Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

Microethics is about the ethics of everyday clinical practice. The subtle nuances in communication between doctor and patient (the doctor’s choice of words, tone, body language, gestures, etc.) can influence the exercise of the patient’s autonomy. The four models of the doctor- patient/physician-patient relationship (paternalistic, informative, interpretive, deliberative) weigh respect for autonomy and beneficence in varying proportions. Each model may be appropriate in certain circumstances. This article considers these models from the perspective of microethics and the unique dimensions (...) created by the doctor-child-parent relationship. In particular, the article considers the nuances to the autonomy principle created by the child’s developing maturity and the parent’s role as a co-fiduciary of the child’s interests. Ultimately, the deliberative model seems most appropriate to the paediatric setting, since it accommodates the child’s developing maturity in making healthcare-related decisions. This model infuses care into the doctor’s communication with the child and parent. (shrink)

In almost every clinical interaction, clinicians must navigate interpersonal challenges with near‐instantaneous responses to patients. Yet medical ethics has largely overlooked these small, interpersonal exchanges, instead focusing on “big” ethical problems, such as euthanasia, brain death, or genetic modification. In 1995, Paul Komesaroff proposed the concept of microethics as a nonprinciplist approach to ethics that focuses on “what happens in every interaction between every doctor and every patient.” We aim to develop a microethics framework to guide everyday clinical (...) encounters, with a special focus on communication with patients and family members. We will advance three core insights: First, communication is an ethical act in ways seldom considered. Second, microethics is an essential lens through which to view the ethics of communication. Third, virtue can bridge reflective and automatic processes. Our intuitionist framework for microethics is thus based on this understanding of the role of virtue, and we propose six virtues that contribute to the goal of healing communication. (shrink)

ABSTRACT The future development of bioethics has been discussed in a number of articles in recent years, principally with regard to the trend towards empirical studies. However, what is meant by empirical studies in this context and how it is to be used concretely have been subject to varying interpretations. The purpose of this article is to develop what we term the microethical approach as a concrete method for an empirically driven bioethics. By adopting a microethical perspective, we will illustrate (...) an analytical concept for describing and demonstrating how, as a result of contextual circumstances and forms of understanding, different individuals in their everyday life adopt different coping strategies and behavior patterns in relation to ethical values. From a deepened perspective, the complexity of human behavior becomes apparent, and knowledge is gained about how moral problems are perceived and construed by those whom they in fact affect. We intend first and foremost to develop the microethical methodology by elucidating the methods and approaches that can help in clarifying moral dilemmas on a microethical level, and how the relationship between the empirical material and the ethical analysis evolves over the course of the analysis. This is exemplified by a study of caregivers’ entrance into patients’ private lives through the provision of care and assistance in the home. (shrink)

It has been argued that ethical frameworks for data science often fail to foster ethical behavior, and they can be difficult to implement due to their vague and ambiguous nature. In order to overcome these limitations of current ethical frameworks, we propose to integrate the analysis of the connections between technical choices and sociocultural factors into the data science process, and show how these connections have consequences for what data subjects can do, accomplish, and be. Using healthcare as an example, (...) attention to sociocultural conversion factors relevant to health can help in navigating technical choices that require broader considerations of the sociotechnical system, such as metric tradeoffs in model validation, resulting in better ethical and technical choices. This approach promotes awareness of the ethical dimension of technical choices by data scientists and others, and that can foster the cultivation of 'ethical skills' as integral to data science. (shrink)

Three frames of reference for engineering ethics are discussed—individual, professional and social—which can be further broken down into “microethics” concerned with individuals and the internal relations of the engineering profession and “macroethics” referring to the collective social responsibility of the engineering profession and to societal decisions about technology. Few attempts have been made at integrating microethical and macroethical approaches to engineering ethics. The approach suggested here is to focus on the role of professional engineering societies in linking individual and (...) professional ethics and in linking professional and social ethics. A research program is outlined using ethics support as an example of the former, and the issuance of position statements on product liability as an example of the latter. (shrink)

Experiments in Love and Death is about the depth and complexity of the ethical issues that arise in illness and medicine. In his concept of 'microethics' Paul Komesaroff provides an alternative to the abstract debates about principles and consequences that have long dominated ethical thought. He shows how ethical decisions are everywhere: in small decisions, in facial expressions, in almost inconspicuous acts of recognition and trust. Through powerful descriptions of case studies and clear and concise explanations of contemporary philosophical (...) theory the book brings discussions about ethics in medicine back to where they belong-to the level of the everyday experience where people actually live, suffer and hope. A fresh and evocative look at the changing world of ethics as it applies to health and illness, this is an important book for all those touched by illness or suffering. About the author Paul Komesaroff is a physician and philosopher at Monash University in Melbourne, Australia. His books include Objectivity, Science and Society, Troubled Bodies, Sexuality and Medicine (ed. with Philipa Rothfield and John Wiltshire) and Pathways to Reconciliation (ed. with Philipa Rothfield and Cleo Fleming). (shrink)

In the past few years, scholars have been questioning whether the current approach in data ethics based on the higher level case studies and general principles is effective. In particular, some have been complaining that such an approach to ethics is difficult to be applied and to be taught in the context of data science. In response to these concerns, there have been discussions about how ethics should be “embedded” in the practice of data science, in the sense of showing (...) how ethical issues emerge in small technical choices made by data scientists in their day-to-day activities, and how such an approach can be used to teach data ethics. However, a precise description of how such proposals have to be theoretically conceived and could be operationalized has been lacking. In this article, we propose a full-fledged characterization of ‘embedding’ ethics, and how this can be applied especially to the problem of teaching data science ethics. Using the emerging model of ‘microethics’, we propose a way of teaching daily responsibility in digital activities that is connected to the higher level ethical challenges discussed in digital/data ethics. We ground this microethical approach into a virtue theory framework, by stressing that the goal of a microethics is to foster the cultivation of moral virtues. After delineating this approach of embedding ethics in theoretical detail, this article discusses a concrete example of how such a ‘micro-virtue ethics’ approach could be practically taught to data science students. (shrink)

Engineering ethics entails three frames of reference: individual, professional, and social. “Microethics” considers individuals and internal relations of the engineering profession; “macroethics” applies to the collective social responsibility of the profession and to societal decisions about technology. Most research and teaching in engineering ethics, including online resources, has had a “micro” focus. Mechanisms for incorporating macroethical perspectives include: integrating engineering ethics and science, technology and society (STS); closer integration of engineering ethics and computer ethics; and consideration of the influence (...) of professional engineering societies and corporate social responsiblity programs on ethical engineering practice. Integrating macroethical issues and concerns in engineering ethics involves broadening the context of ethical problem solving. This in turn implies: developing courses emphasizing both micro and macro perspectives, providing faculty development that includes training in both STS and practical ethics; and revision of curriculum materials, including online resources. Multidisciplinary collaboration is recommended 1) to create online case studies emphasizing ethical decision making in individual, professional, and societal contexts; 2) to leverage existing online computer ethics resources with relevance to engineering education and practice; and 3) to create transparent linkages between public policy positions advocated by professional societies and codes of ethics. (shrink)

In the past few years, the ethical ramifications of AI technologies have been at the center of intense debates. Considerable attention has been devoted to understanding how a morally responsible practice of data science can be promoted and which values have to shape it. In this context, ethics and moral responsibility have been mainly conceptualized as compliance to widely shared principles. However, several scholars have highlighted the limitations of such a principled approach. Drawing from microethics and the virtue theory (...) tradition, in this paper, we formulate a different approach to ethics in data science which is based on a different conception of “being ethical” and, ultimately, of what it means to promote a morally responsible data science. First, we develop the idea that, rather than only compliance, ethical decision-making consists in using certain moral abilities, which are cultivated by practicing and exercising them in the data science process. An aspect of virtue development that we discuss here is moral attention, which is the ability of data scientists to identify the ethical relevance of their own technical decisions in data science activities. Next, by elaborating on the capability approach, we define a technical act as ethically relevant when it impacts one or more of the basic human capabilities of data subjects. Therefore, rather than “applying ethics”, data scientists should cultivate ethics as a form of reflection on how technical choices and ethical impacts shape one another. Finally, we show how this microethical framework concretely works, by dissecting the ethical dimension of the technical procedures involved in data understanding and preparation of electronic health records. (shrink)

In the first part of the paper, the author discusses the origin and obligation of the medical profession and argues that the duty of fidelity in the context of a patient–professional relationship (PPR) is the central obligation of medical professionals. The duty of fidelity entails seeking the patient’s best interests even at the expense of the professional’s own, and refusing to treat a risk-patient infected by SARS is a breach of fidelity because the medical professional is involved in a situation (...) of conflict of interests and places his/her own health interests ahead of the patient. The author attributes the failure to the fact that professional ethical codes are not legally enforceable, and this failure at the microethical level damages the integrity of the profession at the macroethical level. The author argues that professional autonomy must be subordinated to professional fidelity for the medical profession to survive as a social institution. In the second part of the paper, the author shows that the PPR has most of the important attributes of a fiduciary relationship, and analyzes several important court cases in some common law jurisdictions to illustrate the increasing importance of fiduciary law in adjudicating disputes between patients and medical professionals, and appeals to law courts and legislatures to apply more stringent fiduciary principles on the medical profession to ensure that the professional duty of fidelity is enforced and the goal of medicine fulfilled for the interests of members of the community who has established the medical profession in the first place. (shrink)

In a 2015 Hastings Center Report essay, Robert Truog and his coauthors argued that the clinical ethics portion of medical education should cast both a wider and a finer net than is sometimes realized. Many of the morally important moments in patient care are missed if we teach only general moral principles, they held; we also need to give attention to an indefinite stream of “microethical” decisions in everyday clinical practice. In the current issue, Truog plays out a similar theme (...) as he discusses the moral significance of touching a patient and asks how artificial intelligence and other emerging technologies may change this ancient part of the physician‐patient relationship. And one of the articles in this issue examines the significance of clinicians’ relationships with other clinicians. Donna Chen and colleagues propose, in effect, that “teamwork” has become part of the ethics of everyday clinical practice—a new addition to what Larry Churchill and David Schenck called the “healing skills.”. (shrink)

Discussions of ethics within in-service teacher education tend to focus on microethical concerns (e.g., discipline) that deal with decision making at interpersonal levels. Issues concerning educational technology are no exception. Yet, as teachers choose and are expected to integrate technological devices (e.g., laptops) and sociotechnical systems (e.g., learning management systems) into pedagogical practices, their classrooms and schools may become implicated in macroethical issues (e.g., electronic waste) that reach beyond the local consequences of their direct actions. Necessitated by tight couplings of (...) technology and education, this article presents the concept of macroethics for teacher educators by grounding it in three areas of concern: obsolescence, automation, and big data. These three areas offer opportunities to make economic and environmental issues more central to case studies on technology in teacher education. At the same time, teacher educators will need to put emphasis on critical reflection and collective action in units on macroethics since the limited impact of individual decision-making on these issues may put teachers in double binds (i.e., dilemmas with contradictory demands). (shrink)

This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women's powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care (...) to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously‐based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women's reproductive self‐determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone‐marrow or blood donations for their children's survival. Women's unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity. (shrink)

This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women's powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care (...) to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously‐based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women's reproductive self‐determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone‐marrow or blood donations for their children's survival. Women's unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity. (shrink)

Traditional engineering courses typically approach teaching and problem solving by focusing on the physical dimensions of those problems without consideration of dynamic social and ethical dimensions. As such, projects can fail to consider human rights, community questions and concerns, broader impacts upon society, or otherwise result in inequitable outcomes. And, despite the fact that students in engineering receive training on the Professional Code of Ethics for Engineers, to which they are expected to adhere in practice, many students are unable to (...) recognize and analyze real-life ethical challenges as they arise. Indeed, research has found that students are typically less engaged with ethics—defined as the sensitivity and judgment of microethics and macroethics, sensitivity to diversity, and interest in promoting organizational ethical culture—at the end of their engineering studies than they were at the beginning. As such, many studies have focused on developing and improving the curriculum surrounding ethics through, for instance, exposing students to ethics case studies. However, such ethics courses often present a narrow and simplified view of ethics that students may struggle to integrate with their broader experience as engineers. Thus, there is a critical need to unpack the complexity of ethical behavior amongst engineering students in order to determine how to better foster ethical judgment and behavior. Promoting ethical behavior among engineering students and developing a culture of ethical behavior within institutions have become goals of many engineering programs. Towards this goal, we would like to present an overview of the current scholarship of engineering ethics and propose a theoretical framework of ethical behavior using a review of articles related to engineering ethics from 1997-2020. The review engages in theories across disciplines including philosophy, education, and psychology. In this work-in-progress paper, we present a subset of initial results based on a review of the first 50 articles out of the systematically selected 409 articles from Springer, Engineering Village, and EBSCO-Education Full Text. Preliminary results identify two major kinds of drivers of ethical behavior, namely individual level ethical behavior drivers and institutional drivers. Our preliminary results indicate that a sensitivity to both microethics and macroethics as well as the implicit and explicit understanding of ethics are essential in promoting ethical behavior amongst students. Furthermore, while drivers of ethical behavior at the individual level is important, one should not ignore the roles of the drivers of ethical behavior at the institutional level in promoting a collective ethical culture within organizations. The review also points to a need to focus on increasing students’ macroethical sensitivity to topics such as sustainability and protection of human rights. This research thus addresses the need, driven by existing scholarship, 2 to identify a conceptual framework for explaining how ethical judgment and behavior in engineering can be further promoted. (shrink)

A collection of stories by bioethicists writing about their own illnesses displays the importance of microethics. From this perspective, ethics happens not in the application of principles to specific decisions, but rather in the moment-to-moment flow of clinical interaction, as healthcare workers and patients make decisions, especially in their use of language. Microethical issues that are common to multiple stories are described as dense junctures of ethical concern. Three junctures are discussed in detail: conflicts between medical and patient rationalities, (...) issues of how clinicians represent patients, and practices of truth telling. These junctures are illustrated with examples from the bioethicists’ personal stories of treatment. (shrink)

The ethics of social responsibility is discussed in reference to six case vignettes drawn from forensic psychology. A definitional model of social responsibility is proposed, and two unequal components of the concept - respect for the individual and concern for social welfare - are identified. The sources of ethical conflict in regard to social responsibility are enumerated. Scholarly criticism of the value orientation of forensic psychology is reviewed, and forensic psychology is contrasted with social policy advocacy efforts made by organized (...) psychology. The social responsibility obligations of psychologists in the microethical sphere, where their actions affect individuals, are diffentiated from the obligations psychology has when operating in the macroethical sphere of social policy. The ethical problems inherent in policy advocacy brought about by individual psychologists working with individuals are underscored: the inevitable element of deception, the violation of role integrity, and the circumvention of social structures and institutions that safeguard the rights of individuals. (shrink)

The paper provides a critical review of the debate on the foundations of Computer Ethics (CE). Starting from a discussion of Moor’s classic interpretation of the need for CE caused by a policy and conceptual vacuum, five positions in the literature are identified and discussed: the “no resolution approach”, according to which CE can have no foundation; the professional approach, according to which CE is solely a professional ethics; the radical approach, according to which CE deals with absolutely unique issues, (...) in need of a unique approach; the conservative approach, according to which CE is only a particular applied ethics, discussing new species of traditional moral issues; and the innovative approach, according to which theoretical CE can expand the metaethical discourse with a substantially new perspective. In the course of the analysis, it is argued that, although CE issues are not uncontroversially unique, they are sufficiently novel to render inadequate the adoption of standard macroethics, such as Utilitarianism and Deontologism, as the foundation of CE and hence to prompt the search for a robust ethical theory. Information Ethics (IE) is proposed for that theory, as the satisfactory foundation for CE. IE is characterised as a biologically unbiased extension of environmental ethics, based on the concepts of information object/infosphere/entropy rather than life/ecosystem/pain. In light of the discussion provided in this paper, it is suggested that CE is worthy of independent study because it requires its own application-specific knowledge and is capable of supporting a methodological foundation, IE. (shrink)

In the Hastings Center Report's July‐August 2022 issue, articles by Jessica Amalraj and Kavita Shah Arora and by Inmaculada de Melo‐Martín take up very different concerns under the broad topic of reproductive ethics and public policy. Amalraj and Arora call for public deliberation and consensus building to revise a Medicaid sterilization policy, and de Melo‐Martín argues that social resources should not be used to support reproductive embryo editing but should instead be put toward pre‐ and postnatal interventions that, compared to (...) embryonic genome editing, can help far more people have children who are healthy and genetically related to them. The third article, by Bryan Sisk and James M. DuBois, offers a framework to guide clinicians in their everyday communication with patients and their family members. Elsewhere in the issue are arguments about the responsibilities health care organizations have to address large societal problems affecting well‐being. (shrink)

This paper focuses on the question of What kind of engineering ethics (EE) is needed to develop holistic engineers who can practice and promote the principles of sustainable development? -/- It is argued that, given the existence of other models, an approach to EE, as argued for at EESD 2016, centred on “training engineers for handling ethical dilemmas in sustainability contexts” (Lundqvist and Svanstrom 2016) is inadequate to address the sustainability challenge facing engineers.. We contend that while EE is now (...) a diverse and fragmented field sociological tools can be used to understand this diversity. A framework is offered for understanding different approaches. This is used as the basis for arguing for a more extended and broad approach which allows us to focus on the relationship between social structure and human action and the need for “adequate social institutions and structures” (Becker 2012: 28) to enable ethical action. Thus engineers not should only understand the constraints and enablers emanating from the environments in which they work but can also strive for change in these environments. (shrink)