BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: (...) What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)

The Common Health problems that plague Americans today are often the result of people’s choices and behaviors: obesity, cigarette smoking, accidental pediatric head trauma owing to failure to properly restrain children, and failure to adhere to medication regimens. For each problem, there is a well-studied effective behavioral intervention: a healthy diet and exercise for obesity, smoking cessation programs to overcome cigarette addiction, appropriate car restraints to prevent accidental head trauma, and direct observation of treatment and simplification of medical regimens to (...) improve drug adherence. Traditionally, the physician defined the problem and told the patient what she needed to do. In the modern era of .. (shrink)

BackgroundIn clinical research, obtaining informed consent from participants is an ethical and legal requirement. Conveying the information concerning the study can be done using multiple methods yet this step commonly relies exclusively on the informed consent form alone. While this is legal, it does not ensure the participant’s true comprehension. New effective methods of conveying consent information should be tested. In this study we compared the effect of different methods on the knowledge of caregivers of participants of a clinical trial (...) on Pemba Island, Tanzania.MethodsA total of 254 caregivers were assigned to receive (i) a pamphlet (n = 63), (ii) an oral information session (n = 62) or (iii) a pamphlet and an oral information session (n = 64) about the clinical trial procedures, their rights, benefits and potential risks. Their post-intervention knowledge was assessed using a questionnaire. One group of caregivers had not received any information when they were interviewed (n = 65).ResultsIn contrast to the pamphlet, attending an information session significantly increased caregivers’ knowledge for some of the questions. Most of these questions were either related to the parasite (hookworm) or to the trial design (study procedures).ConclusionsIn conclusion, within our trial on Pemba Island, a pamphlet was found to not be a good form of conveying clinical trial information while an oral information session improved knowledge. Not all caregivers attending an information session responded correctly to all questions; therefore, better forms of communicating information need to be found to achieve a truly informed consent. (shrink)

Objective: Ethical guidelines are designed to ensure benefits, protection and respect of participants in clinical research. Clinical trials must now be registered on open-access databases and provide details on ethical considerations. This systematic survey aimed to determine the extent to which recently registered clinical trials report the use of standard of care and post-trial obligations in trial registries, and whether trial characteristics vary according to setting. Methods: We selected global randomized trials registered on http://www.clinicaltrials.gov and http://www.controlled-trials.com. We searched for intervention (...) trials of HIV/AIDS, malaria, and tuberculosis from 9 October 2004, the date of the most recent version of the Helsinki Declaration, to 10 April 2007. Results: We collected data from 312 trials. Fifty-eight percent (58%, 95% CI = 53 to 64) of trial protocols report informed consent. Fifty-eight percent (58%, 95% CI = 53 to 64) of trials report active controls. Almost no trials (1%, 95% CI = 0.5 to 3) mention post-trial provisions. Most trials measure surrogate outcomes. Twenty percent (20%, 95% CI = 16 to 25) of trials measure patient-important outcomes, such as death; and the odds that these outcomes are in a low income country are five times greater than for a developed country (odds ratio (OR) 5.03, 95% CI = 2.70 to 9.35, p = < 0.001). Pharmaceutical companies are involved in 28% (CI = 23 to 33) of trials and measure surrogate outcomes more often than nonpharmaceutical companies (OR 2.45, 95% CI = 1.18 to 5.09, p = 0.31). Conclusion: We found a large discrepancy in the quality of reporting and approaches used in trials in developing settings compared to wealthier settings. (shrink)

Canada has historically relied on a system of ad hoc committees for ethical guidance on public health and science policy, unlike the more centralized approach of more than 140 countries worldwide. Here, drawing on interviews with leaders across the country, we offer a perspective on the imperative and a strategy for a coordinated, Bioethics Council for Canada structured to ensure proactive thinking, provide rapid responses, and engage the public on urgent bioethics matters concerning the health and well-being of Canadians.

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical (...) framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. (shrink)

Like more than two hundred thousand other Americans, George Floyd howled horribly for air before his death. But his breathlessness was not born from a virus. He was murdered with the burden of anti...

This article analyzes narratives about encounters between police officers and domestic violence victim/survivors in the context of domestic violence calls. Narratives are sites in which individuals create relationships between themselves and others, oriented around a set of unfolding events. Narrative is a motivated, engaged retelling of prior or anticipated events produced in interaction with others, in a particular context stocked with constraints and affordances. In the process of telling stories, identities emerge. In order to understand the relationship between narrative and (...) identity, I analyze stories told about police interactions with domestic violence victim/survivors from the perspectives of both the police and the victim/survivors. Working empirically with a data set of 48 interviews, I use critical discourse analysis and discourse analysis to analyze the ways both groups narrate domestic violence and confrontations with police officers, the ways they create story worlds stocked with characters, the ways story characters are formed and deployed, and the ways those characters are positioned against/with/by the storyteller, allowing the storyteller’s identity to emerge. This article is an analysis of the relationship between the storyteller and the story world and the storyteller’s process of constructing an/other in order to position in relation to that other. Ultimately, I argue that identity emerges for the storyteller in the way she or he constructs characters in a story and then positions in relation to those characters. (shrink)

As Japan marks the 75th anniversary of World War II in 2020, Prime Minister Shinzo Abe did not offer a fresh apology and maintained that future generations should not have to keep apologizing for past mistakes. This paper uses the unresolved war issue of the military comfort women system as a context to discuss what it means for political apologies to be more than mere political gestures founded on political interests and discusses what it takes to facilitate forgiveness. It will (...) examine the features of a repentant wrongdoer who deserves forgiveness based on how one relates to one’s past wrongdoing in order to distinguish political apologies that are genuine from those that are mere gestures aimed at hasty reconciliation. This will be discussed through the works of Jacques Derrida and Vladimir Jankélévitch. Next, through Jankélévitch’s and Paul Ricoeur’s ideas of forgiveness, it will be discussed how matters of justice and forgiveness should be understood as well as how the history of past wrongs and injustice is necessary for a genuine apology and makes forgiveness possible. It is also a moral responsibility for both perpetrators and victims to remember history in order to achieve personal forgiveness as well as begin social and political reconciliation. (shrink)

In this important new book, Jacques Derrida talks with Bernard Stiegler about the effect of teletechnologies on our philosophical and political moment. Improvising before a camera, the two philosophers are confronted by the very technologies they discuss and so are forced to address all the more directly the urgent questions that they raise. What does it mean to speak of the present in a situation of "live" recording? How can we respond, responsibly, to a question when we know that the (...) so-called "natural" conditions of expression, discussion, reflection, and deliberation have been breached? As Derrida and Stiegler discuss the role of teletechnologies in modern society, the political implications of Derrida's thought become apparent. Drawing on recent events in Europe, Derrida and Stiegler explore the impact of television and the internet on our understanding of the state, its borders and citizenship. Their discussion examines the relationship between the juridical and the technical, and it shows how new technologies for manipulating and transmitting images have influenced our notions of democracy, history and the body. The book opens with a shorter interview with Derrida on the news media, and closes with a provocative essay by Stiegler on the epistemology of digital photography. In Echographies of Television, Derrida and Stiegler open up questions that are of key social and political importance. Their book will be of great interest to all those already familiar with Derrida's work, as well as to students and scholars of philosophy, literature, sociology and media studies. (shrink)

The purpose of this paper is to utilize virtue ethics as the appropriate paradigm by which to improve health care delivery to transgender individuals. Health disparities for transgender individuals occur external to the medical environment as well as internal to the medical profession. A commitment to virtue ethics should be undertaken to improve the care to transgender individuals. In this manuscript I call on virtue ethics to address the intersectionality of such environmental structures for the promotion of the good of (...) the patient as per the telos of medicine by Edmund Pellegrino, consistent with the eudaimonia of Aristotle’s Nicomachean Ethics. Virtue ethics is the appropriate paradigm for which bioethics can address the framework that poses barriers to access to health care and maintenance of health through a lack of competent, knowledgeable and compassionate providers for the transgender population. Further, I pose that ascribing to improving the care to the individual transgender patient involves a call to action to overcome social ecological spheres of influence that are affecting the health of the individual and thereby the population of the transgender individuals as a whole. Through virtue ethics, the virtuous physician improves the health of the transgender individual and the character of themselves and the profession of medicine. (shrink)

Das »Richtige und das Gute« (1930), das ethische Hauptwerk W. D. Ross’, enthält eine Vielzahl wichtiger moralphilosophischer Thesen und Argumente, die bis in die Gegenwart kontrovers diskutiert werden. Im Mittelpunkt steht seine pluralistische Deontologie, der zufolge sich die richtige Handlung aus einer Abwägung der in der jeweiligen Situation relevanten und unableitbaren Prima-facie-Pflichten ergibt, von denen nur ein Teil auf die Optimierung der Handlungsfolgen bezogen ist. Diese Deontologie wurde zu einem modernen Klassiker unter den normativen ethischen Theorien. Darüber hinaus stellt Ross’ (...) These, dass moralische Intuitionen eine Quelle selbstevidenten Wissens sein können, einen wichtigen Referenzpunkt in Debatten um den erkenntnistheoretischen Fundamentalismus dar. Auch für die Handlungstheorie liefert Ross einflussreiche Argumente, wenn er die Ansicht vertritt, dass Pflichten nie ein bestimmtes Motiv des Handelnden zum Gegenstand haben können. Eine zentrale Stellung nimmt für Ross die Güterlehre ein, in welcher er von vier Grundgütern, Tugend, Wissen, Lust und Gerechtigkeit, ausgeht. Wurde Ross in den ersten Jahrzehnten des 20. Jahrhunderts im damaligen Großbritannien als ein herausragender Ethiker – einer der bedeutendsten des Jahrhunderts, auf Augenhöhe mit G.E. Moore – angesehen, wandelte sich das Meinungsbild in den folgenden Jahrzehnten unter dem Einfluss besonders des Logischen Positivismus und der Philosophie Wittgensteins. In den letzten Jahrzehnten ist jedoch wieder ein wachsendes Interesse an Ross’ Ethik festzustellen. Dabei wird »Das Richtige und das Gute« bisweilen sogar mit der »Nikomachischen Ethik«, Kants »Grundlegung« und Humes »Untersuchung über die Prinzipien der Moral« verglichen. (shrink)

The New Edith Wharton Studies uncovers new evidence and presents new ideas that invite us to reconsider our understanding of one of America's most highly acclaimed, versatile, and prolific writers. The volume addresses themes that have previously been missed or underdeveloped, and examines areas where previous scholarship does not take account of key, contemporary issues: Wharton and ecocriticism, Wharton and queer studies, Wharton and animal studies, Wharton and whiteness, and Wharton and contemporary psychology. Essays explore Wharton's treatment of the poor (...) in her emerging career, the ways in which French thinkers helped her envision community, the importance of Greece to Wharton, her transnationalism, the ongoing revelations of the author's archives, and new perspectives on her agency in the literary marketplace. It addresses key themes and examines contemporary issues, while reassessing Edith Wharton's life and career. (shrink)

The doctrine of the image of God is often regarded as grounding human dignity in something permanent and unchanging that transcends our attitudes and behaviors. Yet we persistently encounter the argument that particular human individuals or groups have acted so as to forfeit their moral standing as fellow humans. They are bestialized, categorized as non-human animals, lifting ordinary restraints on punishment. I examine the logic of this argument in John Locke, Thomas Aquinas, and contemporary felony disenfranchisement, showing how it involves (...) slippage between the unobjectionable notion that specific rights may in particular circumstances be forfeited, and the deeply troubling claim that one’s moral standing as human can as such be forfeited. I argue that an apparently similar rhetoric of dehumanization employed by Frederick Douglass, in contrast, refrains from stripping the opponent of moral considerability. (shrink)

Theological reckoning with our contemporary post-truth context must be cognizant of the ways in which adherence to biblical inerrancy fostered the rise of partisan epistemology. It is essential as well to grapple with the question of whether postliberal theologies, by way of a very different theory of truth, also promote the epistemic insulation of Christian faith communities. We need to understand how groups threatened with the erosion of social influence are tempted to indulge in partisan epistemology. It is equally critical (...) to grasp how unjust power exploits such tendencies in girding its loins with epistemological supremacy. Jesus, facing in Pilate a post-truth dominator, models an alternative, namely, disruptive engagement that resists epistemic injustice and opens new space for the construction of unbounded communities of trust and shared understanding. (shrink)

The authors, one a trained geneticist and the other a trained ethicist, designed and team-taught a bioethics course where nineteen third- and fourth-year undergraduate students were enrolled at Aquinas College in Grand Rapids, Michigan, during the fall 2016 semester. The syllabus, including democratically-chosen ethical debate topics, peer-led student working groups, and varied assessment methods were novel aspects of the course. The students, being either philosophy or biology majors or minors, successfully completed the course and indicated being highly satisfied with the (...) course at its completion. Although there were limitations to a course such as this one, educators at similar small liberal arts institutions could offer a bioethics course by following our suggestions, including collaborative teaching and assessment and incorporating students’ preferences into the scheduled curriculum. (shrink)

Several ant species are known with genetic effects on caste determination but, for termites, the role of environment has been assumed to be omnipotent. Now Hayashi et al. report that commitment to the nymph and worker pathways in Reticulitermes speratus follows a simple model involving two alleles at a sex‐linked locus.1 The spread of this system of genetic caste determination seems best explained by selection at the colony level. This remarkable system may be widely applicable throughout termites, although it cannot (...) be universal, and may provide a window into causal aspects of the molecular biology of caste determination. BioEssays 30:299–302, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

This article evaluates New Zealand’s Medicines Amendment Bill 2011. This Bill is currently before Parliament and will amend the Medicines Act 1981. On June 20, 2011, the Australian and New Zealand governments announced their decision to proceed with a joint scheme for the regulation of therapeutic products such as medicines, medical devices, and new medical interventions. Eventually, the joint arrangements will be administered by a single regulatory agency: the Australia New Zealand Therapeutic Products Agency. The medicines regulations in Australia and (...) New Zealand will be updated as part of this process. The Medicines Amendment Bill addresses some of the well-recognised deficiencies in the Medicines Act 1981. However, a comprehensive overhaul of the Act is not being undertaken. I argue that repealing and replacing the Medicines Act 1981 would be preferable and advisable, given the number of legal difficulties with the Act and, in particular, where it does not align with equivalent current international law. (shrink)

Duchenne's muscular dystrophy (DMD), which affects 1/3500 live male births, involves a progressive degeneration of skeletal and cardiac muscle, leading to early death. The protein dystrophin is lacking in DMD and present, but defective, in the allelic, less severe, Becker muscular dystrophy and is also missing in the mdx mouse. Experiments on the mdx mouse have suggested two possible therapies for these myopathies. Implantation of normal muscle precursor cells (mpc) into mdx skeletal muscle leads to the conversion of dystrophin‐negative fibres (...) to ‐positive, with consequent improvement in muscle histology. Direct injectidn of dystrophin cDNA into skeletal or cardiac muscle also gives rise to dystrophin‐positive fibres. Although both appear promising, there are a number of questions to be answered and refinements to be made before either technique could be considered possible as treatments for myopathies in man. (shrink)

English popular science was more than a mid-nineteenth century phenomenon, whether defined as practical, utilitarian and comprehensible knowledge, or as a nexus of ¡deas, rhetoric and practice. All these criteria were fulfilled in four Stationers’ Company almanacs for forty years by Henry Andrews, an astronomer, mathematician, astrologer and meteorologist. Andrews employed these as instruments for an extensive campaign in the history of science education devised to acquaint working class readers with the key figures, ideas and methodologies of science.

A 16 year old Hodgkin lymphoma patient refuses to have his blood specimen drawn, thus canceling his scheduled oncologic treatment. As a 16 year old, he has no legal standing as an adult. His parents are split over his decision. One supports his right to choose; the other wishes the specimen to be drawn and the chemotherapy reinstated. The physicians at the hospital are seeking legal redress to have the court order the blood specimens to be taken.

Frank Herbert's gholas are a curious twist on the golem, a creature inspired by Jewish theology and folklore. Although Herbert's gholas differ in interesting ways from the traditional golem, the historic similarities can enrich and add to our appreciation of these creatures, especially Dune 's most famous and enduring ghola, Duncan Idaho. As is often the case with good science fiction, Herbert demonstrates remarkable foresight for many scientific and technological developments that had yet to occur when he wrote the Dune (...) series. This chapter explores Herbert's gholas from both of the perspectives; gholas as an extension of the golem tradition and as the anticipation of contemporary breakthroughs in biological science. The creators of the gholas, the Tleilaxu, retain their closely guarded, highly secretive knowledge, just as the golem creators of the legends. (shrink)