Cancer screening programmes cause harm to individuals via overdiagnosis and overtreatment, even where they confer population-level benefit. Screening thus appears to violate the principle of non-maleficence, since it entails medically unnecessary harm to individuals. Can consent to screening programmes negate the moral significance of this harm? In therapeutic medical contexts, consent is used as a means of rendering medical harm morally permissible. However, in this paper, I argue that it is unclear that the model of consent used within therapeutic (...) medicine can be applied unproblematically to preventive medicine. Invitation to screening changes the pragmatic norms and expectations of the patient–doctor encounter such that two key principles of consent may be violated. First, the pragmatics of a medical invitation are such that patients may fail to be adequately informed, since patients appear to assume medical invitations are made with their best interests in mind, even where information to the contrary is outlined. Second, screening invitations may place pressure on patients; in the context of a medical encounter, to make an invitation to screening may constitute an inducement to accept. In order to be sure that a patient’s consent to a screening invitation is valid, we must make clear to patients that their decision to accept screening may be shaped not only by how information about screening is presented, but by the pragmatic form of the invitation itself. (shrink)

The principle of non-maleficence, primum non nocere, has deep roots in the history of moral philosophy, being endorsed by John Stuart Mill, W. D. Ross, H. L. A. Hart, Karl Popper and Bernard Gert. And yet, this principle is virtually absent from current debates on social justice. This article suggests that non-maleficence is more than a moral principle; it is also a principle of social justice. Part I looks at the origins of non-maleficence as a principle of (...) ethics, and medical ethics in particular. Part II introduces the idea of non-maleficence as a principle of social justice. Parts III and IV define the principle of justice as non-maleficence in terms of its scope and coherence, while Part V argues that the motivation of not doing harm makes this principle an alternative to two well-established paradigms in the literature on social justice: justice as mutual advantage (David Gauthier) and justice as impartiality (Brian Barry). (shrink)

Disability activists' redefinition of “disability” as a social, rather than a medical, problem attempts to reassign causality. We explicate the untenable implications of this approach and argue this definition is maleficent, unjust, and inconsistent. Thus, redefining disability as a socially caused phenomenon is, from a moral point of view, ill-advised.

Important advances in biomedical and behavioral research ethics have occurred over the past few decades, many of them centered on identifying and eliminating significant harms to human subjects of research. Comprehensive attention has not been paid to the totality of harms experienced by animal subjects, although scientific and moral progress require explicit appraisal of these harms. Science is a public good and the prioritizing within, conduct of, generation of, and application of research must soundly address questions about which research is (...) morally defensible and valuable enough to support through funding, publication, tenure, and promotion. Likewise, educational pathways of re-imagined science are critical. (shrink)

An abundance of data unequivocally shows that exercise can be an effective tool in the fight against obesity and its associated co-morbidities. Indeed, physical activity can be more effective than widely-used pharmaceutical interventions. Whilst metformin reduces the incidence of diabetes by 31% (as compared with a placebo) in both men and women across different racial and ethnic groups, lifestyle intervention (including exercise) reduces the incidence by 58%. In this context, it is notable that a group of prominent medics and exercise (...) scientists recently sent a well-publicised letter to the General Medical Council and Medical Schools Council calling for the introduction of evidence-based lifestyle education into all medical curricula. The letter warns that there is a lack of understanding of the impact that exercise and nutrition can have on physical health amongst doctors. In the absence of an educational overhaul, the signatories warn that the government is likely to fail to reach its goal of preventing tens of thousands of premature deaths from heart disease and cancer by 2020. Whilst we agree with the need to address this apparent lack of understanding, we argue that the ethical justification of doing so is not limited to this broadly beneficence-based justification. There is also a justification grounded in the duty of non-maleficence, that is, the duty to avoid unreasonably harming patients. This duty requires that doctors refrain from (i) preventing patients from undergoing beneficial treatment without good reason, (ii) exposing patients to unreasonable risks and (iii) reducing the therapeutic effect of an effective medical intervention. This requires an understanding of the physical impact of exercise. (shrink)

New reproductive technologies allow parents some choice over their children. Various moral principles have been suggested to regulate such choices. This article starts from a discussion of Julian Savulescu's Principle of Procreative Beneficence, according to which parents ought to choose the child expected to have the best quality of life, before combining two previously separate lines of attack against this principle. First, it is suggested that the appropriate moral principles of guiding reproductive choices ought to focus on general wellbeing rather (...) than prioritizing that of the child and, second, that they ought to be non-maximizing. Though neither of these suggestions is entirely novel, combining them results in a new, and arguably more plausible, principle to regulate procreative choices, which I call the Principle of Generalized Procreative Non-Maleficence. According to this principle, the primary obligation on parents is not to cause harm to other people through their reproductive choices. (shrink)

In “IRBs and The Protection Inclusion Dilemma: Finding a Balance,” Friesen et al. (2023) argue that IRBs ought to attend more, and better, to the need for the inclusion of under-researched populati...

Higher education institutions are increasingly relying on learning analytics to collect voluminous amounts of data ostensibly to inform student learning interventions. The use of learning analytics, however, can result in a tension between the Council for the Advancement of Standards in Higher Education (CAS) principles of autonomy and non-malfeasance on the one hand, and the principle of beneficence on the other. Given the complications around student privacy, informed consent, and data justice in addition to the potential to do harm, many (...) current practices around learning analytics within higher education can be considered to be in violation of CAS standards. This paper aims to explore this tension in greater detail and argues that the student voice offers a promising way to ensure that students’ autonomy is respected, harm is reduced, and that higher education institutions can still fulfil the principle of beneficence. (shrink)

Artificial Intelligence (AI) is already having a major impact on society. As a result, many organizations have launched a wide range of initiatives to establish ethical principles for the adoption of socially beneficial AI. Unfortunately, the sheer volume of proposed principles threatens to overwhelm and confuse. How might this problem of ‘principle proliferation’ be solved? In this paper, we report the results of a fine-grained analysis of several of the highest-profile sets of ethical principles for AI. We assess whether these (...) principles converge upon a set of agreed-upon principles, or diverge, with significant disagreement over what constitutes ‘ethical AI.’ Our analysis finds a high degree of overlap among the sets of principles we analyze. We then identify an overarching framework consisting of five core principles for ethical AI. Four of them are core principles commonly used in bioethics: beneficence, non-maleficence, autonomy, and justice. On the basis of our comparative analysis, we argue that a new principle is needed in addition: explicability, understood as incorporating both the epistemological sense of intelligibility (as an answer to the question ‘how does it work?’) and in the ethical sense of accountability (as an answer to the question: ‘who is responsible for the way it works?’). In the ensuing discussion, we note the limitations and assess the implications of this ethical framework for future efforts to create laws, rules, technical standards, and best practices for ethical AI in a wide range of contexts. (shrink)

Nearly all Disney movies represent to people mere possibilities. One can conceive of scenarios with genies, wooden puppets coming to life, flying elephants, and mermaids. And there certainly seems to be no special problem in conceiving of a scenario where all the author's experiences are a mere dream induced by a Maleficent‐like evil genius. The problem in the present context is that the possibility of a dream‐inducing Maleficent‐like evil genius guarantees that how things appear would be no different, whether she (...) is dreaming or not. But maybe there is a difference: does it not appear to her that there is a difference between dreaming and wakefulness? The very fact that she is aware of such a distinction at all suggests the distinction is real. People prefer a real life over an experientially identical dream life, or even a more pleasurable dream life, because there is more to life than just experience. (shrink)

In this paper, I respond to the (infamous) causal impotence objection to the standard arguments for ethical vegetarianism. The paper defends a non-consequentialist response to this objection, one that draws on an account of the principle of non-maleficence inspired by Ross.

The principles of biomedical ethics – autonomy, non-maleficence, beneficence, and justice – are of paradigmatic importance for framing ethical problems in medicine and for teaching ethics to medical students and professionals. In order to underline this significance, Tom L. Beauchamp and James F. Childress base the principles in the common morality, i.e. they claim that the principles represent basic moral values shared by all persons committed to morality and are thus grounded in human moral psychology. We empirically investigated the (...) relationship of the principles to other moral and non-moral values that provide orientations in medicine. By way of comparison, we performed a similar analysis for the business & finance domain. (shrink)

Purpose: To survey the attitudes of the general public in Sweden to biobank research and to discuss the findings in the light of some well-known ethical principles.Methods: A questionnaire was used to survey the opinions of the general public in Sweden, and an ethical analysis (using the principles of autonomy, non-maleficence, beneficence and justice) was performed to discuss the possible conditions of such research.Findings: Between 3 and 9% answered that they did not want their samples to be collected and (...) stored in a biobank. Many respondents required information about the purpose of the research and wanted to be able to consent or refuse. About one third of the respondents said they would have answered differently if financial gain was involved and those who commented indicated a more negative attitude. The principle of autonomy maintains that the right to self-determination should be respected, and the principles of non-maleficence and beneficence that the probable harms and benefits resulting from a particular project by using samples from a biobank should be balanced. The general public disagree about how these principles are to be balanced. Interpretation: In the light of the findings different interpretations of the situation as well as possible alternatives are discussed in this paper. (shrink)

Background: Ethical frameworks for organ donation following circulatory death (DCD) were established >20 years ago. However, considerable variation exists among these, indicating consensus has not been reached on all issues. Additionally, advances such as cardiac DCD transplants and normothermic regional perfusion (NRP) may have reignited old debates.Methods: We reviewed the English-language literature addressing ethical issues in DCD from 1993 to 2022, examining changes in frequency with which ethical principles and their sub-themes identified within each, were addressed.Results: Non-maleficence was the (...) most frequently addressed principle (192 of 199 articles), as well as the most varied, with 9 subthemes (versus 2-4 within each of the other bioethical principles).Conclusions: There were several changes in the terminology used to refer to DCD over time, and substantial interest in cardiac DCD and NRP in recent publications, arising in 11 and 19 of the 30 publications from 2018 to 2022. (shrink)

“Violence” and “nonviolence” are, increasingly, misleading translations for the Sanskrit words hiṃsā and ahiṃsā—used by Gandhi as the basis for his philosophy of satyāgraha. I argue for rereading hiṃsā as “maleficence” and ahiṃsā as “beneficence.” These two more mind-referring English words capture the primacy of intention implied by Gandhi’s core principles. Reflecting a political turn in moral accountability detectable through linguistic data, both the scope and the usage of the word “violence” have expanded dramatically, making it harder to convincingly (...) characterize people and actions as “nonviolent.” New terminology could clarify the distinction between hiṃsā and ahiṃsā, and, thereby, prevent misunderstandings of Gandhi. Training in beneficence would reflect Gandhi’s psychological path to reducing avoidable harm: ego-detachment, universal love, and seeking truth by experiment. -/- NOTE: An extended, unpublished version, with additional arguments and evidence, is also available on PhilPapers as "The Primacy of Intention and the Duty to Truth: A Gandhi-Inspired Argument for Retranslating Hiṃsā and Ahiṃsā, with Connections to History, Ethics, and Civil Resistance". (shrink)

The words "violence" and "nonviolence" are increasingly misleading translations for the Sanskrit words hiṃsā and ahiṃsā -- which were used by Gandhi as the basis for his philosophy of satyāgraha. I argue for re-reading hiṃsā as “maleficence” and ahiṃsā as “beneficence.” These two more mind-referring English words – associated with religiously contextualized discourse of the past -- capture the primacy of intention implied by Gandhi’s core principles, better than “violence” and “nonviolence” do. Reflecting a political turn in moral accountability (...) detectable through linguistic data, both the scope and the usage of the word “violence” have expanded dramatically. The expanded scope of “violence” reflects greater consciousness of the various forms that serious harm can take, but also makes it harder to convincingly characterize people and actions as “nonviolent.” New translations could clarify the distinction between hiṃsā and ahiṃsā, and thereby prevent some misunderstandings of Gandhi. Training in beneficence would reflect Gandhi’s psychological path to reducing avoidable harm: detachment from the ego, learning to love universally, and seeking truth by experiment. (shrink)

Organizations such as the EU High-Level Expert Group on AI and the IEEE have recently formulated ethical principles and (moral) values that should be adhered to in the design and deployment of artificial intelligence (AI). These include respect for autonomy, non-maleficence, fairness, transparency, explainability, and accountability. But how can we ensure and verify that an AI system actually respects these values? To help answer this question, I propose an account for determining when an AI system can be said to (...) embody certain values. This account understands embodied values as the result of design activities intended to embed those values in such systems. AI systems are here understood as a special kind of sociotechnical system that, like traditional sociotechnical systems, are composed of technical artifacts, human agents, and institutions but—in addition—contain artificial agents and certain technical norms that regulate interactions between artificial agents and other elements of the system. The specific challenges and opportunities of embedding values in AI systems are discussed, and some lessons for better embedding values in AI systems are drawn. (shrink)

Significant disagreement remains in ethics about the duties we have towards wild animals. This paper aims to mediate those disagreements by exploring how they are supported by, or diverge from, the common-sense ethical principles of non-maleficence, beneficence, autonomy and justice popular in medical ethics. We argue that these principles do not clearly justify traditional conservation or a ‘hands-off ’ approach to wild-animal welfare; instead, they support natural negative duties to reduce the harms that we cause as well as natural (...) positive duties to promote the welfare of wild animals. (shrink)

The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The (...) gazette empowers the government to monitor the spread of infection. Despite there being an infrastructure of research ethics committees in almost all hospitals in Bangladesh, a lack of such committees in the clinical setting often forces healthcare professionals to allocate scarce healthcare resources to the task. These personnel are often either influenced by materialistic matters or guided by the emergency policies, without reaching a consensus on how to allocate scarce resources in times of need, especially in the time of the COVID-19 pandemic. Ethical dilemmas often arise when a number of patients with COVID-19, especially in poor and middle-class areas, are denied care while elites are prioritized to receive such scarce resources. Resource allocation in healthcare during the COVID-19 pandemic in Bangladesh appears to be unethical and in direct conflict with the biomedical principles of non-maleficence and procedural justice. The findings of this study suggest that the Act needs substantive changes in the stipulation of policy directing hospitals in the provision of resource allocation framework. Furthermore, parliament should produce guidance outlining how to successfully implement the law with the aim of protecting public health in times of emergency, especially the COVID-19 pandemic. (shrink)

It is widely maintained that a clinical trial is ethical only if some form of equipoise between the treatments being compared obtains. To be in equipoise between two treatments A and B is to be cognitively indifferent between the statement ‘A is strictly more effective than B’ and its negation. It is natural to claim that equipoise regarding A and B is necessary for randomised assignment to treatments A and B to be beneficent and non‐maleficent and is sufficient for such (...) an assignment to be fair. Cashing this out precisely is difficult, and various forms of equipoise have been discussed which consider whose equipoise is relevant to the decision. This is to make judgement of equipoise something to be managed socially, while its prima facie significance is supposedly cognitive. Recent reconstructions of equipoise‐like concepts in epistemology give clues about how to understand equipoise cognitively. In this paper I examine some of this work and discuss how successful it has been. I suggest that while this work is promising, it still has far to go, and that while equipoise remains the best theory we have of the cognitive justification for clinical trials, it is nonetheless incoherent. (shrink)

Background There have been different ethical approaches to the issues in the history of philosophy. Two American philosophers Beachump and Childress formulated some ethical principles namely 'respect to autonomy', 'justice', 'beneficence' and 'non-maleficence'. These 'Four Principles' were presented by the authors as universal and applicable to any culture and society. Mawlana, a great figure in Sufi tradition, had written many books which not only guide people how to worship God to be close to Him, but also advise people how (...) to lead a good life to enrich their personality, as well as to create a harmonious society and a peaceful world. Methods In this study we examined the major works of Mawlana to find out which of these 'Four Principles of Bioethics' exist in Mawlana's ethical understanding. Results We have found in our study that all these principles exist in Mawlana's writings and philosophy in one form or another. Conclusions We have concluded that, further to Beachump and Childress' claim that these principles are universal and applicable to any culture and society, these principles have always existed in different moral traditions in different ways, of which Mawlana's teaching might be presented as a good example. (shrink)

Ethical aspects of management control systems are attracting increasing attention among scholars and practitioners. Much of the work centers on their aims. We complement this scholarship by applying the ethical principle of “no harm,” i.e., non-maleficence, to examine how those aims are achieved. We illustrate this approach by exploring the effects of four MCS designs on job-related stress drawing on the differentiation of stress into two dimensions: a challenge and a threat dimension. Results from a lagged field-survey with 471 (...) managers and employees from the UK and the U.S. support key predictions and offer first insights into designing MCS based on a “no harm” ethics. Our study highlights the benefits of interdisciplinary research in business ethics and hopefully encourages more work on MCS from a perspective based on the non-maleficence principle. (shrink)

This book provides a framework for approaching ethical and policy dilemmas in research with human subjects from the perspective of trust. It explains how trust is important not only between investigators and subjects but also between and among other stakeholders involved in the research enterprise, including research staff, sponsors, institutions, communities, oversight committees, government agencies, and the general public. The book argues that trust should be viewed as a distinct ethical principle for research with human subjects that complements other principles, (...) such as autonomy, beneficence, non-maleficence, and justice. The book applies the principle of trust to numerous issues, including informed consent, confidentiality, risk minimization, risks and benefits, protection of vulnerable subjects, experimental design, research integrity, and research oversight.This work also includes discussions of the history of research involving human subjects, moral theories and principles, contemporary cases, and proposed regulatory reforms. The book is useful for undergraduate and graduate students studying ethical policy issues related to research with human subjects, as well as for scientists and scholars who are interested in thinking about this topic from the perspective of trust. (shrink)

The principles of autonomy, beneficence, non-maleficence, and justice are well established ethical principles in health research. Of these principles, justice has received less attention by health researchers. The purpose of this article is to broaden the discussion of health research ethics, particularly the ethical principle of justice, to include societal considerations — who and what are studied and why? — and to critique current applications of ethical principles within this broader view. We will use a feminist intersectional approach in (...) the context of health disparities research to firmly establish inseparable links between health research ethics, social action, and social justice. The aim is to provide an ethical approach to health disparities research that simultaneously describes and seeks to eliminate health disparities. (shrink)

Machine intelligence already helps medical staff with a number of tasks. Ethical decision-making, however, has not been handed over to computers. In this proof-of-concept study, we show how an algorithm based on Beauchamp and Childress’ prima-facie principles could be employed to advise on a range of moral dilemma situations that occur in medical institutions. We explain why we chose fuzzy cognitive maps to set up the advisory system and how we utilized machine learning to train it. We report on the (...) difficult task of operationalizing the principles of beneficence, non-maleficence and patient autonomy, and describe how we selected suitable input parameters that we extracted from a training dataset of clinical cases. The first performance results are promising, but an algorithmic approach to ethics also comes with several weaknesses and limitations. Should one really entrust the sensitive domain of clinical ethics to machine intelligence? (shrink)

How are we to appraise new technological developments that may bring revolutionary social changes? Currently this is often done by trying to predict or anticipate social consequences and to use these as a basis for moral and regulatory appraisal. Such an approach can, however, not deal with the uncertainties and unknowns that are inherent in social changes induced by technological development. An alternative approach is proposed that conceives of the introduction of new technologies into society as a social experiment. An (...) ethical framework for the acceptability of such experiments is developed based on the bioethical principles for experiments with human subjects: non-maleficence, beneficence, respect for autonomy, and justice. This provides a handle for the moral and regulatory assessment of new technologies and their impact on society. (shrink)

Providing in-utero treatments to target specific conditions in the fetus is a relatively new approach in perinatal care, with the vast majority of these treatments being used off-label. The high degree of off-label medication use in the perinatal and neonatal settings raises concern for the safety of both the fetuses and expectant mothers. This report presents two examples of intra-amniotic drug administration based on reported clinical cases. From the ethical framework of medical principlism, we examine the competing ethical duties of (...) autonomy, beneficence, and non-maleficence in this setting. We then lay out three fundamental ethical principles for obtaining informed consent and maximizing clinical benefit. (shrink)

The opioid epidemic demands the development, implementation, and evaluation of innovative, research-informed practices such as diversion programs. Aritürk et al. have articulated important bioethical considerations for implementing diversion programs in resource-constrained service environments. In this commentary, we expand and advance Aritürk et al.’s discussion by discussing existing resources that can be utilized to implement diversion programs that prevent or otherwise minimize the issues of autonomy, non-maleficence, beneficence, and justice identified by Aritürk et al.

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five key (...) ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare. (shrink)

Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp (...) good clinical judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated. (shrink)

Tom Beauchamp and James Childress have always maintained that their four principles approach (otherwise known as principlism) is a globally applicable framework for biomedical ethics. This claim is grounded in their belief that the principles of respect for autonomy, non-maleficence, beneficence and justice form part of a 'common morality', or collection of very general norms to which everyone who is committed to morality subscribes. The difficulty, however, has always been how to demonstrate, at least in the absence of a (...) full-blooded analysis of the concept of morality, whether the four principles are foundational, and so globally applicable, in this way. In the recently published sixth edition of Principles of Biomedical Ethics, an imaginative and non-question-begging empirical method of determining the common morality's norms is suggested. In this paper, I outline this method, before arguing that it is difficult to see how it might be thought to achieve its purpose. (shrink)

The bioethical principle of autonomy is of paramount importance within medical practice. The extent to which a patient’s autonomy overlaps or conflicts with the physician’s duty of beneficence and non-maleficence, however, is not so clear cut, especially for those cases in which the patient’s request for medical intervention goes against the physician’s advice, either because of personal belief or because there is uncertainty regarding the therapeutic approach. Body integrity dysphoria (BID) is a condition that has been included recently in (...) the International Classification of Diseases, 11th edition (ICD-11). It may lead an affected individual to develop an intense desire to remove a specific body part in order to restore congruity between their body and their mind. Thus, its occurrence creates challenging moral and ethical dilemmas for the medical world (Loriga, 2023). The aim of this study was to investigate how Czech physicians understood, assessed and supported patient autonomy regarding requests for invasive body modifications. The objective was to produce a blueprint regarding how much a patient could influence the medical treatment they could gain within the Czech medical system and to develop a comparison with the ethical challenges of BID. A five-section survey was designed and submitted to Czech physicians on topics relevant to the BID debate. On the surface, the results showed an apparent predisposition toward collaboration between doctors and patients. However, further investigation showed that this supposed collaboration crumbled as the physiological risk-reward ratio moved further toward risk, which caused physicians progressively to rely less on the patient’s opinion and psychological needs. Moreover, a strongly authoritarian approach was evident, which became overwhelming in cases of amputation requests and removed, a priori, any collaboration. The results indicate that the Czech medical system does not accept or comprehend fully patients’ psychological needs, and therefore the BID phenomenon is a long way from being understood, which requires a fundamental paradigm shift. (shrink)

The need for research to advance scientific understanding must be balanced with ensuring the rights and wellbeing of participants are safeguarded, with some research topics posing more ethical quandaries for researchers than others. Moral injury is one such topic. Exposure to potentially morally injurious experiences can lead to significant distress, including post-traumatic stress disorder, depression, and selfinjury. In this article, we discuss how the rapid expansion of research in the field of moral injury could threaten the wellbeing, dignity and integrity (...) of participants. We also examine key guidance for carrying out ethically responsible research with participants’ rights to self-determination, confidentiality, non-maleficence and beneficence discussed in relation to the study of moral injury. We describe how investigations of moral injury are likely to pose several challenges for researchers including managing disclosures of potentially illegal acts, the risk of harm that repeated questioning about guilt and shame may pose to participant wellbeing in longitudinal studies, as well as the possible negative impact of exposure to vicarious trauma on researchers themselves. Finally, we offer several practical recommendations that researchers, research ethics committees and other regulatory bodies can take to protect participant rights, maximise the potential benefits of research outputs and ensure the field continues to expand in an ethically responsible way. (shrink)

Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for describing and assessing morally problematic situations in healthcare. However, surprisingly scarce attention has been devoted to how epistemic injustice relates to physicians’ professional duties on a conceptual level. I argue that epistemic injustice, specifically testimonial, collides with physicians’ duty of nonmaleficence and should thus be actively fought against in healthcare encounters on the (...) ground of professional conduct. I do so by fleshing out how Fricker’s conception of testimonial injustice conflicts with the duty of nonmaleficence as defined in Beauchamp and Childress on theoretical grounds. From there, I argue that testimonial injustice produces two distinct types of harm, epistemic and non-epistemic. Epistemic harms are harms inflicted by the physician to the patient qua knower, whereas non-epistemic harms are inflicted to the patient qua patient. This latter case holds serious clinical implications and represent a failure of the process of due care on the part of the physician. I illustrate this through examples taken from the literature on fibromyalgia syndrome and show how testimonial injustice causes wrongful harm to patients, making it maleficent practice. Finally, I conclude on why nonmaleficence as a principle will not be normatively enough to fully address the problem of epistemic injustice in healthcare but nevertheless may serve as a good starting point in attempting to do so. (shrink)

Digital apps using Bluetooth to log proximity events are increasingly supported by technologists and governments. By and large, the public debate on this matter focuses on privacy, with experts from both law and technology offering very concrete proposals and participating to a lively debate. Far less attention is paid to effective incentives and their fairness. This paper aims to fill this gap by offering a practical, workable solution for a promising incentive, justified by the ethical principles of non-maleficence, beneficence, (...) autonomy and justice. This incentive is a free phone optimised for running such app. (shrink)

The practice of coercive measures in psychiatry is controversial. Although some have suggested that it may be acceptable if patients are a danger to others or to themselves, others committed themselves to eliminate it. Ethical, legal and clinical considerations become more complex when the mental incapacity is temporary and when the coercive measures serve to restore autonomy. We discuss these issues, addressing the conflict between autonomy and beneficence/non-maleficence, human dignity, the experiences of patients and the effects of coercive measures. (...) We argue that an appeal to respect autonomy and/or human dignity cannot be a sufficient reason to reject coercive measures. All together, these ethical aspects can be used both to support and to reject a non-seclusion approach. The total lack of controlled trials about the beneficial effects of coercive measures in different populations however, argues against the use of coercive measures. (shrink)

People in extraordinary situations are vulnerable. As research participants, they are additionally threatened by abuse or exploitation and the possibility of harm through research. To protect people against these threats, informed consent as an instrument of self-determination has been introduced. Self-determination requires autonomous persons, who voluntarily make decisions based on their values and morals. However, in nursing research, this requirement cannot always be met. Advanced age, chronic illness, co-morbidity and frailty are reasons for dependencies. These in turn lead to limited (...) abilities or opportunities for decision-making and self-determination. Exclusion of vulnerable people from research projects would disadvantage them by not covering their needs, which would violate the ethical principles of justice and beneficence. Commonly, vulnerability is attributed to social groups. The consequence for individuals, attributed as belonging to such a vulnerable group, is that the principles of respect for autonomy, justice and beneficence are subordinated to the principle of non-maleficence, understood as avoiding the risk to cause more harm than good. In addition, group-specific attribution could lead to stigmatizing because labelling a person as deviation from a norm violates integrity. For clinical nursing research, the question arises how the protection of vulnerable people could be granted without compromising ethical principles. The concept of relational ethics provides a possible approach. It defines vulnerability as the relation between a person’s health status and the extent to which this person is dependent on the researcher and the research context. Vulnerability is not attributed solely to a person but to a situation, meaning the person is viewed in context. By combining vulnerability as a context-related and situational concept with existing approaches of informed consent, the different ethical principles can be balanced and preserved at every step of the research process. (shrink)

Through the exponential growth in digital devices and computational capabilities, big data technologies are putting pressure upon the boundaries of what can or cannot be considered acceptable from an ethical perspective. Much of the literature on ethical issues related to big data and big data technologies focuses on separate values such as privacy, human dignity, justice or autonomy. More holistic approaches, allowing a more comprehensive view and better balancing of values, usually focus on either a design-based approach, in which it (...) is tried to implement values into the design of new technologies, or an application-based approach, in which it is tried to address the ways in which new technologies are used. Some integrated approaches do exist, but typically are more general in nature. This offers a broad scope of application, but may not always be tailored to the specific nature of big data related ethical issues. In this paper we distil a comprehensive set of ethical values from existing design-based and application-based ethical approaches for new technologies and further focus these values to the context of emerging big data technologies. A total of four value lists were selected for this. The integrated list consists of a total of ten values: human welfare, autonomy, non-maleficence, justice, accountability, trustworthiness, privacy, dignity, solidarity and environmental welfare. Together, this set of values provides a comprehensive and in-depth overview of the values that are to be taken into account for emerging big data technologies. (shrink)

The urgency of the resuscitation and the impaired ability of the patient to make a reasonable autonomous decision both conspire against adequate consideration of the principles of medical ethics. Informed consent is usually not possible for these reasons and this leads many to consider that consent is not required for resuscitation, because resuscitation brings benefit and prevents harm and because the patient is not in a position to give or withhold consent. However, consent for resuscitation is required and the common (...) models employed for this purpose are presumed consent or consent from a patient proxy. However, if we are to honour the principles of respect for patient autonomy, as well as beneficence and non-maleficence, when starting and continuing resuscitation we must try and achieve the best balance between benefit and harm from the patient's perspective. The concept of professional substituted judgment involves the resuscitators gathering as much information about the patient as they possibly can, including any previously expressed attitudes towards such a situation, and combining this with their acquired professional knowledge of the likely benefits and harms of the resuscitation endeavour and then exercising their moral imagination, imagining themselves as the patient, and asking "would I want this treatment?" By employing professional substituted judgment resuscitators should recognise when the balance of benefit and harm becomes unfavourable from the patient's perspective and at this point they have a moral obligation to withdraw resuscitation as they can no longer presume the patient's consent. In this way the principles of beneficence, non-maleficence and respect for patient autonomy are more favourably balanced than under other resuscitation decision making processes. (shrink)

The ethics of firefighting is a seriously underexplored field. This is unfortunate, since firefighting raises issues of great social importance and has the potential to inform moral theorizing. In the first part of this paper, I explore possible reasons why firefighting ethics has received so little academic attention and argue that it warrants study in its own right. I do so primarily by comparing firefighting ethics to medical ethics, demonstrating their close relationship yet pointing out important differences: firefighting is less (...) professionalized than medicine, the caregiver-patient relationship is not central in firefighting, firefighters need to concern themselves with other values than life and limb, they face greater and qualitatively different risks than medical personnel, and they have to make almost every operative decision under conditions of temporal stress. In the second part of the paper, I argue that some elements from medical ethics may be adapted for use in firefighting ethics. I illustrate this by applying four mid-level principles from mainstream medical ethics to firefighting – the principles of autonomy, non-maleficence, beneficence, and justice. I argue that they are indeed applicable in firefighting ethics, but that they need modification and their relative weight is different. Respect for autonomy is of limited importance in firefighting. Non-maleficence is important, and beneficence is central. The special principle of beneficence for firefighters is best thought of as grounded in firefighters’ contractual obligations rather than in a general principle that one should help someone in peril. As regards the principle of justice, there is a case for applying a utilitarian principle of justice on the operative level and a principle of a decent minimum aid on the policy level. The latter can be brought about by comparatively simple and low-cost means, such as a volunteer fire service and subsidized fire equipment. (shrink)

In the paper, titled ‘Choosing death in unjust conditions: hope, autonomy and harm reduction,’ Wiebe and Mullin argue that people living in unjust social conditions are sufficiently autonomous to request medical assistance in dying (MAiD). The ethical issue is that some people may request MAiD primarily because of unjust social conditions, not their illness, disease, disability or decline in capability. It is easily agreed that people living in unjust social conditions can be autonomous. Nevertheless, Wiebe and Mullin fail to appreciate (...) that autonomy is only a necessary condition for MAiD. In addition to autonomy, one must decide that providing assisted dying to a patient because they are living in unjust social conditions is ethical. Central to making this ethical decision is the principle of non-maleficence, famously articulated as ‘do no harm.’ The authors admit that performing MAiD in response to unjust social circumstances is harmful, but they justify this harmful action by appealing to the principle of harm reduction. A fundamental flaw of their approach is that it relies on the legislative definition of intolerable suffering, which is based on circular reasoning and given that 99.2% of patients that have applied for MAiD satisfied this criterion, it is essentially equivalent to no standard/criterion. Canadian society is struggling with the ethical implications of its permissive MAiD programme, and, fundamental to this debate, will be determining the proper balance between autonomy and non-maleficence for people living in unjust social conditions. (shrink)

The Human Organ Transplantation Act came into officially force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors. The Act was amended by the Parliament on January 8, 2018, with the changes coming into effect shortly afterwards on January 28. The Act was revised to extend a living donor pool from close relatives to include certain other relatives such as grandparents, grandchildren, and first cousins. The Act was also revised to allow individuals to prioritize (...) family members in receiving their organs after their death. The aim of this paper is not to carry out an ethical analysis of the Act as a whole but only to focus on aspects relating to priority access for family members to organs. Despite Islam encouraging Muslims to be sympathetic, and to save the life of any member of humankind, saving the life of a relative through organ donation is even more highly valued. The collective and extended structure of the family impacts on the provisions of the Act that only allows Bangladeshis to legally donate their organs to save the lives of relatives and allows individuals to prioritize family members. Recent progress in the practice of organ transplantation raises a number of ethical dilemmas around the allocation of available organs in the context of organ scarcity. A key purpose of introducing incentive into the system of organ allocation is to increase the number of donations from living relatives and initiation of vital organ donations from brain-dead donors. However, allocation criteria based on a living organ donation incentive system would appear to be unethical because there is no provision in the Act with regard to financial compensation for a distant relative donor’s post-operative care in the absence of healthcare coverage. Receiving organs from a distant relative without giving financial compensation for post-operative care places them in a grave health condition and violates the biomedical principle of non-maleficence. An incentive system around brain-dead donors would appear to be ethical as the amended Act allows individuals to prioritize relatives in receiving their organs after death. This provision is intended to initiate the transplantation of vital organs from brain-dead donors as families might bear the cost of keeping the organs alive for transplantation. Regular reassessment of the impact of the Act is necessary to maximize the donation rate of transplantable organs using ethical means. (shrink)

Getting people not to harm others is a central goal of morality. But while it is commonly perceived that those who benefit others merit gratitude, those who do not harm others are not ordinarily thought to merit anything. I attempt to argue against this, claiming that all the arguments against gratitude to the non-maleficent are unsuccessful. Finally, I explore the difference it would make if we thought that we owe gratitude to those who do not harm us.

The use of drones in public healthcare is suggested as a means to improve efficiency under constrained resources and personnel. This paper begins by framing drones in healthcare as a social experiment where ethical guidelines are needed to protect those impacted while fully realizing the benefits the technology offers. Then we propose an ethical framework to facilitate the design, development, implementation, and assessment of drones used in public healthcare. Given the healthcare context, we structure the framework according to the four (...) bioethics principles: beneficence, non-maleficence, autonomy, and justice, plus a fifth principle from artificial intelligence ethics: explicability. These principles are abstract which makes operationalization a challenge; therefore, we suggest an approach of translation according to a values hierarchy whereby the top-level ethical principles are translated into relevant human values within the domain. The resulting framework is an applied ethics tool that facilitates awareness of relevant ethical issues during the design, development, implementation, and assessment of drones in public healthcare. (shrink)

Biomarker-based predictive tests for subjectively asymptomatic Alzheimer’s disease (AD) are utilized in research today. Novel applications of artificial intelligence (AI) promise to predict the onset of AD several years in advance without determining biomarker thresholds. Until now, little attention has been paid to the new ethical challenges that AI brings to the early diagnosis in asymptomatic individuals, beyond contributing to research purposes, when we still lack adequate treatment. The aim of this paper is to explore the ethical arguments put forward (...) for AI aided AD prediction in subjectively asymptomatic individuals and their ethical implications. The ethical assessment is based on a systematic literature search. Thematic analysis was conducted inductively of 18 included publications. The ethical framework includes the principles of autonomy, beneficence, non-maleficence, and justice. Reasons for offering predictive tests to asymptomatic individuals are the right to know, a positive balance of the risk-benefit assessment, and the opportunity for future planning. Reasons against are the lack of disease modifying treatment, the accuracy and explicability of AI aided prediction, the right not to know, and threats to social rights. We conclude that there are serious ethical concerns in offering early diagnosis to asymptomatic individuals and the issues raised by the application of AI add to the already known issues. Nevertheless, pre-symptomatic testing should only be offered on request to avoid inflicted harm. We recommend developing training for physicians in communicating AI aided prediction. (shrink)

Home births continue to constitute only a small percentage of all deliveries in the United States, in part because of concerns about their safety. While the literature is decidedly mixed in regard to the degree of risk, there are several studies that report that home birth may at times entail a small absolute increase in perinatal risks in circumstances that cannot always be anticipated prior to the onset of labor. While the definition of “small” will vary between individuals, and publications (...) vary in the level of risk they ascribe to birth at home, studies with the least methodological flaws and with adequate power often cite an excess death rate in the range of one per thousand.Home birth is, in that regard, but one example of patients’ choices and plans that sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. Our intention in this opinion piece is not to advocate for or against home birth. Rather, we recognize that home birth is but one example of a patient choice that might differ from what a provider feels is in a woman’s best interests.In this article we will discuss ethical considerations in such circumstances using home birth as an example. We consider in this article how the ethical principles of respect for autonomy and non-maleficence can be balanced using, among other examples, the choice by some for a home birth. We discuss how absolute rather than relative risk should guide individuals’ evaluation of patient choices. We also consider how in some circumstances, the value and safety added by a physician’s participation may outweigh a potentially small increment in absolute risk that might result from a patient’s decision to deliver at home because of a perceived physician endorsement.We recognize, however, that doctors and midwives participating in choices they have not recommended, or may even believe will lead to or increase risk for adverse outcomes, presents dilemmas and raises important questions. When does respect for patient choice and autonomy become support for poor decision making? When is participation not respectful but enabling? Finally we discuss the role and responsibility of organized medicine in making all births as safe as possible. (shrink)

How are we to appraise new technological developments that may bring revolutionary social changes? Currently this is often done by trying to predict or anticipate social consequences and to use these as a basis for moral and regulatory appraisal. Such an approach can, however, not deal with the uncertainties and unknowns that are inherent in social changes induced by technological development. An alternative approach is proposed that conceives of the introduction of new technologies into society as a social experiment. An (...) ethical framework for the acceptability of such experiments is developed based on the bioethical principles for experiments with human subjects: non-maleficence, beneficence, respect for autonomy, and justice. This provides a handle for the moral and regulatory assessment of new technologies and their impact on society. (shrink)

Traditional medical practices and relationships are changing given the widespread adoption of AI-driven technologies across the various domains of health and healthcare. In many cases, these new technologies are not specific to the field of healthcare. Still, they are existent, ubiquitous, and commercially available systems upskilled to integrate these novel care practices. Given the widespread adoption, coupled with the dramatic changes in practices, new ethical and social issues emerge due to how these systems nudge users into making decisions and changing (...) behaviours. This article discusses how these AI-driven systems pose particular ethical challenges with regards to nudging. To confront these issues, the value sensitive design approach is adopted as a principled methodology that designers can adopt to design these systems to avoid harming and contribute to the social good. The AI for Social Good factors are adopted as the norms constraining maleficence. In contrast, higher-order values specific to AI, such as those from the EU High-Level Expert Group on AI and the United Nations Sustainable Development Goals, are adopted as the values to be promoted as much as possible in design. The use case of Amazon Alexa's Healthcare Skills is used to illustrate this design approach. It provides an exemplar of how designers and engineers can begin to orientate their design programs of these technologies towards the social good. (shrink)