BackgroundAt the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients.MethodsBetween April and November 2021, the Ethics and Oncology (...) Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint. We used a mainly qualitative methodological approach based on questionnaires and interviews.ResultsIn April 2021, 29 cancer patients refused or were reluctant to be vaccinated. Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal. One of the main reasons for the decrease in refusals was probably the introduction of the “pass sanitaire” in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients.ConclusionWe identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between “the recommendation of anti-COVID-19 vaccination” and “free will”, and the duty to “protect each other”. Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life, or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished. (shrink)

Contemporary Christian ethics encounters the challenge to communicate genuinely Christian normative orientations within the scientific debate in such a way as to render these orientations comprehensible, and to maintain or enhance their plausibility even for non-Christians. This essay, therefore, proceeds from a biblical motif, takes up certain themes from the Christian tradition (in particular the idea of social justice), and connects both with a compelling contemporary approach to ethics by secular moral philosophy, i.e. with Axel Honneth's reception of Hegel, as (...) based on Hegel's theory of recognition. As a first step, elements of an ethics of recognition are developed on the basis of an anthropological recourse to the conditions of intersubjective encounters. These conditions are then brought to bear on the idea of social justice, as developed in the social-Catholic tradition, and as systematically explored in the Pastoral Letter of the United States Conference of Catholic Bishops, Economic Justice For All (1986). Proceeding from this basis, aspects of a Christian ethics of community service with regard to long-term care can be defined. (shrink)

One of the most common contemporary approaches for developing an ethics of artificial intelligence (AI) involves elaborating guiding principles. This essay explores the limitations of this approach, using the history of bioethics as a comparative case. The examples of bioethics and recent AI ethics suggest that principles are difficult to implement in everyday practice, fail to direct individual action, and can frequently result in a pure proceduralism. The essay encourages an additional attention to virtue, which forms the dispositions (...) of actors, directs them to valued ends, and encourages right action in particular situation to complement principles. Practices and professions like medicine or warfighting that already have rich traditions of reflection on virtue ethics will be especially fruitful fields for developing an AI ethics of virtue. (shrink)

This essay contrasts the notions of charity employed by Traditional Christianity and by liberal cosmopolitan bioethics, arguing that: (1) bioethics attempts to reconstruct the notion of charity in a manner that is caustic to the Traditional Christian moral vision, (2) Christians are, on the whole, more charitable than proponents of bioethics' reconstructed view (even given the standards of the latter), and (3) the theistically oriented conception of charity employed by Traditional Christianity cannot be expressed in (...) bioethics' purportedly neutral public vocabulary. The upshot is that, in the name of neutrality and pluralism, liberal cosmopolitan bioethicists seek to impose an impoverished moral vocabulary that reflects liberal cosmopolitan ideology while excluding input from Traditional Christianity and other non-liberal-humanistic moral visions. (shrink)

Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of (...) framing central decision problems. Traditional bioethics applies a restricted scope of values to assess clinical decisions: primarily health-related patient well-being (including life) and patient autonomy. If a decision improves (or, as in Parker’s inhaler case, maintains) a patient’s health-related well-being, this supports it. However, if a decision improves a patient’s non health-related well-being, say, winning a beauty contest or securing a job by having cosmetic surgery, it is not supported. And so on. This idea of healthcare as, in Michael Walzer’s classic terminology, a separate ‘sphere of justice’ has two interrelated limitations: it reflects a bias towards individual patients over other people, and it restricts the scope of values allowed to influence healthcare ethical judgements. These limitations appear once we see that the issue addressed by Parker can be framed either as prescription decisions taken by individual doctors against the background of …. (shrink)

In the face of the pandemic, bioethics, once again, proved its scientific utility. In France, in particular, the academic approach should be given priority over the institutional approach, in hospitals, research institutes, universities, and companies, with the professionalization that this would imply.

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

This essay introduces this special issue on virtue ethics in relation to military AI. It describes the current situation of military AI ethics as following that of AI ethics in general, caught between consequentialism and deontology. Virtue ethics serves as an alternative that can address some of the weaknesses of these dominant forms of ethics. The essay describes how the articles in the issue exemplify the value of virtue-related approaches for these questions, before ending with thoughts for further research.

Daniel Steel’s new book on the precautionary principle illustrates the need to work ahead to fuse perspectives of epistemology and philosophy of science with those of ethics to accomplish progress in the debate on the proper role of precaution in a broad selection of bioethical areas. Steel advances the territory greatly with regard to conceptual clarity and epistemology, but from a bioethics standpoint he is mistaken in discounting the need for ethical underpinnings of a sound theory of the precautionary (...) principle. (shrink)

Scripture is somehow normative for any bioethic that would be Christian. There are problems, however, both with Scripture and with those who read Scripture. Methodological reflection is necessary. Scripture must be read humbly and in Christian community. It must be read not as a timeless code but as the story of God and of our lives. That story moves from creation to a new creation. At the center of the Christian story are the stories of Jesus of Nazareth as healer, (...) preacher of good news to the poor, and sufferer. The story shapes character and conduct and enables communal discernment. (shrink)

The focus of this special issue is on moral psychology and the goals of moral education. My focus will be considerably narrower in addressing the following question: In light of the situationist movement in psychology and philosophy, what should be the goal(s) of character education? The main conclusion will be that the central goal of character education should be modified in a certain way to make it more empirically informed. But not to worry, as this modification should be amenable to (...) most contemporary supporters of character education. (shrink)

This essay describes and critically evaluates a co-operative educational program to train Ugandan health care workers in bioethics. It describes one bottom-up effort, a week-long intensive workshop in bioethics provided by the authors to health care professionals in a developing country—Uganda. We will describe the background and circumstances that led to the organization of the workshop, and review its planning, design, curriculum, and outcome. We will focus especially on measures taken to make the workshop relevant for the audience (...) of Ugandan professionals, and describe lessons learned after two presentations of the workshop. Finally, we will discuss the strengths and weaknesses of such a format, and its potential value in raising bioethical expertise in developing countries. (shrink)

Deep Brain Stimulation (DBS) represents a key area of neuromodulation that has gained wide adoption for the treatment of neurological and experimental testing for psychiatric disorders. It is associated with specific therapeutic effects based on the precision of an evolving mechanistic neuroscientific understanding. At the same time, there are obstacles to achieving symptom relief because of the incompleteness of such an understanding. These obstacles are at least in part based on the complexity of neuropsychiatric disorders and the incompleteness of DBS (...) devices to represent prosthetics that modulate the breadth of pathological processes implicated in these disorders. Neuroprostheses, such as an implanted DBS system, can have vast effects on subjects in addition to the specific neuropsychiatric changes they are intended to produce. These effects largely represent blind spots in the current debate on neuromodulation. Anthropological accounts can illustrate the broad existential dimensions of patients’ illness and responses to neural implants. In combination with current neuroscientific understanding, neuropsychiatric anthropology may illuminate the possibilities and limits of neurodevices as technical “world enablers”. (shrink)

This book represents a collaborative effort among the Christians and Jewish religious thinkers. They all focus on a bioethical moment at the beginning or the end of life. As members of a distinct tradition that has addressed the subject in a formal way, each one attempts an explanation of that tradition's position on the subject and suggests further developments. Healthcare issues are complex to begin with and these analyses and discussions make it a bit more likely they will be dealt (...) with on sound moral grounds. (shrink)

La mise en garde d'un psychiatre spécialiste de l'enfance sur les dérives de l'indifférenciation sexuelle.

In response to recent concerns about the overmedication of children, this paper considers ethical and conceptual issues that arise in the issue of when children who are diagnosed with attention deficit hyperactivity disorder should be given stimulants such as the psychotropic drug Ritalin as part of their treatment. There is considerable resistance and worry about the possibility of overmedication. This is linked to the worry that the diagnosis of ADHD is overused, and the paper considers some reasons to worry about (...) the overuse of the diagnosis itself. The paper then focuses on the resistance to the use of drugs, which is particularly strong for children in the gray area of diagnosis, where it is dubious whether the children really meet the strict diagnostic criteria. The reasons behind such resistance are often not well articulated, so part of the task of the paper is spell out what they might be. The reasons are given the following labels: side effects, unnaturalness, profit motives, thought control, competitiveness, and doctors' power. The paper ends in taking the polemical position that while there is some legitimate concern about possible short and long term side effects of children taking psychotropic drugs, the other reasons for resistance are not well‐founded. (shrink)

As work on practical wisdom and medicine accelerates, now is a good time to outline some important challenges that any approach to developing an account of this virtue faces. More specifically, I develop five challenges having to do with the existence and nature of practical wisdom, and whether it connects with objective and general normative truths. The main goal is to provide a guide to the challenges themselves and some of the options available for tackling them, rather than trying to (...) resolve them here. (shrink)

Many Christian scholars, if not all of them, consider Genesis to be foundational texts of the Bible and the spring for all the other doctrines of the Scripture. Therefore, I'm considering the attempt to search and find arguments for cell therapy ethical issues in the fundamental text of Genesis as a challenging and educative task. Moreover, this could be the first step in analyzing the relationships between Christian religions and bioethics, in terms of finding reasonable decisions for ethical challenges, (...) raised by the current biomedical research. As for many other dilemmas of humanity, we have to recall the text of Genesis for analyzing the goodness or evilness of our actions in translational medicine, even though that is not the only way to get a reasonable ethical decision. My contribution is an essay that is trying to correlate the Genesis lessons with the needed arguments in deciding what could be good and what could be evil in the stem cell research, according to the religious convictions. The biggest challenges of biomedical research for Christian religions were due to the human cloning issue, made possible by the somatic cell nuclear transfer, but those challenges update the older debates on birth control pill, technologically assisted reproduction, or gene therapy. Issues related to in vitro fertilization, gene enhancement and gene therapy, human cell cloning, embryonic stem cell using, and chimera cell obtaining for research are being considered and related to the putative arguments extracted from the book of Genesis, describing the origins. As a matter of fact, I may conclude that the single way to reach a reasonable ethical decision in our society is to intersect ethics, science and theology and to engage large debates involving scientists, theologians, civil society representatives, ethicists (experts in applied ethics) and moral philosophers, having the two latest professionals as referees. (shrink)

We commend Hempeler et al. (2024) on their important manuscript outlining a context-sensitive and patient-centered model for informal coercion in mental healthcare. Indeed, in clinical experience a...

In the climate ethics debate, scholars largely agree that individuals should promote institutions that ensure the reduction of greenhouse gas emissions. This paper aims to establish that there are individual duties beyond compliance with and promotion of institutions. Duties of individuals to reduce their emissions are often objected to by arguing that an individual’s emissions do not make a morally relevant difference. We challenge this argument from inconsequentialism in two ways. We first show why the argument also seems to undermine (...) the case for duties to promote institutions that the arguments’ proponents endorse. Second, we argue that individuals ought to cut emissions if they exceed their fair share of emissions entitlements and, by emitting, contribute to climate-related harm. In response to inconsequentialism, we specify the notion of ‘contribution’ via the so-called NESS theory, according to which an act is causally relevant for and contributes to an outcome if it is a Necessary Element of a Set of conditions that is Sufficient for the outcome. After refuting two objections to our approach, we conclude by discussing how to deal with possible conflicts between duties to promote institutions and to reduce one’s emissions. (shrink)

ABSTRACTThis paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a ‘dual role’ dilemma afflicting forensic psychiatry is more complicated than acknowledged. Our suggestion acknowledges the good of criminal law and crime prevention as a part that should be balanced against familiar research ethical considerations. Research aiming at improvements of criminal justice and treatment is a societal priority, and the total benefit of studies has to be (...) balanced against the risks for research subjects inferred by almost all systematic studies. Direct substantial risks must be balanced by health benefits, and normal informed consent requirements apply. When direct risks are slight, as in register‐based epidemiology, lack of consent may be counter‐balanced by special measures to protect integrity and the general benefit of better understanding of susceptibility, treatment and prevention. Special requirements on consent procedures in the forensic psychiatric context are suggested, and the issue of the relation between decision competence and legal accountability is found to be in need of further study. The major ethical hazard in forensic psychiatric research connects to the role of researchers as assessors and consultants in a society entertaining strong prejudices against mentally disordered offenders. (shrink)

Reducing disparities in health for racial and ethnic minorities has been a focus for US public health since the Heckler Report. Yet, a majority of racial and ethnic minorities in the US continue to have lower life expectancies and are more susceptible to poorer health outcomes compared to their white counterparts. Improvements in public health have been thwarted by ideological differences and structural restraints that necessitate an alternative method aimed at reorienting ethical discourse and guiding the public health as an (...) institution. Informed by a neo-Aristotelian concept of justice and the good life explicated through the Catholic social tradition, a new framework will enable public health to more wholly achieve its aim in the service of the populations that continue to be marginalized. (shrink)

The Congregation for the Doctrine of the Faith, under the prefecture of Joseph Ratzinger, published its instruction Donum vitae in 1987 to provide moral guidance on bioethical issues. Since 1987, many new ethical issues have arisen, especially in the areas of regenerative medicine (which includes stem cellresearch) and assisted reproduction. To address these the CDF, under the prefecture of William Levada, published the bioethical instruction Dignitas personae inDecember 2008. The present symposium includes reflections on the strengths and weaknesses of the (...) new document by six moral theologians noted for theirwork in bioethics: Christian Brugger, John Finnis, Luke Gormally, Christopher Kaczor, William E. May, and Peter F. Ryan, S.J. National Catholic Bioethics Quarterly 9.3 (Autumn 2009): 461–483. (shrink)

Scholars have debated the role that altruistic considerations play—and should play—in recruitment and decision-making processes for clinical trials. Little empirical data are available to support their various perspectives. We analyzed 140 audiotaped pediatric informed consent sessions, of which 95 (68%) included at least one discussion of how participation in a cancer clinical trial might benefit: 1) the pursuit of scientific knowledge generally; 2) other children with cancer specifically; and 3) “the future” and other vaguely defined recipients. Clinicians initiated most (80%) (...) of these discussions of altruism. The enrollment rate of children in the clinical trial was high (83%) overall, but not higher among children whose parents were involved in an altruism-oriented discussion. These findings suggest that: (1) clinicians invoke a spectrum of altruistic considerations rather than a single monothematic notion of altruism, and (2) the effect of altruistic considerations on subsequent enrollment decisions is marginal. While further research on this topic is warranted, bioethical debate should strive to reflect the diversity of altruistic discourse in clinical research encounters and to place this discourse in the context of other, including nonaltruistic, considerations. (shrink)

We present here a new method for bioethics: systemic modelling. In this method, the complex phenomenon being studied (e.g. personalized medicine, genetic testing, gene therapy, genetically modified organisms) is modelled as a whole, to shed light on its organization and functioning, and major (bio)ethical issues and solutions for their resolution are then identified. This systemic modelling method is ideal for use in the identification of solutions, rather than their validation, with other methods then used to test the solutions found. (...) We provide a description and reproducible instructions for the application of systemic modelling in bioethics, together with a brief example of the application of this method to the study of the impact of personalized medicine on French society. (shrink)

Antibiotic resistance, arising when bacteria develop defences against antibiotics, is creating a public health threat of massive proportions. This raises challenging questions for standard notions in bioethics when suitable policy is to be characterized and justified. We examine the particular proposal of expediting innovation of new antibiotics by cutting various forms of regulatory ‘red tape’ in the standard system for the clinical introduction of new drugs. We find strong principled reasons in favour of such a lowering of the ethical (...) standards of research and the clinical introduction of new antibiotic formulas. However, this support is undermined by pragmatic challenges owing to expected responses from stakeholders, creating uncertainty about which policies could actually be effectively implemented. We describe an underlying dilemma on how to rationally justify compromises between ideal ethical justification and pragmatic risks that needs to be further addressed in this light. We suggest a solution to this dilemma related to proposals of expediting antibiotic drug innovation. (shrink)

Few studies have considered in detail the ethical issues surrounding research in which investigators ask community members to engage in research subject recruitment within their own communities. Peer-driven recruitment and its variants are useful for accessing and including certain populations in research, but also have the potential to undermine the ethical and scientific integrity of community-based research. This paper examines the ethical implications of utilizing community members as recruiters of human subjects in the context of PDR, as well as the (...) authors' experience with a variant of PDR in a research project in South Africa. The importance of situating PDR in a comprehensive community engagement process that is responsive to the constraints of science and local needs and interests is emphasized. The paper will have relevance to bioethicists, health researchers, and research regulators concerned about the appropriate use of peer-driven recruitment strategies in health research. (shrink)

100 years ago, the editors of the Journal of Educational Psychology conducted one of the most famous studies of experts’ conceptions of human intelligence. This was reason enough to prompt the question where we stand today with making sense of “intelligence”. In this paper, we argue that we should overcome our anthropocentrism and appreciate the wonders of intelligence in nonhuman and nonbiological animals instead. For that reason, we study two cases of octopus intelligence and intelligence in machine learning systems to (...) embrace the notion of intelligence as a non-unitary faculty with pluralistic forms. Furthermore, we derive lessons for advancing our human self-understanding. (shrink)

A new landscape of prenatal testing is presently developing, including new techniques for risk-reducing, non-invasive sampling of foetal DNA and drastically enhanced possibilities of what may be rapidly and precisely analysed, surrounded by a growing commercial genetic testing industry and a general trend of individualization in healthcare policies. This article applies a set of established ethical notions from past debates on PNT for analysing PNT screening-programmes in this new situation. While some basic challenges of PNT stay untouched, the new development (...) supports a radical individualization of how PNT screening is organized. This reformation is, at the same time, difficult to reconcile with responsible spending of resources in a publicly funded healthcare context. Thus, while the ethical imperative of individualization holds and applies to PNT, the new landscape of PNT provides reasons to start rolling back the type of mass-screening programmes currently established in many countries. Instead, more limited offers are suggested, based on considerations of severity of conditions and optimized to simultaneously serve reproductive autonomy and public health within an acceptable frame of priorities. The new landscape of PNT furthermore underscores the ethical importance of supporting and including people with disabilities. For the very same reason, no ban on what may be analysed using PNT in the new landscape should be applied, although private offers must, of course, conform to strict requirements of respecting reproductive autonomy and what that means in terms of counselling. (shrink)

Volume 20, Issue 6, June 2020, Page 40-42.

‘Researcher identity’ affects global health research in profound and complex ways. Anthropologists in particular have led the way in portraying the multiple, and sometimes tension-generating, identities that researchers ascribe to themselves, or have ascribed to them, in their places of research. However, the central importance of researcher identity in the ethical conduct of global health research has yet to be fully appreciated. The capacity of researchers to respond effectively to the ethical tensions surrounding their identities is hampered by lack of (...) conceptual clarity, as to the nature and scope of the issues involved. This paper strives to provide some clarification of these ethical tensions by considering researcher identity from the perspective of (1) Guillemin and Heggen's (2009) key distinction between procedural ethics and ethics in practice, and (2) our own distinction between perceptions of identity that are either symmetrical or asymmetrical, with the potential to shift research relationships toward greater or lesser ethical harmony. Discussion of these concepts is supported with ethnographic examples from relevant literature and from our own (United States (US) Government-funded) research in South Africa. A preliminary set of recommendations is provided in an effort to equip researchers with a greater sense of organization and control over the ethics of researcher identity. The paper concludes that the complex construction of researcher identity needs to be central among the ethical concerns of global health researchers, and that the conceptual tools discussed in the paper are a useful starting point for better organizing and acting on these ethical concerns. (shrink)

A biblically informed guidebook for Christians facing difficult health care decisions, from the making of life (infertility, organ donation, cloning) and taking of life (abortion, euthanasia) to the technologically driven faking of life (genetic engineering, etc.).

We consider the implications for the ethical evaluation of research programs of two fundamental changes in the revised research ethical guideline of the Council for International Organizations of Medical Sciences. The first is the extension of scope that follows from exchanging “biomedical” for “health‐related” research, and the second is the new evaluative basis of “social value,” which implies new ethical requirements of research. We use the example of antibiotic resistance interventions to explore the need to consider the instances of what (...) we term the pragmatic risks of such interventions to evaluate the social value of certain kinds of health‐related research. These (pragmatic) risks severely threaten the social value of interventions in every area where human and social responses significantly impact on their effectiveness. Thus, the social value of health‐related research needed to demonstrate its effectiveness depends on the extent and successful management of such risks. Research designed to take into account the management of pragmatic risks also gives rise to similar types of risks, and the potential for social value in light of those risks needs to be considered in ethical reviews based on the new guidelines. We argue that, to handle this new expanded task, the international system of research ethical review addressed by the guidelines needs institutional development. (shrink)

The job of veterinarians is often described as morally challenging. This online survey (n = 123) investigated how farm veterinarians in Germany perceive these challenges. Most participants described their job in accordance with the literature: as a profession that regularly has to deal with morally difficult decisions. The majority assumed that their moral challenges were greater than the ones of small animal practitioners. The results indicate that the typical moral challenges are (a) situations in which the farm veterinarians are convinced (...) to know what is morally right, however, specific external obstacles prevent them from implementing their convictions. Therefore, the central moral problem from the veterinarians’ point of view can be described with the following words: “I would like to, but I can’t.” Other ideal types of moral challenges like (b) open ethical questions, (c) ethical dilemmas or (d) “duty vs. inclination” conflicts play a less prominent role. With regard to dealing with these challenges, the study shows that farm veterinarians are looking for exchange, for example with colleagues. Most participants see the current social debate about livestock farming as something that stresses them, arguing that their university’s curriculum did not adequately prepare them to participate in these controversies. (shrink)