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Generative AI presents significant opportunities for instructional designers to create content and personalize online learning environments. Alongside its benefits, generative AI also poses ethical considerations and potential risks, such as perpetuating biases or disrupting the learning process. Navigating these complexities requires an approach to design deliberation that involves careful analysis, discussion, and decision-making throughout the design process. This paper proposes a conceptual framework to support instructional designers in leveraging generative AI to promote inclusivity within their design deliberations, emphasizing the importance of addressing ethical considerations and engaging in iterative design practices. [ABSTRACT FROM AUTHOR]

With its potential to contribute to the ethical governance of AI, eXplainable AI (XAI) research frequently asserts its relevance to ethical considerations. Yet, the substantiation of these claims with rigorous ethical analysis and reflection remains largely unexamined. This contribution endeavors to scrutinize the relationship between XAI and ethical considerations. By systematically reviewing research papers mentioning ethical terms in XAI frameworks and tools, we investigate the extent and depth of ethical discussions in scholarly research. We observe a limited and often superficial engagement with ethical theories, with a tendency to acknowledge the importance of ethics, yet treating it as a monolithic and not contextualized concept. Our findings suggest a pressing need for a more nuanced and comprehensive integration of ethics in XAI research and practice. To support this, we propose to critically reconsider transparency and explainability in regards to ethical considerations during XAI systems design while accounting for ethical complexity in practice. As future research directions, we point to the promotion of interdisciplinary collaborations and education, also for underrepresented ethical perspectives. Such ethical grounding can guide the design of ethically robust XAI systems, aligning technical advancements with ethical considerations. [ABSTRACT FROM AUTHOR]

Patient refusal of care often puts healthcare professionals in an ethical dilemma. The ethics of refusing nursing care are examined in this editorial, which emphasizes the patient’s autonomy and the healthcare professional’s duty to provide care. Coercion and information manipulation to override patient’s refusal contradict principles of autonomy and justice. Through ethical analysis and case examples of assisting post-operative patients with early ambulation, it is clear that an excessive focus on patient’s autonomy and the duty to provide care could jeopardize ethical practice.

Patient refusal of care often puts healthcare professionals in an ethical dilemma. The ethics of refusing nursing care are examined in this editorial, which emphasizes the patient's autonomy and the healthcare professional's duty to provide care. Coercion and information manipulation to override patient's refusal contradict principles of autonomy and justice.... [ABSTRACT FROM AUTHOR]

Abstract Background The end-users’ acceptance is a core concept in the development, implementation and evaluation of new systems like robotic systems in daily nursing practice. So far, studies have shown various findings concerning the acceptance of systems that are intended to assist people with support or care needs. Not much has been reported on the acceptance of robots that provide direct physical assistance to nurses in bedside care. Therefore, this study aimed to investigate the acceptance along with ethical implications of the prototype of an assistive robotic arm aiming to support nurses in bedside care, from the perspective of nurses, care recipients and their relatives. Methods A cross-sectional survey design was applied at an early stage in the technological development of the system. Professional nurses, care recipients and relatives were recruited from a university hospital and a nursing home in Germany. The questionnaire was handed out following either a video or a live demonstration of the lab prototype and a subsequent one-to-one follow-up discussion. Data analysis was performed descriptively. Results A total of 67 participants took part in the study. The rejection of specified ethical concerns across all the respondents was 77%. For items related to both perceived usefulness and intention to use, 75% of ratings across all the respondents were positive. In the follow-up discussions, the participants showed interest and openness toward the prototype, although there were varying opinions on aspects such as size, appearance, velocity, and potential impact on workload. Conclusions Regarding the current state of development, the acceptance among the participants was high, and ethical concerns were relatively minor. Moving forward, it would be beneficial to explore the acceptance in further developmental stages of the system, particularly when the usability is tested.

Solidarity between generations served as a prominent but controversially discussed normative reference point in public debates about the Coronavirus-pandemic. The aim of this contribution is the empirical reconstruction and ethical evaluation of prominent notions of intergenerational solidarity and their underlying assumptions in the public media discourse on the pandemic in Germany. After a brief introduction to the concept of intergenerational solidarity and the pertinent discourses during the pandemic, we present the results of a comprehensive qualitative content analysis of 149 articles from leading media in Germany. On this basis, we carve out three typical understandings of intergenerational solidarity: (a) communal care, (b) mutual support, and (c) responsible use of freedom. We discuss these understandings and the underlying 'moral paradigms' and evaluate their theoretical and practical implications from an ethical point of view, drawing conclusions for discourses on future societal crises. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The effective provision of health services is affected by human resources and this renders upholding ethical principles in hospitals more urgent than in any other organization. This study aimed to determine the ethical predictability of human resources in hospitals in 2022. MATERIAL AND METHODS: This descriptive cross-sectional study was conducted in public, private, and "social security" hospitals in Mazandaran province in 2022. Data were collected through a researcher-made questionnaire designed based on Iranian national accreditation standards. The questionnaire consisted of 18 questions from 6 areas, including organizing manpower, employee evaluation, employee satisfaction and participation, employee empowerment, job promotion, and paying attention to employee motivation. The content validity was confirmed using experts' views, and its reliability was confirmed by Cronbach's alpha coefficient higher than 0.78. Data were analyzed by one-way ANOVA and Tukey's post hoc tests. RESULTS: There was a significant difference between the mentioned hospitals regarding the ethical predictability of human resources (p < 0.05), which was higher in social security hospitals (3.80 ± 0.00) compared to public hospitals (3.30 ± 0.00) and private hospitals (2.49 ± 0.00). The highest and the lowest mean ethical predictability of human resources in selected hospitals were reported for the areas of employee empowerment (3.89 ± 0.00) and employee evaluation (2.83 ± 0.00), respectively. CONCLUSIONS: In addition to exerting an impact on enhancing the satisfaction and productivity of employees, identifying ethical predictability factors will help medical and health services managers identify the priorities of human resources and adopt solutions to improve them. [ABSTRACT FROM AUTHOR]

Background: The end-users’ acceptance is a core concept in the development, implementation and evaluation of new systems like robotic systems in daily nursing practice. So far, studies have shown various findings concerning the acceptance of systems that are intended to assist people with support or care needs. Not much has been reported on the acceptance of robots that provide direct physical assistance to nurses in bedside care. Therefore, this study aimed to investigate the acceptance along with ethical implications of the prototype of an assistive robotic arm aiming to support nurses in bedside care, from the perspective of nurses, care recipients and their relatives. Methods: A cross-sectional survey design was applied at an early stage in the technological development of the system. Professional nurses, care recipients and relatives were recruited from a university hospital and a nursing home in Germany. The questionnaire was handed out following either a video or a live demonstration of the lab prototype and a subsequent one-to-one follow-up discussion. Data analysis was performed descriptively. Results: A total of 67 participants took part in the study. The rejection of specified ethical concerns across all the respondents was 77%. For items related to both perceived usefulness and intention to use, 75% of ratings across all the respondents were positive. In the follow-up discussions, the participants showed interest and openness toward the prototype, although there were varying opinions on aspects such as size, appearance, velocity, and potential impact on workload. Conclusions: Regarding the current state of development, the acceptance among the participants was high, and ethical concerns were relatively minor. Moving forward, it would be beneficial to explore the acceptance in further developmental stages of the system, particularly when the usability is tested. [ABSTRACT FROM AUTHOR]

Background: Physicians have to make countless decisions every day. The medical, ethical and legal aspects are often intertwined and subject to change over time. Involving an ethics committee or arranging an ethical consultation are examples of potential aids to decision making. Whether and how artificial intelligence (AI) and the large language model (LLM) of the company OpenAI (San Francisco, CA, USA), known under the name ChatGPT, can also help and support ethical decision making is increasingly becoming a matter of controversial debate. Material and methods: Based on a case example, in which a female physician is confronted with ethical and legal issues and presents these to ChatGPT to come up with answers, the first indications of the strengths and weaknesses are ascertained. Conclusion: Due to the rapid technical development and access to ever increasing quantities of data, the utilization should be closely observed and evaluated. [ABSTRACT FROM AUTHOR]

Facial recognition technology (FRT) has emerged as a powerful tool for public governance and security, but its rapid adoption has also raised significant concerns about privacy, civil liberties, and ethical implications. This paper critically examines the current rules and policies governing FRT, highlighting the tensions between state and corporate interests on one hand, and individual rights and ethical considerations on the other. The study also investigates international legal frameworks aimed at protecting individual rights and privacy, arguing that current legislative measures often fall short of robust scholarly standards and international human rights norms. The paper concludes with recommendations for developing principled and adaptable governance frameworks that harness the benefits of FRT while mitigating its risks and negative impacts, underscoring the importance of placing human rights and ethics at the center of regulating this transformative technology.

Early hype cycles surrounding new technologies may promote simplistic binary options of either adoption or rejection, but socio-historical analyses of technologies illuminate how they are worked into shape by human actors. Humans enact agency through many choices that result in adaptations and contextual variations. In this piece, we argue that the changes that result from emerging technologies are the ones that we work into shape through professional methods, artistry, and effort. We draw on historical and contemporary examples such as writing and learning analytics to illustrate this shaping cycle and apply ethical analysis to identify potential harms and benefits of emerging AI technologies that then inform learning design decisions. We conclude with an example of the application of "cognitive partnerships" as some of the important theory building that is part of the professional work still to be done in working AI – or any emerging technology – towards the change we desire. [ABSTRACT FROM AUTHOR]

An institution providing health services, which seeks to meet challenging goals in the sale of health services that allow it to substantially improve its economic income and obtain significant operating surpluses to distribute among its partners, decides to launch a broad and aggressive marketing plan to position itself as the best health institution in its area in the region. The center of its marketing campaign is the search for the conviction of patients from high socioeconomic strata that the institution is the only one qualified in the city and the region to care for patients with cardiovascular diseases, that it has the best technology and that their doctors and health personnel are the best. The campaign seeks to reach the population through all available means, such as billboards, messages on radio and television, and illustrative brochures, to distribute among the population of the social sectors that are the focus of its work. Other peer institutions and groups of doctors question this campaign and decide to ask the regional Ethics Committee for a statement on the matter. The Ethics Committee, after analyzing the marketing of the IPS, defines its position on the matter. [ABSTRACT FROM AUTHOR]

This article starts by examining the present state of death ethics by attending to the euthanasia debate. Given that voluntary active euthanasia has seen strong support in the academic community, insights on the choiceworthiness of continued existence may be derived. Having derived cases of choiceworthy nonexistence (which I refer to as choiceworthy nonexistence [CNE] cases), I extend these intuitions to lives not worth starting, or choiceworthy nonexistence for potential people (which I refer to as foetal-CNE, or fCNE cases). Although I depart from Benatarian antinatalism by rejecting Benatar's claim that all existence is necessarily a harm, I posit a weaker argument that all existence is likely a harm since we cannot know until later in life if an existence is a harm. If I am right, then we have prudential reasons not to bear children, since they are more likely to suffer in lives not worth living than not., (© 2024 The Author(s). Bioethics published by John Wiley & Sons Ltd.)

Competing Interests: Competing interests: None declared.

In this paper, I leverage the pragmatist tradition in philosophy, the collective wisdom of scholarship in clinical ethics consultation, and earlier attempts to apply pragmatism in clinical ethics to develop a new vision of clinical ethics practice called New Clinical Pragmatism. It argues that clinical ethics methodology, from the New Clinical Pragmatist's perspective, amounts to the recommendation that consultants should customize a methodological approach, drawing on the various available methods, depending on the demands of the specific case, and should avoid attempts to identify a 'true' methodology but to the incoherence and inevitable failure of those attempts. I argue that pragmatism's emphasis on practical wisdom and experimentation allow the New Clinical Pragmatist to do this while avoiding irrationality in choosing methods. I discuss how the New Clinical Pragmatist gives a unique, constructive perspective on key aspects of clinical ethics consultation such as the choice of common morality vs. internal morality of medicine approaches, process standards, bioethics mediation, and narrative ethics, and suggest how New Clinical Pragmatism's relaxed approach to choice of methodology encourages consultants to balance attention to the particulars of the case with knowledge of what the many insightful scholars of clinical ethics methodology have found useful in the past. I also argue that New Clinical Pragmatism is consistent with efforts to professionalize clinical ethics consultation., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: The COVID-19 pandemic created conditions of scarcity that led many provinces within Canada to develop triage protocols for critical care resources. In this study, we sought to undertake a narrative synthesis and ethical analysis of early provincial pandemic triage protocols., Methods: We collected provincial triage protocols through personal correspondence with academic and political stakeholders between June and August 2020. Protocol data were extracted independently by two researchers and compared for accuracy and agreement. We separated data into three categories for comparative content analysis: protocol development, ethical framework, and protocol content. Our ethical analysis was informed by a procedural justice framework., Results: We obtained a total of eight provincial triage protocols. Protocols were similar in content, although age, physiologic scores, and functional status were variably incorporated. Most protocols were developed through a multidisciplinary, expert-driven, consensus process, and many were informed by influenza pandemic guidelines previously developed in Ontario. All protocols employed tiered morality-focused exclusion criteria to determine scarce resource allocation at the level of regional health care systems. None included a public engagement phase, although targeted consultation with public advocacy groups and relevant stakeholders was undertaken in select provinces. Most protocols were not publicly available in 2020., Conclusions: Early provincial COVID-19 triage protocols were developed by dedicated expert committees under challenging circumstances. Nonetheless, few were publicly available, and public consultation was limited. No protocols were ever implemented, including during periods of extreme critical care surge. A national approach to pandemic triage that incorporates additional aspects of procedural justice should be considered in preparation for future pandemics., (© 2024. The Author(s).)

Artificial gametes, derived from stem cells, have the potential to enable in vitro fertilization of embryos. Currently, artificial gametes are only being generated in laboratory animals; however, considerable efforts are underway to develop artificial gametes using human cell sources. These artificial gametes are being proposed as a means to address infertility through assisted reproductive technologies. Nonetheless, the availability of artificial gametes obtained from adult organisms can potentially expand the possibilities of reproduction. Various groups, such as same-sex couples, post-menopausal women, and deceased donors, could potentially utilize artificial gametes to conceive genetically related offspring. The advent of artificial gametes raises significant bioethical questions. Should all these reproductive scenarios be accepted? How can we delineate the range of future reproductive choices? A normative bioethical framework may be necessary to establish a consensus regarding the use of human artificial gametes. This review aims to present the current state of research on the biological roadmap for generating artificial gametes, while also summarizing proposed approaches to establish a normative framework that delineates ethically acceptable paths for reproduction., (© 2024. The Author(s), under exclusive licence to Society for Reproductive Investigation.)

Living donor kidney transplantation (LDKT) is one of the most effective treatment options for people with end-stage renal disease. Traditionally, LDKT can be either "directed" or "nondirected," based on whether the recipient is specified by the donor. Recently, there has been an increase in conditional and semidirected live kidney donation among strangers, where the donor specifies the characteristics of the recipient whom they wish to donate to. This practice has both gained popularity and sparked controversy in the state of Israel through the nonprofit organization Matnat Chaim. We analyze the ethical implications of this practice by applying traditional principles of medical ethics to conditional LDKT. Although semidirected and conditional LDKT presents some ethical challenges, overall, its practice effectively aligns with core ethical principles. The donors' right to make stipulations respects the donor's autonomy, the practice avoids harm and benefits both donor and recipient, and justice and utility are upheld as the practice specifically benefits marginalized patients and optimizes resource utilization. Finally, we present data from our institution demonstrating how conditional LDKT increased transplantation for all ethnic groups; Jewish recipients of LDKT increased by 151.32% (P = .034) Arab recipients of LDKT increased by 111.11% (P = .036)., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Facial recognition technology (FRT) has emerged as a powerful tool for public governance and security, but its rapid adoption has also raised significant concerns about privacy, civil liberties, and ethical implications. This paper critically examines the current rules and policies governing FRT, highlighting the tensions between state and corporate interests on one hand, and individual rights and ethical considerations on the other. The study also investigates international legal frameworks aimed at protecting individual rights and privacy, arguing that current legislative measures often fall short of robust scholarly standards and international human rights norms. The paper concludes with recommendations for developing principled and adaptable governance frameworks that harness the benefits of FRT while mitigating its risks and negative impacts, underscoring the importance of placing human rights and ethics at the center of regulating this transformative technology., Competing Interests: XW was employed by Sage IT Consulting Group. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Wu, Zhou and Fu.)

In mental health ethics, it is generally assumed that coercive measures are sometimes justified when persons with mental illness endanger themselves or others. Coercive measures are regarded as ethically justified only when certain criteria are fulfilled: for example, the intervention must be proportional in relation to the potential harm. In this paper, we demonstrate shortcomings of this established ethical framework in cases where people with mental illness experience structural racism. By drawing on a case example from mental healthcare, we first demonstrate that biases in assessing whether the coercive intervention is proportional are likely, for example, due to an overestimation of dangerousness. We then show that even if proportionality is assessed correctly, and the specific coercive intervention would thus be regarded as ethically justified according to the standard framework, coercion may still be ethically problematic. This is because the standard framework does not consider how situations in which coercive measures are applied arise. If structural racism causally contributes to such situations, the use of coercion can compound the prior injustice of racist discrimination. We conclude that the ethical analysis of coercion in mental healthcare should consider the possibility of discriminatory biases and practices and systematically take the influence of structural discrimination into account., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The field of medical ethics, such as the discipline of ethics in general, has traditionally focused on moral dilemmas and quandaries at the expense of 'everyday' moral issues. The methodologies, norms and principles of the field reflect this. Although the principle of double effect works well in adjudicating the provision of life-shortening medications to relieve pain, it fails to guide the vast majority of mundane moral decisions that providers make daily.This article contends that exemplarist medical ethics provides action guidance on everyday medical ethical issues. Further, it offers an ethical methodology that is not tethered to a comprehensive doctrine of the good.The paper develops an account of, and draws on Zagzebski's exemplarist moral theory. It then describes how medical providers can morally deliberate by appealing to exemplars. I contend there are three modes of exemplarist action guidance: dialogue, emulation and substituted judgement. It demonstrates how each of these modes guides moral deliberation regarding quotidian medical ethical issues. The article then turns to a moral exemplar of medical practice, Dr. Jim O'Connell, who Tracy Kidder profiles in his 2023 book, Rough Sleepers: Dr. Jim O'Connell's Urgent Mission to Bring Healing to Homeless People. The advantages and challenges of this approach are delineated before a brief conclusion., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Technological advancements before and after delivery have greatly altered the counseling of pregnant patients facing a fetal diagnosis of severe oligohydramnios or anhydramnios secondary to congenital anomalies of the kidneys and urinary tract. Once considered a nearly uniformly lethal abnormality, long-term survival may now be possible secondary to prenatal innovations aimed at restoring the amniotic fluid volume and the availability of more advanced neonatal dialysis techniques. However, these available therapies are far from perfect. The procedures are onerous for pregnant patients without a guarantee of success, and families must prepare themselves for the complex life-long medical care that will be necessary for surviving individuals. Multidisciplinary counseling is imperative to help pregnant individuals understand the complexity of these conditions and assist them in exercising their right to informed decision-making. Moreover, as with any developing field of medicine, providers must contend with ethical questions related to the treatment options, including questions regarding patient-hood, distributive justice, and the blurred lines between research, innovation, and standard care. These ethical questions are best addressed in a multidisciplinary fashion with consideration of multiple points of view from various subspecialties. Only by seeing the entirety of the picture can we hope to best counsel patients about these highly complex situations and help navigate the most appropriate care path., (Copyright © 2024 by the American Academy of Pediatrics.)

AbstractEmpirical studies of pediatric clinical ethics cases are scant in the biomedical and bioethics literature. In this study, more than 100 detailed records of clinical ethics consultations spanning from 2000 to 2020 at a moderately sized U.S. Mid-Atlantic children's hospital were abstracted and analyzed. Findings of the analysis were generally consistent with other studies in pediatric clinical ethics, with additional insight into aspects of moral distress associated with cases, family engagement with consultations, and other characteristics of interest also documented. Over the 20-year time frame, ethics consults were completed on average twice a year, with a detectable upward trend. Consultations were requested across the spectrum of services and units within the hospital, with critical care environments represented most frequently and genetic and neurological conditions being the most common primary diagnoses. Ethical analysis most commonly related to questions around the principles of autonomy and beneficence.

Nanotechnology (NT)-enabled disease-free life is a form of reconstruction of the human body that promises a paradigm shift toward a new form of human existence in an imaginable life. However, as human reconstruction may be within the limits of the concept of "human enhancement," it is not clear to what extent "enhanced humans" will be ethically acceptable or desired. This study discusses the ethical implications of NT-embedded enhanced humans and this new imaginable life. First, ethical concerns arising from the existence of a grey zone of certain dilemmas regarding benefits and possible/unpredicted risks are addressed in terms of the four main principles of bioethics. Then, we focus on the ethical problems in human nano-enhancement. Finally, we study the methods of analyzing these ethical problems within the framework of principlism to conceive a comprehensive and coherent bioethical understanding., (© 2023 John Wiley & Sons Ltd.)

In terminally ill individuals who would otherwise end their own lives, active voluntary euthanasia (AVE) can be seen as life-extending rather than life-shortening. Accordingly, AVE supports key pro-euthanasia arguments (appeals to autonomy and beneficence) and meets certain sanctity of life objections. This paper examines the extent to which a terminally ill individual's wish to donate organs after death contributes to those life-extension arguments. It finds that, in a terminally ill individual who wishes to avoid experiencing life he considers to be not worth living, and who also wishes to donate organs after death, AVE maximizes the likelihood that such donations will occur. The paper finds that the wish to donate organs strengthens the appeals to autonomy and beneficence, and fortifies the meeting of certain sanctity of life objections, achieved by life-extension arguments, and also generates appeals to justice that form novel life-extension arguments in favour of AVE in this context.

The integration of normative analysis with empirical data often remains unclear despite the availability of many empirical bioethics methodologies. This paper sought bioethics scholars' experiences and reflections of doing empirical bioethics research to feed these practical insights into the debate on methods. We interviewed twenty-six participants who revealed their process of integrating the normative and the empirical. From the analysis of the data, we first used the themes to identify the methodological content. That is, we show participants' use of familiar methods explained as "back-and-forth" methods (reflective equilibrium), followed by dialogical methods where collaboration was seen as a better way of doing integration. Thereafter, we highlight methods that were deemed as inherent integration approaches, where the normative and the empirical were intertwined from the start of the research project. Second, we used the themes to express not only how we interpreted what was said but also how things were said. In this, we describe an air of uncertainty and overall vagueness that surrounded the above methods. We conclude that the indeterminacy of integration methods is a double-edged sword. It allows for flexibility but also risks obscuring a lack of understanding of the theoretical-methodological underpinnings of empirical bioethics research methods., (© 2023. The Author(s).)

Forensic genomics now enables law enforcement agencies to undertake rapid and detailed analysis of suspect samples using a technique known as massively parallel sequencing (MPS), including information such as physical traits, biological ancestry, and medical conditions. This article discusses the implications of MPS and provides ethical analysis, drawing on the concept of joint rights applicable to genomic data, and the concept of collective moral responsibility (understood as joint moral responsibility) that are applicable to law enforcement investigations that utilize genomic data. The widespread and unconstrained use of this technology without appropriate legal protections of individual moral rights and associated accountability mechanisms, could potentially not only involve violations of individual moral rights but also lead to an unacceptable shift in the balance of power between governments and the citizenry. We argue that in light of the rights of victims and the security benefits for society, there is a collective moral responsibility for individuals to submit their DNA to law enforcement and for MPS to be used where other, less invasive techniques are not effective. However, this application should be limited by legislation, including that any data obtained should be directly relevant to the investigation and should be destroyed at the conclusion of the investigation., (© 2023. Journal of Bioethical Inquiry Pty Ltd.)

Trait Selective Abortions (TSA) have come under critique as a medical practice that presents potential disabled infants as burdens and lacking the potential for meaningful lives. This paper, using the author's background as a disabled person, contends that the philosophy underpinning TSAs reflects liberal society's lack of a theory of needs. The author argues for a care ethics based approach informed by disability analyses to engage with TSAs., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

'Social inclusion' is the leading ideal in services and care for people with intellectual disabilities in most countries in the Global North. 'Social inclusion' can refer simply to full equal rights, but more often it is taken to mean something like 'community participation'. This narrow version of social inclusion has become so ingrained that it virtually goes unchallenged. The presumption appears to be that there is a clear moral consensus that this narrow understanding of social inclusion is good. However, that moral consensus is not clear in the case of people with profound intellectual and/or multiple disabilities (PIMD), who are not able to express their needs and preferences verbally. Moreover, social inclusion has proven to be difficult to conceptualize and implement for people with PIMD. Therefore, it becomes imperative to ask about the ethical rationale of the narrow understanding of social inclusion. For what reasons do we think social inclusion is good? And do those reasons also apply for people with PIMD? This article addresses these questions by providing an ethical analysis of the ideal of social inclusion for people with PIMD. It discusses four ethical arguments for social inclusion and probes their relevance for people with PIMD. The article argues that none of these arguments fully convince of the value of the narrow understanding of social inclusion for people with PIMD. It ends with advocating for an ethical space for imagining a good life for people with PIMD otherwise., (© 2023. The Author(s).)

Health Recommender Systems are promising Articial-Intelligence-based tools endowing healthy lifestyles and therapy adherence in healthcare and medicine. Among the most supported areas, it is worth mentioning active aging. However, current HRS supporting AA raise ethical challenges that still need to be properly formalized and explored. This study proposes to rethink HRS for AA through an autonomy-based ethical analysis. In particular, a brief overview of the HRS' technical aspects allows us to shed light on the ethical risks and challenges they might raise on individuals' well-being as they age. Moreover, the study proposes a categorization, understanding, and possible preventive/mitigation actions for the elicited risks and challenges through rethinking the AI ethics core principle of autonomy. Finally, elaborating on autonomy-related ethical theories, the paper proposes an autonomy-based ethical framework and how it can foster the development of autonomy-enabling HRS for AA., (© 2024. The Author(s).)

The technical possibilities of biomedicine open up the opportunity to intervene in ageing itself with the aim of mitigating, reducing or eliminating it. However, before undertaking these changes or rejecting them outright, it is necessary to ask ourselves if what would be lost by doing so really has much value. This article will analyse the desirability of ageing from an individual point of view, without circumscribing this question to the desirability or undesirability of death. First, we will present the three most widely used arguments to reject biomedical interventions against ageing. We will argue that only the last of these arguments provides a consistent answer to the question of the desirability of ageing. Second, we will show that the third argument falls prey to a conceptual confusion that we will call the paradox of ageing: although ageing entails negative health effects, it leads to a life stage with valuable goods. Both valuations, one positive and the other negative, refer to two different dimensions of ageing: the chronological and the biological. We will defend that, by not adequately distinguishing these two types of ageing, it does not become apparent that all the valuable goods exclusive to ageing derive only from its chronological dimension. Third, we will argue that, if we just conceive ageing biologically, it is undesirable. We will elaborate on the two kinds of undesirable effects biological ageing has: direct and indirect. Finally, we will respond to potential objections by adducing that these are insufficient to weaken our argument., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

In this article, we provide an ethical analysis of the first porcine cardiac xenotransplant, performed in Maryland, USA in early 2022. David Bennett was offered the experimental procedure after he was deemed ineligible for human heart transplantation and mechanical circulatory support, based on a history of non-compliance. It was reported that Mr Bennett's previous instances of non-compliance were for medically non-life-threatening conditions years earlier, where the risks of non-compliance were not as high. We argue that, in Mr Bennett's case, a history of non-compliance in a different context, should not necessarily rule him ineligible for a potentially life-saving treatment now. Furthermore, using previous non-compliance to exclude individuals from donor organs may have the unintended effect of placing the burden of testing xenotransplantation on those who are already disadvantaged. We then argue that it is not enough to rely on patient consent to ethically justify xenotransplantation research. Taking a broad ethical perspective is crucial when mapping a clinical pathway for xenotransplantation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Australia II became the first foreign yacht to win the America's Cup in 1983. The boat had a revolutionary wing keel and a better underwater hull form. In official documents, Ben Lexcen is credited with the design. He is also listed as the sole inventor of the wing keel in a patent application submitted on February 5, 1982. However, as reported in New York Times, Sydney Morning Herald, and Professional Boatbuilder, the wing keel was in fact designed by engineer Peter van Oossanen at the Netherlands Ship Model Basin in Wageningen, assisted by Dr. Joop Slooff at the National Aerospace Laboratory in Amsterdam. Based on telexes, letters, drawings, and other documents preserved in his personal archive, this paper presents van Oossanen's account of how the revolutionary wing keel was designed. This is followed by an ethical analysis by Martin Peterson, in which he applies the American NSPE and Dutch KIVI codes of ethics to the information provided by van Oossanen. The NSPE and KIVI codes give conflicting advice about the case, and it is not obvious which document is most relevant. This impasse is resolved by applying a method of applied ethics in which similarity-based reasoning is extended to cases that are not fully similar. The key idea, presented in Peterson's book The Ethics of Technology (Peterson, The ethics of technology: A geometric analysis of five moral principles, Oxford University Press, 2017), is to use moral paradigm cases as reference points for constructing a "moral map"., (© 2024. The Author(s).)

This essay analyzes from a personalistic bioethics the model of technological progress supported by an autonomy without controls and an imperative that is governed by the maxim: if it can be done, let's do it!, as a necessary and sufficient condition of progress. This puts us on the slippery slope between the technically feasible and the morally lawful. The pioneering work of the philosopher, José Sanmartin Esplugues 2 , urges reflection in the face of a technological profusion that sees the human being as a useful embodied object and offers powers of intervention on human life that were previously unimaginable. The reduction of the person to mere biological-material data opens the door to increasing deshumanization by subordination to the calculations of an instrumental rationalism. Underlying the desire to see ourselves at the top of the world and genetic techniques are the ultimate expression of a longing for human emancipation that aspires to take the reins of evolution through an abstract postbiological imaginary. Sanmartin proposes a model of ethical evaluation and social insertion of technoscientific activity that goes beyond the conventional categories of impact, use and effectiveness to distinguish social, cultural, economic, political and values correlates, in order to embroider a pattern that decides on the means and ends of human life through technologies that are neither innocuous nor neutral. A society without antidotes to manipulation that also teaches us to cultivate utopian dreams about human nature is easily malleable by elites who promise happy worlds and redeem us from our vulnerability.

Background: In this study, we examined the ethical implications of Egypt's new clinical trial law, employing the ethical framework proposed by Emanuel et al. and comparing it to various national and supranational laws. This analysis is crucial as Egypt, considered a high-growth pharmaceutical market, has become an attractive location for clinical trials, offering insights into the ethical implementation of bioethical regulations in a large population country with a robust healthcare infrastructure and predominantly treatment-naïve patients., Methods: We conducted a comparative analysis of Egyptian law with regulations from Sweden and France, including the EU Clinical Trials Regulation, considering ethical human subject research criteria, and used a directed approach to qualitative content analysis to examine the laws and regulations. This study involved extensive peer scrutiny, frequent debriefing sessions, and collaboration with legal experts with relevant international legal expertise to ensure rigorous analysis and interpretation of the laws., Results: On the rating of the seven different principles (social and scientific values, scientific validity, fair selection of participants, risk-benefit ratio, independent review, informed consent and respect for participants) Egypt, France, and EU regulations had comparable scores. Specific principles (Social Value, Scientific Value, and Fair selection of participants) were challenging to directly identify due to certain regulations embodying 'implicit' principles more than explicitly stated ones., Conclusion: The analysis underscores Egypt's alignment with internationally recognized ethical principles, as outlined by Emanuel et al., through its comparison with French, Swedish, and EU regulations, emphasizing the critical need for Egypt to continuously refine its ethical regulations to safeguard participant protection and research integrity. Key issues identified include the necessity to clarify and standardize the concept of social value in research, alongside concerns regarding the expertise and impartiality of ethical review boards, pointing towards a broader agenda for enhancing research ethics in Egypt and beyond., (© 2024. The Author(s).)

Antimicrobial resistance (AMR) is a global health and one health problem. Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder efforts to address AMR. First, there is a tension between access and excess in the current population: addressing lack of access requires facilitating use of antimicrobials for some populations, while addressing excessive use for other populations. Second, there is a tension between personal interests and a wider, shared interest in curbing AMR. These personal interests can be viewed from the perspective of individuals seeking care and healthcare providers whose livelihoods depend on using or selling antimicrobials and who profit from the sales and use of antimicrobials. Third, there is a tension between the interests of current populations and the interests of future generations. Last, there is a tension between addressing immediate health threats such as pandemics, and AMR as a 'silent', chronic threat. For each of these tensions, we apply 'descriptive ethics' methods that draw from existing evidence and our experiences living and working in low-income and middle-income countries to highlight how these ethical tensions apply in such settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H883 ).

This article presents a revised version of negative utilitarianism. Previous versions have relied on a hedonistic theory of value and stated that suffering should be minimized. The traditional rebuttal is that the doctrine in this form morally requires us to end all sentient life. To avoid this, a need-based theory of value is introduced. The frustration of the needs not to suffer and not to have one's autonomy dwarfed should, prima facie , be decreased. When decreasing the need frustration of some would increase the need frustration of others, the case is deferred and a fuller ethical analysis is conducted. The author's perceptions on murder, extinction, the right to die, antinatalism, veganism, and abortion are used to reach a reflective equilibrium. The new theory is then applied to consumerism, material growth, and power relations. The main finding is that the burden of proof should be on those who promote the status quo.

Background: Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture., Methods: To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher's Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers., Results: After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals., Conclusions: The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies., (© 2024. The Author(s).)

The shift towards "empirical bioethics" was largely triggered by a recognition that stakeholders' views and experiences are vital in ethical analysis where one hopes to produce practicable recommendations. Such perspectives can provide a rich resource in bioethics scholarship, perhaps challenging the researcher's perspective. However, overreliance on a picture painted by a group of research participants-or on pre-existing literature in that field-can lead to a biased view of a given context, as the subjectivity of data generated in these ways cannot (and should not wholly) be escaped. In response, we propose the implementation of a complementary approach of ethno-immersion in bioethics research. By positioning oneself in the context being researched, the researcher can better understand the realities of that context. The researcher's understanding will, naturally, be subjective too. However, it will act as a better developed and more informed outsider view, when considering the picture painted by participants and previous studies, thus enabling the researcher to introduce more nuance when analysing data. We introduce this approach after examining what we call the context detachment problem, whereby some bioethics scholarship-empirical or otherwise-fails to reflect the reality of the healthcare setting it concerns. Our proposed ethno-immersion (which differs from formal ethnography) is then explored as a response, highlighting its benefits, and answering the question of timing within a research project. Finally, we reflect on the applicability of our proposal to non-empirical bioethics scholarship, concluding that it remains important but may require some adjustments., (© 2023 The Authors. Bioethics published by John Wiley & Sons Ltd.)

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified., (© 2023. The Author(s).)

Mental disorders in university students are very frequent, therefore higher education institutions have established in-campus mental healthcare centres. These clinics have particular characteristics that differ from other mental health centres, as they report to and represent an educational institution, while at the same time looking after the interests and well-being of patients requesting assistance, thus generating unique bioethical conflicts. Ethics Committees are useful tools to offer support to mental health professionals in making ethical decisions. In order to respond to these issues, it was decided that an Ethics Committee would be created in the mental health clinic of a private university in Mexico City. This article describes the implementation process for this Committee, its duties and scope, as well as the case work and review methodology. A list of the most frequent ethical conflicts is attached, jointly with the ethical analysis of the cases treated throughout the year and a half or work by the Committee., (© 2023. Journal of Bioethical Inquiry Pty Ltd.)

The anti-natalist philosopher David Benatar defends a position asserting that all life is harmful, and that it is, therefore, wrong to have children. In this paper, I critique Benatar's less-discussed claim that his anti-natalism provides solutions to population ethics problems, such as the Non-Identity Problem, the Repugnant Conclusion, and the Mere Addition Problem, all of which are presented in Derek Parfit's Reasons and Persons. Since the publication of his Better Never to Have Been, Benatar has continued to claim that its provision of such solutions strengthens his defense of anti-natalism. Although Benatar's view has received much criticism, this argument has not been discussed at length. I undertake a thorough examination of the argument and identify reasons to reject it. The central point of my critique is that the implications of Benatar's views in determining ranges of wrong and not-wrong cases of procreation are extensionally inadequate when applied to the problems of population ethics., (© 2023 The Authors. Bioethics published by John Wiley & Sons Ltd.)

This article presents three clinical scenarios that might be encountered in ambulatory pediatrics. The framework for ethical analysis presented by Dr Hughes in a separate article in this issue of the Journal is used to examine these clinical scenarios and demonstrate application of the framework. The three cases involve a physician being asked by parents to write a letter for better housing that would require the doctor to be dishonest; parents who decline to have their 8-month-old daughter vaccinated; and a physician who believes contraception is a sin and therefore would not prescribe it to a sexually active 17-year-old girl., (Copyright © 2023 Elsevier Inc. All rights reserved.)

In the paper 'COVID-19 vaccine boosters for young adults: a risk-benefit assessment and ethical analysis of mandate policies at universities,' Bardosh et al argued that college mandates of the COVID-19 booster vaccine are unethical. The authors came to this conclusion by performing three different sets of comparisons of benefits versus risks using referenced data and argued that the harm outweighs the risk in all three cases. In this response article, we argue that the authors frame their arguments by comparing values that are not scientifically or reasonably comparable and that the authors used values that represent grossly different risk profiles and grouped them into a set of figures to create an illusion of fair comparisons. We argue that absent the falsely skewed portrayals of a higher level of risk over benefit in their misrepresented figures, the five ethical arguments they presented completely fall apart., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207-42 836 young adults aged 18-29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least 18.5 serious adverse events from mRNA vaccines, including 1.5-4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430-4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Deep palliative sedation (DPS) is applied as a response to refractory suffering at the end of life when symptoms cannot be relieved in an awake state. DPS entails a dilemma of whether to provide uninterrupted sedation-in which case DPS would turn into deep and continuous palliative sedation (DCPS) -to minimise the risk that any further intolerable suffering will occur or whether to pause sedation to avoid unnecessary sedation. DPS is problematic in that it leaves the patient 'socially dead' by eradicating their autonomy and conscious experiences., Aim: To perform a normative ethical analysis of whether guidelines should recommend attempting to elevate consciousness during DPS., Design: A structured analysis based on the four principles of healthcare ethics and consideration of stakeholders' interests., Results: When DPS is initiated it reflects that symptom relief is valued above the patient's ability to exercise autonomy and experience social interaction. However, if a decrease in symptom burden occurs, waking could be performed without patients experiencing suffering. Such pausing of deep sedation would satisfy the principles of autonomy and beneficence. Certain patients require substantial dose increases to maintain sedation. Waking such patients risks causing distressing symptoms. This does not happen if deep sedation is kept uninterrupted. Thus, the principle of non-maleficence points towards not pausing sedation. The authors' clinical ethics analysis demonstrates why other stakeholders' interests do not appear to override arguments in favour of providing uninterrupted sedation., Conclusion: Stopping or pausing DPS should always be considered, but should not be routinely attempted., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)