. I show that, for deeper meaningfulness as place attachment, within the appropriable there is always a tension with the non-appropriable; there is a successful connection between both. Estrangement and loss of meaning occur the moment the non-appropriable resides outside the familiar. Drenthen unintentionally causes confusion by failing to (...) take this subtlety into account systematically. (shrink)

Even though artists and philosophers sometimes succeed in finding words for the meaning that places can have for us, we can never fully identify the meaning that places have for us. Nicole Note is right in arguing (using the work of Arnold Burms) that the ineffable plays a key role in the meaningful relations we have with the world, and that the experience of meaning can only emerge if there is a real risk that it fails to appear. Therefore, (...) meaning cannot be ‘produced’. I have argued, however, that we can be confronted with a far more radical loss of meaning when most at first meaningful interpretations of place turn out to be consciously produced by marketeers and lobbyists. Yet, even this very feeling of estrangement can lead us to a sensitivity for the otherness of nature as a transcendental source of meaning. (shrink)

Este artículo tiene camo finalidad estudiar la noción de aserción en dos obras del sigla XVII francés: La Logique ou l’art de penser (conocida como Lógica de Port-Royal), de Antoine Arnauld y Pierre Nicole, y la Grammaire générale et raisonnée, de Antoine Arnauld y Claude Lancelot. Se ha dividido el artículo en dos apartados dedicados respectivamente a la concepción de Port-Royal acerca del juicio, y a la teoría del verbo. A lo largo de la reflexión en torno a estos (...) importantes conceptos en la teoría del lenguaje de Port-Royal, pretendemos probar que sus autores efectuaron la distinción entre contenido proposicianal y actitud proposicianal antes de que Frege la estableciera de forma sólida y definitiva.The present paper sets out to examine the notion of assertion within two French 17th century works: Antoine Arnauld and Pierre Nicole’s La Logique ou l’art de penser (known as the Port-Royal Logic), and Antoine Arnauld and Claude Lancelot’s Grammaire générale et raisonnée. This article has been divided into two sections. The first section is devoted to the Port-Royalian doctrine about judgment; the second section analyzes the theory of verb. On our account of these important notions of Porl-Royal’s theory of language, we intend to prove that its authors had made out the distinction btween propositional content and propositional attitude before Frege could set it forth in a solid and definitive way. (shrink)

L’addition, dans la cinquième édition en 1683 de La Logique ou L’Art de penser, d’un chapitre consacré à la définition générale du signe et de plusieurs chapitres relevant spécifiquement d’une analyse des signes linguistiques, a été parfois interprétée comme une apparition tardive du “problème du langage” dans le traité d’Arnauld et Nicole. Parce que la plupart de ces chapitres supplémentaires sont la transposition de passages auparavant destinés dans la Perpétuité de la foi (1669-1674) à réfuter le sens calviniste de (...) Ceci est mon corps, on a été enclin à attribuer l’importance de la question du signe et du “problème du langage” dans l’édition de 1683 à une origine théologique. J’essaie au contraire de montrer que, dès la première édition de L’Art de penser en 1662, la problématisation des écarts des expressions linguistiques avec une correspondance terme à terme entre les mots et les idées a été indissociable pour Port-Royal de l’analyse des opérations de l’esprit. Selon moi, dans la Perpétuité de la foi, la critique du sens calviniste de la formule eucharistique constitue elle-même une application de cette analyse logique du langage : les passages incorporés ensuite dans L’Art de penser sont dans le prolongement des réflexions de 1662 sur les difficultés d’adéquation entre le dire et le vouloir-dire. Je montre pour finir que la définition générale du signe à Port-Royal suppose une restructuration de la définition augustinienne du De doctrina christiana, et fonde en 1683 une identification de la relation de signification linguistique à un rapport de représentation des mots aux idées, qui vient redoubler le rapport de représentation des idées aux choses établi en 1662. (shrink)

The Port Royal Logic Logic or the Art of Thinking, commonly known as The Port Royal Logic, was written by Antoine Arnauld and Pierre Nicole and first published in 1662. Although it was a textbook containing much worked-over material, the Logic was extremely influential, certainly the most important textbook in logic for the next two … Continue reading Port Royal Logic →.

The paper shows that in the Art of Thinking (The Port Royal Logic) Arnauld and Nicole introduce a new way to state the truth-conditions for categorical propositions. The definition uses two new ideas: the notion of distributive or, as they call it, universal term, which they abstract from distributive supposition in medieval logic, and their own version of what is now called a conservative quantifier in general quantification theory. Contrary to the interpretation of Jean-Claude Parienté and others, the truth-conditions (...) do not require the introduction of a new concept of ‘indefinite’ term restriction because the notion of conservative quantifier is formulated in terms of the standard notion of term intersection. The discussion shows the following. Distributive supposition could not be used in an analysis of truth because it is explained in terms of entailment, and entailment in terms of truth. By abstracting from semantic identities that underlie distribution, the new concept of distributive term is definitionally prior to truth and can, therefore, be used in a non-circular way to state truth-conditions. Using only standard restriction, the Logic’s truth-conditions for the categorical propositions are stated solely in terms of (1) universal (distributive) term, (2) conservative quantifier, and (3) affirmative and negative proposition. It is explained why the Cartesian notion of extension as a set of ideas is in this context equivalent to medieval and modern notions of extension. (shrink)

Even though artists and philosophers sometimes succeed in finding words for the meaning that places can have for us, we can never fully identify the meaning that places have for us. Nicole Note is right in arguing (using the work of Arnold Burms) that the ineffable plays a key role in the meaningful relations we have with the world, and that the experience of meaning can only emerge if there is a real risk that it fails to appear. Therefore, (...) meaning cannot be ‘produced’. I have argued, however, that we can be confronted with a far more radical loss of meaning when most at first meaningful interpretations of place turn out to be consciously produced by marketeers and lobbyists. Yet, even this very feeling of estrangement can lead us to a sensitivity for the otherness of nature as a transcendental source of meaning. (shrink)