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Evaluating readiness for discharge from the intensive care unit (ICU) is a critical aspect of patient care. Whereas evidence-based criteria for ICU admission have been established, practical criteria for discharge from the ICU are lacking. Often discharge guidelines simply state that a patient no longer meets ICU admission criteria. Such discharge criteria can be interpreted differently by different healthcare providers, leaving a clinical void where misunderstandings of patients' readiness can conflict with perceptions of what readiness means for patients, families, and healthcare providers. In considering ICU discharge readiness, the use and application of ethical principles may be helpful in mitigating such conflicts and achieving desired patient outcomes. Ethical principles propose different ways of understanding what readiness might mean and how clinicians might weigh these principles in their decision-making process. This article examines the concept of discharge readiness through the lens of the most widely cited ethical principles (autonomy [respect for persons], nonmaleficence/beneficence, and justice) and provides a discussion of their application in the critical care environment. Ongoing bioethics discourse and empirical research are needed to identify factors that help determine discharge readiness within critical care environments that will ultimately promote safe and effective ICU discharges for patients and their families. [ABSTRACT FROM AUTHOR]

This article provides a literature review on aesthetics and ethics, with a particular focus on how attention to aesthetics generates needed insights into ethical theory and the dynamics of moral practice. [ABSTRACT FROM AUTHOR]

This article discusses an approach to translational bioethics (TB) that is concerned with the adaptation—or 'translation'—of concepts, theories and methods from bioethics to practical contexts, in order to support 'non‐bioethicists', such as researchers and healthcare practitioners, in dealing with their ethical issues themselves. Specifically, it goes into the participatory development of clinical ethics support (CES) instruments that respond to the needs and wishes of healthcare practitioners and that are tailored to the specific care contexts in which they are to be used. The theoretical underpinnings of this participatory approach to TB are found in hermeneutic ethics and pragmatism. As an example, the development of CURA, a low‐threshold CES instrument for healthcare professionals in palliative care, is discussed. From this example, it becomes clear that TB is a two‐way street. Practice may be improved by means of CES that is effectively tailored to specific end users and care contexts. The other way around, ethical theory may be enriched by means of the insights gained from engaging with practice in developing CES in a process of co‐creation. TB is also a two‐way street in the sense that it requires collaboration and commitment of both bioethicists and practitioners, who engage in a process of mutual learning. However, substantial challenges remain. For instance, is there a limit to the extent to which a method of moral reasoning can be adapted in order to meet the constraints of a given healthcare setting? Who is to decide, the bioethicist or the practitioners? [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: to understand the bioethical perspectives on mobile tracking device use. Methods: theoretical study based on action research, carried out with eight graduate students from a public university. A focus group was used, with a thematic content analysis methodology with a codebook structure, approved by the Research Ethics Committee. Results: from the analysis, there was a concern about using devices after the pandemic ended. Using or not the device, rights inherent to humans, legislation and effectiveness of methods deepen interpretations, moving participants from a personalistic conception of the topic to a vision focused on professional implications about the methods. Final considerations: the debate on the impact of using technological devices on health, especially those that imply restriction of rights that refer to individuals’ private life, involves a discussion of a professional nature, in addition to requirement for clear rules on the topic.

Moral bioenhancement presents the possibility of enhancing morally desirable emotions and dispositions. While some scholars have proposed that moral bioenhancement can produce virtue, we argue that within a virtue ethics framework moral bioenhancement cannot reliably produce virtue. Moreover, on a virtue ethics framework, the pursuit of moral bioenhancement carries moral risks. To make this argument, we consider three aspects of virtue-its motivational, rational, and behavioral components. In order to be virtuous, we argue, a person must (i) take pleasure in doing the right thing and have the correct motivational attitudes; (ii) reason correctly about what is called for in a particular ethical dilemma; and (iii) intentionally and continuously practice and cultivate virtues. These dimensions of morality-in short: precisely those emphasized in a virtue ethics framework-cannot be consistently or reliably met using existing moral bioenhancement technology., (© The Author(s) 2024. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: The psychology of moral decision-making classically contrasts utilitarianism (based on consequences) and deontology (based on moral norms). Previous studies capitalizing on this dichotomy have suggested the presence of a utilitarian bias among patients with severe alcohol use disorder (SAUD). We aimed to further disentangle the processes involved in such bias through a more validated approach, the CNI model of moral decision-making. This model allows to go further than the classical approach by distinguishing sensitivity to consequences (C), to moral norms (N), and general preference for inaction over action (I) in response to moral dilemmas., Methods: Thirty-four recently detoxified patients with SAUD and 34 matched control participants completed a battery of 48 dilemmas derived from the CNI model, as well as social cognition tasks., Results: In contrast with the utilitarian bias suggested in previous studies based on the classical approach, patients with SAUD did not show an increased sensitivity to consequences in comparison with control participants. However, they showed a reduced sensitivity to moral norms, as well as a greater action tendency. These biases were not related to social cognition deficits., Conclusions: Patients with SAUD are not more utilitarian than healthy controls, this previously reported bias being artificially generated by the methodological limits of the classical approach. Instead, they present a reduced sensitivity to moral norms and an action bias, which might impact their interpersonal relations and contribute to the social isolation frequently reported in this population, thus identifying moral decision-making as a new therapeutic lever in SAUD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice., Objective: Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare., Material and Methods: Conceptual and ethical analyses., Results: After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed., Conclusion: Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants., (© 2024. The Author(s).)

According to the sufficiency theory of justice in health, justice requires that people have equal access to adequate health. In this article, I lay out the structure of this view and I assess its distributive implications for setting priority (i) between health needs across persons and (ii) between health care spending and other societal goods. I argue, first, that according to the sufficiency theory, deficiency in health cannot be completely offset by providing other societal goods. And, second, that it can prevent the medicalization of societies by stressing that improvements beyond the level of adequate health have relatively little weight, if any, from the standpoint of justice., (© 2024 The Author(s). Bioethics published by John Wiley & Sons Ltd.)

Any moral algorithm for autonomous vehicles must provide a practical solution to moral problems of the trolley type, in which all possible courses of action will result in damage, injury, or death. This article discusses a hitherto neglected variety of this type of problem, based on a recent psychological study whose results are reported here. It argues that the most adequate solution to this problem will be achieved by a moral algorithm that is based on Confucian ethics. In addition to this philosophical and psychological discussion, the article outlines the mathematics, engineering, and legal implementation of a possible Confucian algorithm. The proposed Confucian algorithm is based on the idea of making it possible to set an autonomous vehicle to allow an increased level of protection for selected people. It is shown that the proposed algorithm can be implemented alongside other moral algorithms, using either the framework of personal ethics settings or that of mandatory ethics settings., (© 2024. The Author(s).)

To facilitate engineering students' understanding of engineering ethics and support instructors in developing course content, this study introduces an innovative educational tool drawing inspiration from the Rubik's Cube metaphor. This Engineering Ethics Knowledge Rubik's Cube (EEKRC) integrates six key aspects-ethical theories, codes of ethics, ethical issues, engineering disciplines, stakeholders, and life cycle-identified through an analysis of engineering ethics textbooks and courses across the United States, Singapore, and China. This analysis underpins the selection of the six aspects, reflecting the shared and unique elements of engineering ethics education in these regions. In an engineering ethics course, the EEKRC serves multiple functions: it provides visual support for grasping engineering ethics concepts, acts as a pedagogical guide for both experienced and inexperienced educators in course design, offers a complementary assessment method for evaluating students learning outcomes, and assists as a reference for students engaging in ethical analysis., (© 2024. The Author(s).)

The popularisation of Artificial Intelligence (AI) technologies has sparked discussion about their ethical implications. This development has forced governmental organisations, NGOs, and private companies to react and draft ethics guidelines for future development of ethical AI systems. Whereas many ethics guidelines address values familiar to ethicists, they seem to lack in ethical justifications. Furthermore, most tend to neglect the impact of AI on democracy, governance, and public deliberation. Existing research suggest, however, that AI can threaten key elements of western democracies that are ethically relevant. In this paper, Rawls's theory of justice is applied to draft a set of guidelines for organisations and policy-makers to guide AI development towards a more ethical direction. The goal is to contribute to the broadening of the discussion on AI ethics by exploring the possibility of constructing AI ethics guidelines that are philosophically justified and take a broader perspective of societal justice. The paper discusses how Rawls's theory of justice as fairness and its key concepts relate to the ongoing developments in AI ethics and gives a proposition of how principles that offer a foundation for operationalising AI ethics in practice could look like if aligned with Rawls's theory of justice as fairness., (© 2024. The Author(s).)

Controlled human infection studies (CHIs) involve the intentional infection of human subjects for a scientific aim. Though some past challenge trials have involved serious ethical abuses, in the last few decades, CHIs have had a strong track record of safety. Despite increased attention to the ethics of CHIs during the COVID-19 pandemic, CHIs remain controversial, and there has been no in-depth treatment of CHIs through the lens of virtue ethics. In this article, we argue that virtue theory can be helpful for addressing CHIs that present a constellation of controversial, unresolved, and/or under-regulated ethical issues. We begin with some brief background on virtue ethics. We then substantiate our claim that some CHIs raise a constellation of ethical issues that are unresolved in the ethics literature and/or lack adequate regulatory guidance by demonstrating that CHIs can present indeterminate social value, risks to third parties, limitations on the right to withdraw from research, and questions about the upper limit of allowable risk. We argue that the presence of a virtuous investigator, with virtues such as prudence, compassion, and integrity, is especially important when these unresolved research ethics issues arise, which is the case for certain types of controlled human infection studies. We use the historical example of Walter Reed and the Yellow Fever Commission to illustrate this claim, and we also highlight some contemporary examples. We end by sketching some practical implications of our view, such as ensuring that investigators with experience running CHIs are involved in novel CHI models., (© 2024 The Author(s). Bioethics published by John Wiley & Sons Ltd.)

With the growing application of machine learning models in medicine, principlist bioethics has been put forward as needing revision. This paper reflects on the dominant trope in AI ethics to include a new 'principle of explicability' alongside the traditional four principles of bioethics that make up the theory of principlism. It specifically suggests that these four principles are sufficient and challenges the relevance of explicability as a separate ethical principle by emphasizing the coherentist affinity of principlism. We argue that, through specification, the properties of explicability are already covered by the four bioethical principles. The paper finishes by anticipating an objection that coherent principles could not facilitate technology induced change and are not well-suited to tackle moral differences., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

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.)

To provide deeper insights into the relationships between psychopathic traits and utilitarian moral judgment, we studied N = 702 adults using three psychopathy scales: (a) the Levenson's Self-report Psychopathy Scale; (b) the Psychopathic Personality Inventory; and (c) the Triarchic Psychopathy Measure; and three measures of utilitarian moral judgment: (a) trolley dilemmas; (b) the Consequences, Norms, and Inaction (CNI) model of moral decision-making; and (c) the Oxford Utilitarianism Scale. When using the traditional approach to moral judgment (i.e., trolley dilemmas, instrumental harm, traditional score from the CNI model), we found that higher levels of psychopathic traits were associated with a higher utilitarian tendency. When using the modeling approach, we found that a higher level of psychopathic traits was related to weaker sensitivity to moral norms and less action averse in morally problematic situations. In addition, we found negative associations between impartial beneficence and all psychopathy scores., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Physicians frequently encounter situations in which their professional practice is intermingled with moral affordances stemming from other domains of the physician's lifeworld, such as family and friends, or from general morality pertaining to all humans. This article offers a typology of moral conflicts 'at the margins of professionalism' as well as a new theoretical framework for dealing with them. We start out by arguing that established theories of professional ethics do not offer sufficient guidance in situations where professional ethics overlaps with moral duties of other origins. Therefore, we introduce the moral theory developed by Christine M. Korsgaard, that centres around the concept of practical identity. We show how Korsgaard's account offers a framework for interpreting different types of moral conflicts 'at the margins of professionalism' to provide either orientation for solving the conflict or an explanation for the emotional and moral burden involved in moral dilemmas., 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.)

This paper investigates the ethical implications of applying open science (OS) practices on disruptive technologies, such as generative AIs. Disruptive technologies, characterized by their scalability and paradigm-shifting nature, have the potential to generate significant global impact, and carry a risk of dual use. The tension arises between the moral duty of OS to promote societal benefit by democratizing knowledge and the risks associated with open dissemination of disruptive technologies. Van Rennselaer Potter's 'third bioethics' serves as the founding horizon for an ethical framework to govern these tensions. Through theoretical analysis and concrete examples, this paper explores how OS can contribute to a better future or pose threats. Finally, we provide an ethical framework for the intersection between OS and disruptive technologies that tries to go beyond the simple 'as open as possible' tenet, considering openness as an instrumental value for the pursuit of other ethical values rather than as a principle with prima facie moral significance., (© 2024. The Author(s).)

Recent ethical debate about compassionate conservation has invoked moral theories to oppose or support traditional practices of killing animals to protect biodiversity and ecosystems. The debate has featured the mainstream moral theories of consequentialism and utilitarianism, deontology, and virtue ethics. We identify problematic applications and critique of these moral theories in conservation discussions. Problems include a lack of clarity when invoking moral theories, misunderstanding and mischaracterizing theories, and overlooking features and circumstances affecting a theory's application. A key omission in the debate is a detailed discussion of the moral significance of animals and nature. We then examine the role of moral theory as such in ethical discussion, contrasting moral theory with ethical outlooks that center, for example, forms of love and care. Our aim is to advance the ethical debate about harming animals in conservation., (© 2024 The Authors. Conservation Biology published by Wiley Periodicals LLC on behalf of Society for Conservation Biology.)

It is well established that one's sense of morality may be readily influenced by one's culture, education, and life situation. Very few psychometric tools are currently available to measure facets of human morality in different cultures. Therefore, the purpose of the present study was to develop a French adaptation of the Oxford Utilitarianism Scale (OUS-Fr) and formally evaluate its validity. The OUS-Fr was developed through a process of back-translation and administered to a sample of 552 participants. Results from exploratory factor analyses revealed a bidimensional structure with satisfactory loadings that was then also supported in the confirmatory factor analysis check. The OUS-Fr scale demonstrated good psychometric properties, with acceptable internal consistency and coherent results in the convergent validity analyses. These findings contribute to morality measurement literature by providing evidence for the reliability and validity of the French adaptation of the OUS. The OUS-Fr can be viewed as a valuable tool for researchers and practitioners for assessing utilitarian tendencies within the French-speaking population, which could pave the way for cross-cultural understandings that are important for fully understanding the intricacies of human morality., (© 2023. The Author(s).)

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.)

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.)

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).)

We expand on Della Croce's ambition to interpret "epistemic injustice" as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce's attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson's concept of "contributory injustice" and Scheman's concept of "perceptual autonomy," we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy., (© 2023. Journal of Bioethical Inquiry Pty Ltd.)

Background: At the beginning of the coronavirus (Covid-19) pandemic, many non-Covid healthcare services were suspended. In April 2020, the Department of Health in England mandated that non-Covid services should resume, alongside the continuing pandemic response. This 'resetting' of healthcare services created a unique context in which it became critical to consider how ethical considerations did (and should) underpin decisions about integrating infection control measures into routine healthcare practices. We draw on data collected as part of the 'NHS Reset Ethics' project, which explored the everyday ethical challenges of resetting England's NHS maternity and paediatrics services during the pandemic., Methods: Healthcare professionals and members of the public participated in interviews and focus group discussions. The qualitative methods are reported in detail elsewhere. The focus of this article is our use of Frith's symbiotic empirical ethics methodology to work from our empirical findings towards the normative suggestion that clinical ethics should explicitly attend to the importance of relationships in clinical practice. This methodology uses a five-step approach to refine and develop ethical theory based on a naturalist account of ethics that sees practice and theory as symbiotically related., Results: The Reset project data showed that changed working practices caused ethical challenges for healthcare professionals, and that infection prevention and control measures represented harmful barriers to the experience of receiving and offering care. For healthcare professionals, offering care as part of a relational interaction was an ethically important dimension of healthcare delivery., Conclusions: Our findings suggest that foregrounding the importance of relationships across a hospital community will better promote the ethically important multi-directional expression of caring between healthcare professionals, patients, and their families. We offer two suggestions for making progress towards such a relational approach. First, that there is a change of emphasis in clinical ethics practice to explicitly acknowledge the importance of the relationships (including with their healthcare team) within which the patient is held. Second, that organisational decision-making should take into account the moral significance afforded to caring relationships by healthcare professionals, and the role such relationships can play in the negotiation of ethical challenges., (© 2024. 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 medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians' normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard's neo-Kantian moral account of practical identities. We begin by showing the case of physicians' duty to climate protection, before we succinctly introduce Korsgaard's account. We subsequently show how the duty to climate protection can follow from physicians' identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians' professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The rapid proliferation and integration of AI chatbots in office environments, specifically the advanced AI model ChatGPT, prompts an examination of how its features and updates impact knowledge processes, satisfaction, and word-of-mouth (WOM) among office workers. This study investigates the determinants of WOM among office workers who are users of ChatGPT. We adopted a quantitative approach, utilizing a stratified random sampling technique to collect data from a diverse group of office workers experienced in using ChatGPT. The hypotheses were rigorously tested through Structural Equation Modeling (SEM) using the SmartPLS 4. The results revealed that system updates, memorability, and non-language barrier attributes of ChatGPT significantly enhanced knowledge acquisition and application. Additionally, the human-like personality traits of ChatGPT significantly increased both utilitarian value and satisfaction. Furthermore, the study showed that knowledge acquisition and application led to a significant increase in utilitarian value and satisfaction, which subsequently increased WOM. Age had a positive influence on WOM, while gender had no significant impact. The findings provide theoretical contributions by expanding our understanding of AI chatbots' role in knowledge processes, satisfaction, and WOM, particularly among office workers., (© 2024. The Author(s).)

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.

What do we owe other persons? Are we as much obliged to promote their wellbeing as we are to reduce their suffering? This question is crucial for a range of social institutions and welfare services, and especially for the health services. To address this question the article investigates prominent positions and arguments in moral philosophy. It finds that while classical utilitarianism claims that there is symmetry in the moral obligation with respect to peoples' wellbeing and their suffering, a wide range of other positions and perspectives argue for an asymmetric relationship with stronger moral obligations towards other persons' suffering than towards their wellbeing. This difference in obligations is supported ontologically by basic differences inherent in wellbeing and suffering and axiologically by a relative (gradual) difference in value. The many well-founded arguments for stronger moral obligations towards other persons' suffering than towards their wellbeing has important implications for health policy; especially for priority setting. Avoiding and reducing suffering should have priority to the promotion and enhancement of wellbeing., (Copyright © 2024 The Author. Published by Elsevier B.V. All rights reserved.)

Matti Häyry presents a new ethical theory that he calls "conflict-responsive need-based negative utilitarianism." 1 In this commentary, I present my critical observations on his main points against the more general background of utilitarianism and theories of value.

In 2017, Michael Nair-Collins formulated his Transitivity Argument which claimed that brain-dead patients are alive according to a concept that defines death in terms of the loss of moral status. This article challenges Nair-Collins' view in three steps. First, I elaborate on the concept of moral status, claiming that to understand this notion appropriately, one must grasp the distinction between direct and indirect duties. Second, I argue that his understanding of moral status implicit in the Transitivity Argument is faulty since it is not based on a distinction between direct and indirect duties. Third, I show how this flaw in Nair-Collins' argument is grounded in the more general problems between preference utilitarianism and desire fulfillment theory. Finally, I present the constructivist theory of moral status and the associated moral concept of death and explain how this concept challenges the Transitivity Argument. According to my view, brain death constitutes a valid criterion of death since brain death is incompatible with the preserved capacity to have affective attitudes and to value anything., (© 2024. The Author(s).)

International carbon allocation confronts the conflict between efficiency and equality. Previous research based on the intergroup bias perspective has attributed carbon allocation preference to the defence of ingroup interests (i.e., national interests) while overlooking the critical role of trade-offs between competing moral values. Integrating the contingency theory of justice and moral philosophical theories of utilitarianism and egalitarianism, we proposed that the moral-values trade-off between utilitarianism and egalitarianism determines carbon allocation preference through justice reasoning. Analysis of large-scale survey datasets (Study 1) revealed that aggregated national endorsement of utilitarianism over egalitarianism predicted greater efficiency preference in total and per capita carbon emission levels. Study 2 demonstrated that experimentally manipulating endorsement of utilitarianism versus egalitarianism boosted efficiency (vs. equality) preference in carbon allocation, and justice reasoning characterized by enhanced efficiency-focused justice and diminished equality-focused justice accounted for these effects. Using a 'manipulation-of-mediator' design, Study 3 further confirmed the causal link in the mediation model. By highlighting the significance of moral trade-offs in shaping carbon allocation preference, this research not only provides a novel moral perspective in understanding debates on international carbon allocation but also has important implications for fostering international carbon abatement cooperation., (© 2023 The British Psychological Society.)

My fundamental thesis is that Rachels dismisses the traditional Western account of the morality of killing without offering a viable replacement. In this regard, I will argue that the substitute account he offers is deficient in at least eight regards: (1) he fails to justify the foundational principle of utilitarianism, (2) he exposes preference utilitarianism to the same criticisms he lodges against classical utilitarianism, (3) he neglects to explain how precisely one performs the maximization procedure which preference utilitarianism requires, (4) his account of the sanctity of life is subject to the very criticism he levels against the traditional position, (5) he cannot justify the exceptions he makes to his interpretation of the sanctity of life, (6) his account could easily be used to justify murder, (7) his embrace of autonomy as an ethical principle undermines his preference utilitarianism, and (8) he cannot maintain the moral identification of acts of killing and letting die., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

The question that this paper tries to answer is Q: "Can good academic bioethics be done without commitment to moral theory?" It is argued that the answer to Q is an unequivocal "Yes" for most of what we could call "critical bioethics," that is, the kind of bioethics work that primarily criticizes positions or arguments already in the literature or put forward by policymakers. The answer is also "Yes" for much of empirical bioethics. The second part of the paper then provides an analysis of Q in relation to "constructive bioethics," that is, bioethics work aimed at providing an argument for a particular position. In this part, it is argued that a number of the approaches or methods used that initially look like they involve no commitment to moral theory, nevertheless, involve such a commitment. This is shown to be the case for reflective equilibrium, mid-level theory, the use of theory fragments, and argument by analogy.

Are moral judgments to sacrificial dilemmas shaped by a latent social norm? The present research addresses this issue. We report a set of six studies (plus a supplementary one) which question the existence of a social norm in the longstanding deontism/utilitarian debate by relying on two original tools, namely substitution technique and self-presentation paradigm. Study 1 showed that American participants asked to answer like most Americans would do gave more utilitarian responses than control participants who answered in their own name (Study 1). Study 2 showed that participants instructed to answer in a disapproval fashion were more utilitarian than both participants instructed to answer in an approval fashion and control participants. Importantly, no difference was observed between the approval and control conditions, suggesting that participants naturally align their moral judgments with a latent norm they think is the most socially desirable. Studies 3-5 explored in addition the effect of the activation of a deontism-skewed norm using the substitution instruction on subsequent impression formation. For the latter task, participants were instructed to evaluate a random participant selected from a previous study who gave utilitarian-like responses (Studies 3a-3b), or to evaluate a fictitious politician who endorsed either a deontic or utilitarian orientation (Studies 4-5). Although we consistently replicated the effect of substitution instruction, we failed to show that attempts to activate a norm in a given individual shaped their evaluation of other people who do not align with this norm. Finally, we report a mini meta-analysis targeting the pooled effect and homogeneity among our studies.

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory-practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real-world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy-making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real-world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real-world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework., (© 2024 The Authors. Bioethics published by John Wiley & Sons Ltd.)

This essay aims to shed some light on the still common sense of a vocation among scientists. Taking its cue from Paul Forman's analysis of twentieth-century disciplinary science and Emile Durkheim's social view of religions, it suggests that modern scientific communities resemble religious communities in their penchant for transcendence. The essay aims to illustrate this perspective by looking at some developments within the physics discipline since its emergence in the late nineteenth century. One indication for this penchant is the tendency to distance oneself from the material conditions which allowed the discipline to flourish. These utilitarian conditions, industrial as well as material, were seen to pose a threat to the disinterested pursuit of truth. Another is the persistent tendency among theoretical physicists to search for otherworldly, immaterial and unifying foundations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Early in 2022 the first pig to human cardiac xenotransplant was performed. The graft initially performed well, and rejection was well controlled. However, the graft failed, and the patient died 60 days after the procedure. The ethical issues relating to xenotransplantation include the risk/benefit to the individual, the risk of porcine-derived infectious agents crossing into humans, animal welfare and rights, issues of human and animal identity and concerns relating to fair allocation of organs and appropriate use of resources.These ethical issues are often addressed using emotional arguments, or through consequentialist or deontological lens. An alternative is to use approaches based on virtue ethics to understand the moral purpose ( telos ) of the research and the virtues (character traits) needed to be a good research clinician. In this review we will consider the virtues of justice, courage, temperance and practical wisdom, as well as the role of clinical curiosity, and their application to xenotransplantation. This provides an alternative approach for the clinical academic and others involved in the research to reflect on their practice., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Andrew has previously carried out research on xenotransplantation. He is involved in the ethical review process in the UK as a member of the Health Research Authority board. He is co-chair of the UK Committee on Research Integrity. He is writing in a personal capacity.

We propose a step-by-step methodological framework of translational bioethics that aims at changing medical practice according to normative-ethical requirements, which we will thus call "transformative medical ethics." The framework becomes especially important when there is a gap between widely acknowledged, ethically justified normative claims and their realization in the practice of biomedicine and technology (ought-is gap). Building on prior work on translational bioethics, the framework maps a process with six different phases and 12 distinct translational steps. The steps involve various research activities including conceptual philosophical inquiry and (socio-)empirical research. On the one hand, the framework can be used as a heuristic tool to identify barriers to the transformation process. On the other hand, it can provide guidance for researchers and practitioners to develop appropriate (conceptual action and practice) models, which are then implemented and evaluated in specific practice contexts. We use the example of realizing the norm of respect for autonomy in the practice of medical decision-making to illustrate the framework. Further research is required, for example, to theoretically underpin the framework, to apply it to other ought-is gaps, and to evaluate its feasibility and effectiveness in various practice areas. Overall, the framework of transformative medical ethics suggests a strategic process to investigate and promote practice change that is ethically informed in all phases., (© 2023 The Authors. Bioethics published by John Wiley & Sons Ltd.)

In recent years, considerable and valuable research progress has been made in indoor positioning technologies based on WLAN Radio Frequency (RF) fingerprinting, identifying it as one of the most promising positioning technologies with substantial potential for wider adoption. However, indoor environmental factors significantly influence the propagation of wireless RF signals, resulting in a considerable decrease in positioning accuracy as the indoor environmental conditions vary. Thus, effectively mitigating the impact of indoor environmental factors on WLAN RF fingerprinting-based positioning systems has become a crucial research problem. Currently, there is a dearth of comprehensive research on the influence of indoor climatic factors, particularly the variations in relative humidity, on the propagation of WLAN RF signals within indoor spaces and its consequential impact on positioning accuracy. To address the aforementioned issues, this paper proposes an Adaptive expansion fingerprint database (AeFd) model based on a regression learning algorithm. The AeFd, through the design of a relationship model describing the interaction between fingerprint databases under varying relative humidity, allows the fingerprint database expanded by AeFd to dynamically adapt to the changes in indoor relative humidity. Our experiments show that using the AeFd model with the KNN algorithm, a 5% performance improvement was observed over 10 days and an 8% improvement over 10 months. According to experimental test results, the fingerprint database expansion model AeFd proposed in this paper can effectively expand the fingerprint database under different relative humidity levels, thereby significantly enhancing the positioning performance of the system and improving its stability., Competing Interests: The author declares that there is no conflict of interest., (Copyright: © 2024 Fan, Sun. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: During the pandemic, social and health care professionals operated in 'crisis conditions'. Some existing rules/protocols were not operational, many services were closed/curtailed, and new 'blanket' rules often seemed inappropriate or unfair. These experiences provide fertile ground for exploring the role of virtues in professional life and considering lessons for professional ethics in the future., Research Design and Aim: This article draws on an international qualitative survey conducted online in May 2020, which aimed to explore the ethical challenges experienced by social workers during Covid-19., Participants and Research Context: 607 social workers responded from 54 countries, giving written online responses. This article first summarises previously published findings from the survey regarding the range of ethical challenges experienced, then develops a new analysis of social workers' accounts of ethically challenging situations from a virtue ethics perspective. This analysis took a narrative ethics approach, treating respondents' accounts as stories featuring the tellers as moral agents, with implicit or explicit implications for their professional ethical identity and character. The article is illustrated with accounts from the 41 UK respondents, drawing particularly on two case examples., Ethical Considerations: Ethical approval was gained from Durham University and anonymity was ensured for participants., Findings/results: This article explores the nature of the ethical space created during the pandemic showing how practitioners were able to draw more on 'inner resources' and professional discretion than usual, displaying virtues such as professional wisdom, care, respectfulness and courage as they took account of the specific contexts of their work, rather than simply adhering to blanket rules., Conclusion: Exploring practice through a virtue ethical lens provides valuable lessons for 'building back better' in social and health care professions., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The Harm Threshold (HT) holds that the state may interfere in medical decisions parents make on their children's behalf only when those decisions are likely to cause serious harm to the child. Such a high bar for intervention seems incompatible with both parental obligations and the state's role in protecting children's well-being. In this paper, I assess the theoretical underpinnings for the HT, focusing on John Stuart Mill's Harm Principle as its most plausible conceptual foundation. I offer (i) a novel, text-based argument showing that Mill's Harm Principle does not give justificatory force to the HT; and (ii) a positive account of some considerations which, beyond significant harm, would comprise an intervention principle normatively grounded in Mill's ethical theory. I find that substantive recommendations derived from Mill's socio-political texts are less laissez-faire than they have been interpreted by HT proponents. Justification for state intervention owes not to the severity of a harm, but to whether that harm arises from the failure to satisfy one's duty. Thus, a pediatric intervention principle derived from Mill ought not to be oriented around the degree of harm caused by a parent's healthcare decision, but rather, the kind of harm-specifically, whether the harm arises from violation of parental obligation. These findings challenge the interpretation of Mill adopted by HT proponents, eliminating a critical source of justification for a protected domain of parental liberty and reorienting the debate to focus on parental duties., (© 2023. The Author(s).)

In this paper I critically examine the implications of the uncodifiability thesis for principlism as a pluralistic and non-absolute generalist ethical theory. In this regard, I begin with a brief overview of W.D. Ross's ethical theory and his focus on general but defeasible prima facie principles before turning to 2) the revival of principlism in contemporary bioethics through the influential work of Tom Beauchamp and James Childress; 3) the widespread adoption of specification as a response to the indeterminacy of abstract general principles and the limitations of balancing and deductive approaches; 4) the challenges raised to fully specified principlism by the uncodifiability thesis and 5) finally offer a defense of the uncodifiability thesis against various critiques that have been raised.

When health professionals experience moral distress during routine clinical practice, they are challenged to maintain integrity through conscientious practice guided by ethical principles and virtues that promote the dignity of all human beings who need care. Their integrity also needs preservation during a crisis like the COVID-19 pandemic, especially when faced with triage protocols that allocate scarce resources. Although a crisis may change our ability to provide life-saving treatment to all who need it, a crisis should not change the ethical values that should always be guiding clinical care. Enduring ethical commitments should encourage clinicians to base treatment decisions on the medical needs of individual patients. This approach contrasts with utilitarian attempts to maximize selected aggregate outcomes by using scoring systems that use short-term and possibly long-term prognostic estimates to discriminate between patients and thereby treat them unequally in terms of their eligibility for life-sustaining treatment. During times of crisis and calm, moral communication allows clinicians to exercise moral agency and advocate for their individual patients, thereby demonstrating conscientious practice and resisting influences that may contribute to compartmentalization, moral injury, and burnout., (© The Author(s) 2023. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This paper proposes a new class of efficient and equitable social welfare orderings, a generalized leximin rule that includes rank-weighted utilitarianism, leximin, and their lexicographic compositions. While the famous Deschamps and Gevers' joint characterization theorem shows that a Paretian, anonymous, separable social welfare ordering must be either weak utilitarianism, leximin, or leximax under the assumption of cardinal full comparability, this study provides a new joint characterization theorem in which imposing rank-separability, instead of separability, enables acceptable social welfare ordering to be the generalized leximin rule. This result is proven by an intuitive and easy-to-understand method, which also helps show the mechanism by which a class of Paretian, anonymous, and separable social welfare orderings is limited to weak utilitarianism and leximin., Competing Interests: The author have declared that no competing interests exist., (Copyright: © 2024 Norihito Sakamoto. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Ethics theory is highly valued to the point that some commentators have claimed that it has taken on a life of its own, with too much focus on the justification of moral judgment and not enough on the needs of users of such theory. Building from various personal experiences of interdisciplinary ethics collaborative developments and empirical research projects, the wisdom gleaned by others, as well as insights from pragmatist theory, this article offers five (non-exhaustive) expectations for ethics theory from the standpoint of a user. The article is intended to prompt broad reflection on expectations toward ethics theory and why user perspectives should be considered early in the development of ethics scholarship.