With the widespread infusion of online technology there has been an increase in various studies investigating the practices in online communities including also philosophical perspectives. What those debates have in common is that they call for more critical thinking about the theory of online communication. Drawing on Techno-Anthropological research perspectives, our interest is placed on exploring and identifying human interactions and technology in intersectional spaces. This article explores information systems that allow for interchanges of different users. We discuss ontological assumptions (...) that focus on understanding the kind of dialogue that can be captured between different expert groups when they utilize information systems. We present the notion of ‘dialogic’ by Mikhail Bakhtin and contextualize it through an analysis of online dialogue. Dialogic or ‘conversation and inquiry’ is discussed as being mediated through human relationships. Acknowledging the existence of at least two voices the underlying differences between dialogue partners are highlighted. (shrink)

Machine learning and other forms of artificial intelligence can improve parts of clinical decision making regarding the gathering and analysis of data, the detection of disease, and the provis...

This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of (...) ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics. (shrink)

We argue that deliberative decision-making that is inclusive, transparent and accountable can contribute to more trustworthy and legitimate decisions on difficult ethical questions and political trade-offs during the pandemic and beyond.

This article examines the role of medical doctors, AI designers, and other stakeholders in making applied AI and machine learning ethically acceptable on the general premises of shared decision-making in medicine. Recent policy documents such as the EU strategy on trustworthy AI and the research literature have often suggested that AI could be made ethically acceptable by increased collaboration between developers and other stakeholders. The article articulates and examines four central alternative models of how AI can be designed and applied (...) in patient care, which we call the ordinary evidence model, the ethical design model, the collaborative model, and the public deliberation model. We argue that the collaborative model is the most promising for covering most AI technology, while the public deliberation model is called for when the technology is recognized as fundamentally transforming the conditions for ethical shared decision-making. (shrink)

The objective of this article is to explore people’s attitudes toward responsibility in the allocation of public health care resources. Special attention is paid to conceptualizations of responsibility involving blame and sanctions. A representative sample of the Norwegian population was asked about various responsibility mechanisms that have been proposed in the theoretical literature on health care and personal responsibility, from denial of treatment to a tax on unhealthy consumer goods. Survey experiments were employed to study treatment effects, such as whether (...) fairness considerations affect attitudes about responsibility. We find that, overall, a substantial minority of the respondents find it fair to let the health care system sanction people—in one way or another—for voluntary behaviors that increase the risk of becoming ill. Quite surprisingly, we find that people are more prone to report that they should themselves be held responsible for unhealthy lifestyles than others. (shrink)

BackgroundResearch proactively and deliberately aims to bring about specific changes to how societies function and individual lives fare. However, in the ever-expanding field of ethical regulations and guidance for researchers, one ethical consideration seems to have passed under the radar: How should researchers act when pursuing actual, societal changes based on their academic work?Main textWhen researchers engage in the process of bringing about societal impact to tackle local or global challenges important concerns arise: cultural, social and political values and institutions (...) can be put at risk, transformed or even hampered if researchers lack awareness of how their ‘acting to impact’ influences the social world. With today’s strong focus on research impacts, addressing such ethical challenges has become urgent within in all fields of research involved in finding solutions to the challenges societies are facing. Due to the overall goal of doing something good that is often inherent in ethical approaches, boundaries to researchers’ impact of something good is neither obvious, nor easy to detect. We suggest that it is time for the field of bioethics to explore normative boundaries for researchers’ pursuit of impact and to consider, in detail, the ethical obligations that ought to shape this process, and we provide a four-step framework of fair conditions for such an approach. Our suggested approach within this field can be useful for other fields of research as well.ConclusionWith this paper, we draw attention to how the transition from pursuing impact within the Academy to trying to initiate and achieve impact beyond the Academy ought to be configured, and the ethical challenges inherent in this transition. We suggest a stepwise strategy to identify, discuss and constitute consensus-based boundaries to this academic activity. This strategy calls for efforts from a multi-disciplinary team of researchers, advisors from the humanities and social sciences, as well as discussants from funding institutions, ethical committees, politics and the society in general. Such efforts should be able to offer new and useful assistance to researchers, as well as research funding agencies, in choosing ethically acceptable, impact-pursuing projects. (shrink)

How do multiple obligations to give, to receive, and to reciprocate contribute to the evolution of international society? This question can be derived from the works of the French anthropologist and sociologist Marcel Mauss, in particular from his classic essay The Gift, published in 1925. The aim of this article is to introduce Mauss’ theory of the gift to international political theorists, to develop a general theoretical argument from his claim about the universality of gift-giving, and to lay out the (...) plan of the Special Issue. First, we explore the basic concepts of gift-giving and reciprocity and how they highlight a type of exchange that differs from market exchange and from other forms of quid-pro-quo interactions. Second, we consider the Marshall Plan as an iconic and controversial example of international gift-giving. Third, we use Martin Wight’s division of international political thought into realism, rationalism, and revolutionism to locate the work of Mauss and neo-Maussian scholars within th... (shrink)

Current debate and policy surrounding the use of genetic editing in humans often relies on a binary distinction between therapy and human enhancement. In this paper, we argue that this dichotomy fails to take into account perhaps the most significant potential uses of CRISPR-Cas9 gene editing in humans. We argue that genetic treatment of sporadic Alzheimer’s disease, breast- and ovarian-cancer causing BRCA1/2 mutations and the introduction of HIV resistance in humans should be considered within a new category of genetic protection (...) treatments. We find that if this category is not introduced, life-altering research might be unnecessarily limited by current or future policy. Otherwise ad hoc decisions might be made, which introduce a risk of unforeseen moral costs, and might overlook or fail to address some important opportunities. (shrink)

BackgroundThe use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of (...) genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023.MethodsA realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available.DiscussionThe A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. (shrink)

Caesarean delivery is a common and life-saving intervention. However, it involves an overall increased risk for short-term and long-term complications for both mother and child compared with vaginal delivery. From a medical point of view, healthcare professionals should, therefore, not recommend caesarean sections without any anticipated medical benefit. Consequently, caesarean sections requested by women for maternal reasons can cause conflict between professional recommendations and maternal autonomy. How can we assure ethically justified decisions in the case of caesarean sections on maternal (...) request in healthcare systems that also respect patients’ autonomy and aspire for shared decisions? In the maternal–professional relationship, which can be characterised in terms of reciprocal obligations and rights, women may not be entitled to demand a C-section. Nevertheless, women have a right to respect for their deliberative capacity in the decision-making process. How should we deal with a situation of non-agreement between a woman and healthcare professional when the woman requests a caesarean section in the absence of obvious medical indications? In this paper, we illustrate how the maternal–professional relationship is embedded in a nexus of power, trust and risk that reinforces a structural inferiority for women. To accommodate for beneficial use of power, these decision processes need to be trustworthy. We propose a framework, inspired by Lukes’ three-dimensional notion of power, which serves to facilitate trust and allows for beneficial power in shared processes of decision-making about the delivery mode for women requesting planned C-sections. (shrink)

Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.

Reducing inequalities in health and the determinants of health is a widely acknowledged health policy goal, and methods for measuring inequalities and inequities in health are well developed. Yet, the evidence base is weak for how to achieve these goals. There is a lack of high-quality randomised controlled trials reporting impact on the distribution of health and non-health benefits and lack of methodological rigour in how to design, power, measure, analyse and interpret distributional impact in RCTs. Our overarching aim in (...) this paper is to contribute to the emerging effort to improve transparency and coherence in the theoretical and conceptual basis for RCTs on effective interventions to reduce health inequity. We endeavour to achieve this aim by pursuing two more specific objectives. First, we propose an overview of three broader health equity frameworks and clarify their implications for the measurement of health inequality in RCTs. Second, we seek to clarify the relationship between theory and translational challenges that researchers would need to attend to, in order to ensure that equity-relevant RCTs are coherently grounded in theory. (shrink)

Backgrounds Most countries are facing increased pressure on healthcare resources. A better understanding of how healthcare providers respond to new demands is relevant for future pandemics and other crises. Objectives This study aimed to explore what nurses and doctors in Norway reported as their main ethical challenges during two periods of the COVID-19 pandemic: February 2021 and February 2022. Research design A longitudinal repeated cross-sectional study was conducted in the Western health region of Norway. The survey included an open-ended question (...) about ethical challenges among doctors and nurses in hospital departments. Free-text comments were analysed using Systematic Text Condensation and also presented in a frequency table. Ethical considerations Ethical approval was granted by the Regional Research Ethics Committee in Western Norway (131,421). All participants provided consent when participating in the study. Results In 2021, 249 and in 2022, 163 healthcare professionals responded to the open-ended question. Nurses and doctors reported three main categories of ethical challenges related to the COVID-19 pandemic: (1) barriers that hindered them in acting as they ethically would have wanted to do; (2) priority-setting dilemmas linked to overtreatment, transfer of resources and ranking patient needs; and (3) workload expansion threatening work–life balance and employees’ health. Category one comprised of resource barriers, regulatory barriers, system barriers, and personal barriers. Regulatory barriers, especially visitor restrictions for next-of-kin, were the most frequently reported in 2021. Resource barriers, related to the increased scarcity of qualified staff, were most frequently reported in 2022. Clinicians stretched themselves thin to avoid compromising on care, diagnostics, or treatment. Conclusions Developing clinicians’ ability to handle and cope with limited healthcare resources is necessary. To foster resilience and sustainability, healthcare leaders, in collaboration with their staff, should ensure fair priority-setting and initiate reflections among doctors and nurses on what it implies to provide ‘good enough’ care. (shrink)

Background Rationing and allocation decisions at the clinical level – bedside rationing – entail complex dilemmas that clinicians and managers often find difficult to handle. There is a lack of mechanisms and aids for promoting fair decisions, especially in hard cases. Reports indicate that clinical ethics committees sometimes handle cases that involve bedside rationing dilemmas. Can CECs have a legitimate role to play in bedside rationing? Main text Aided by two frameworks for legitimate priority setting, we discuss how CECs can (...) contribute to enhanced epistemic, procedural and political legitimacy in bedside rationing decisions. Drawing on previous work we present brief case vignettes and outline several potential roles that CECs may play, and then discuss whether these might contribute to rationing decisions becoming legitimate. In the process, key prerequisites for such legitimacy are identified. Legitimacy places demands on aspects such as the CEC’s deliberation process, the involvement of stakeholders, transparency of process, the opportunity to appeal decisions, and the competence of CEC members. On these conditions, CECs can help strengthen the legitimacy of some of the rationing decisions clinicians and managers have to make. Conclusions On specified conditions, CECs can have a well-justified advisory role to play in order to enhance the legitimacy of bedside rationing decisions. (shrink)

Some bioethicists engage with empirical work on stakeholders’ values, attitudes, and experiences as a basis for theorizing ethics in the context of healthcare. Related to this empirical turn, a deb...

Derk Pereboom's Four-Case Argument is among the most famous and resilient manipulation arguments against compatibilism. I contend that its resilience is not a function of the argument's soundness but, rather, the ill-gotten gain from an ambiguity in the description of the causal relations found in the argument's foundational case. I expose this crucial ambiguity and suggest that a dilemma faces anyone hoping to resolve it. After a thorough search for an interpretation which avoids both horns of this dilemma, I conclude (...) that none is available. Rather, every metaphysically coherent interpretation invites either a hard- or soft-line reply to Pereboom's argument. I then consider a recharacterization of the dilemma which seems to clear the way for the defence of a revised Four-Case Argument. I address this rejoinder by identifying a still more fundamental problem shared by all viable interpretations of the manipulation cases, showing that each involves a type of manipulation which undermines the victim's agency. Because this diagnosis supports a soft-line reply to every viable interpretation of the argument and can be endorsed by any compatibilist, I consider it the final piece of the Soft-line Solution to the Four-Case Argument. Finally, I suggest a new taxonomy of manipulation arguments, arguing that none that employs the suppressive variety of manipulation found in Pereboom's argument offers a threat to compatibilism. -/- (For direct download option, search Kristin M. Mickelson, Soft-line Solution). (shrink)

"The Manipulation Argument has recently taken center stage in the free-will debate, yet little else can be said of this newcomer that is uncontroversial. At present, even the most fundamental elements of the Manipulation Argument--its structure, conclusion, and target audience--are a matter of dispute. As such, we cannot begin, as we ideally would, with a simple and relatively uncontroversial overview of the argument. Instead, clarifying the debate over the basic structure and general conclusion of the Manipulation Argument will be our (...) goal." -/- UPDATE: I now refer to an isolated objection to the counterexample step as a hardline reply, an isolated attack on the generalization step a softline reply, and an isolated response to the explanation step as an "al dente" reply. Al dente replies have been given in Mele's 2005 critique of the Four-Case Argument and my 2015 (2012) critique of Mele's Zygote Argument. I also now refer to a manipulation argument which has a generalization step that concludes to impossibilism and an explanation step which proposes an explanation for the impossibility of free will as a "Master Manipulation Argument" (examples of master manipulation arguments include Mickelson 2015 and 2019). (shrink)

Women have outnumbered men as followers of Christianity at least since the transition to industrial capitalist modernity in the West. Yet developments in women's lives in relation to employment, family and feminist values are challenging their Christian religiosity. Building on a new strand of gender analysis in the sociology of religion, this article argues that gender is central to patterns of religiosity and secularization in the West. It then offers a case study of evangelical Christianity in England to illustrate how (...) changes in women's lives are affecting their religiosity. Specifically, it argues that evangelical Christianity continues to be important among women occupying more traditional social positions, but adherence is declining among the growing number whose lives do not fit this older model. (shrink)

Most legal analyses of selective nontreatment of seriously ill children centre on the question of whether it is in a child’s best interests to be kept alive in the face of extreme suffering and/or an intolerable quality of life. Courts have resisted any direct confrontation with the question of whether the child’s death is in his or her best interests. Nevertheless, representations of death may have an important role to play in this field of jurisprudence. The prevailing philosophy is to (...) configure death as a release from a futile or painful existence and/or as a dignified end in an objectively hopeless situation. However, there can be disagreement about the meaning of death in these settings. Some parents object that death would be premature or that it represents a culpable neglect of their child. A closer examination of these discordant interpretations allows for a better comprehension of the cultural understandings that underscore clinical and legal accounts of death following end-of-life decisions. (shrink)

IntroductionDrug-related deaths are a major public health challenge. Losing a child to a DRD can be a very stressful life event, which places parents at risk of mental and physical health problems. However, traumatic experiences like losing a child to DRD can paradoxically also lead to positive psychological changes. A mixed-method approach was used to understand the complexity of the phenomenon of post-traumatic growth experienced by parents following a DRD.MethodBy combining data from a survey and interviews, we explored positive growth (...) experiences among Norwegian parents. We conducted descriptive analyses of the sample’s demographic characteristics and mean scores for Post-traumatic Growth Inventory items. Hierarchical multiple regression was used to examine the influence of the ability to perform daily activities, self-efficacy, social support, and symptoms of prolonged grief on the outcome variable of post-traumatic growth. Reflexive thematic analysis was applied to analyze the qualitative data. Finally, we integrated the results of the survey and the interviews.ResultsFor items measuring post-traumatic growth, parents scored highest on the item “I discovered that I’m stronger than I thought I was” and lowest on the item “I am able to do better things with my life.” Self-efficacy and social support had a statistically significant relation with post-traumatic growth. Two themes were generated from the interviews: new perspectives on life and new paths in life. Even though the “New Possibilities” subscale had the lowest mean score for the PTGI-SF, new paths in life were important for many of the interviewed parents.DiscussionParents described traumatic stressors associated with having a child who uses narcotics and hence experienced positive changes even before losing their child. We argue that on an individual level, the consequences of spillover stigma, low self-efficacy, and intrusive rumination can hinder potential post-traumatic growth. On a group level, enhancing network support may increase post-traumatic growth experiences. Hence, parents who have experienced a DRD can benefit from help to activate their social networks and strengthen their self-efficacy. (shrink)

Feminist technoscience and feminist phenomenology have seldom been brought into dialogue with each other, despite them sharing concerns with subjectivity and normativity, and despite both of them moving away from sharp subject-object distinctions. This is unfortunate. This article argues that, while differences between these strands need to be acknowledged, such differences should be put to productive use. The article discusses a case of school bullying, and suggests that bringing these analytic perspectives together enables and sharpens examinations of the role of (...) subjectification and subject positions for subjectivity in the phenomenological sense; affectivity within material-discursive entanglements and constellations of humans and things, and as connecting the body, things and the world in specific ways; and normativity as enacted, lived and embedded in perception. (shrink)

The Ethics Ambassador program at the University of Colorado Hospital was born from a desire to encourage earlier ethics consultation, with the goal of providing timely, effective, and patient-centered ethics support. The selected Ethics Ambassadors are individuals from multiple roles across the hospital who receive regular education to serve as an ethics resource for their respective units or specialties. As embedded individuals, they are better able to recognize the unique needs and challenges of their units and provide relevant ethics education (...) to staff and faculty. Outcomes of the first year of the program illustrated the diverse ethics needs across the hospital and the benefits of utilizing embedded individuals, able to straddle both the domains of ethics and the needs of their individual units. (shrink)

*As mentioned in Peter Coy's NYT essay "When Being Good Is Just a Matter of Being Lucky" (2023) -/- ----- -/- How is the problem of free will related to the problem of moral luck? In this essay, I answer that question and outline a new solution to the paradox of moral luck, the source-paradox solution. This solution both explains why the paradox arises and why moral luck does not exist. To make my case, I highlight a few key connections (...) between the paradox of moral luck and two related problems, namely the problem of free will and determinism and the paradox of self-creation. Piecing together intuitions, arguments, and insights from recent work on each of these three problems, I argue that the type of control necessary for moral responsibility can only be had by someone who is a genuine source of his own actions, but the relevant notion of sourcehood admits no coherent characterization. If our commonsense view of moral responsibility is incoherent, it is unsurprising that our commitment to the existence of morally responsible agents commits us to some paradoxical things—e.g. to both the existence and impossibility of moral luck. For more information about this article, please write to gmail account: kristin.mickelson.42. (shrink)

Unrepresented patients are some of the most vulnerable patients encountered in the healthcare system today. One of the challenges associated with healthcare for unrepresented patients is the lack of a standardized legal approach to decision making for this highly vulnerable population. Current statutory approaches vary widely without best practices or consensus guidelines. In 2016, Colorado passed a medical proxy law that established a process for the appointment of an independent physician to serve as a temporary proxy decision maker for an (...) unrepresented patient. Although this approach helps to identify a decision maker when no proxy is available, the appropriate standards for decision making remain uncertain. A peer-to-peer session at the Clinical Ethics Unconference in 2022 approached this conundrum with a focus on the best interests standard and the appropriate use of patients’ context in decision making. (shrink)