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Overconfidence is a prevalent problem and it is particularly consequential in its relation with scientific knowledge: being unaware of one's own ignorance can affect behaviours and threaten public policies and health. However, it is not clear how confidence varies with knowledge. Here, we examine four large surveys, spanning 30 years in Europe and the United States and propose a new confidence metric. This metric does not rely on self-reporting or peer comparison, operationalizing (over)confidence as the tendency to give incorrect answers rather than 'don't know' responses to questions on scientific facts. We find a nonlinear relationship between knowledge and confidence, with overconfidence (the confidence gap) peaking at intermediate levels of actual scientific knowledge. These high-confidence/intermediate-knowledge groups also display the least positive attitudes towards science. These results differ from current models and, by identifying specific audiences, can help inform science communication strategies., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

The great challenge to non-accommodating bioethics is to respond to the argument that euthanasia should be considered a medical procedure protected by law. This article analyzes the relationship between human dignity and the sacredness of human life. The abandonment of dignity for other alternatives open to us implies renouncing a principle that, in its legal embodiment, has served a noble purpose since World War II. Moreover, from an ontological - professional perspective, the innovation proposed with euthanasia and medically-assisted suicide shatters one of the limitations to medical action that exists - at least theoretically - in the Hippocratic Oath. The authors also attempt to deconstruct the use of compassion as an argument on the part of some, the effect of which is to strengthen the position of the person who is stronger or fittest. This occurs primarily with euthanasia and even in abortion. The described manipulation also constitutes the main obstacle to the progression from medicine centered exclusively on curing towards medicine that acknowledges the primary objective of all end-of-life treatment as being to improve quality of life, or at least to achieve that improvement by treating symptoms when it is possible to do so. [ABSTRACT FROM AUTHOR]

This paper traces the reception of the Belmont Report in Europe and its influence on the development of European research ethics thinking and European research ethics systems. It is very difficult to trace a clear, linear reception history because it is difficult to disentangle the influence of the Report from the influence of concurrent developments, such as the 1975 revision of the World Medical Association Declaration of Helsinki and the requirement for research ethics review in the Vancouver Group's 1978 "Uniform Requirements for Manuscript Submission." The Report's insistence that the focus of research ethics should be the rights and interests of the individual research subject, and the use of an ethical framework and not ethical theory as the basis of analysis and justification of recommendations, were nevertheless very important for the development of research ethics. The divergence between Europe and the US in the governance of non-biomedical research can at least partly be explained by the absence of strong drivers for the introduction of research ethics committees outside of biomedicine in Europe, and by the ability of non-biomedical researchers to mobilize effectively against the introduction of such committees.

Austerity, by its very nature, imposes constraints by limiting the options for action available to us because certain courses of action are too costly or insufficiently cost effective. In the context of healthcare, the constraints imposed by austerity come in various forms; ranging from the availability of certain treatments being reduced or withdrawn completely, to reductions in staffing that mean healthcare professionals must ration the time they make available to each patient. As austerity has taken hold, across the United Kingdom and Europe, it is important to consider the wider effects of the constraints that it imposes in healthcare. Within this paper, we focus specifically on one theorised effect-moral distress. We differentiate between avoidable and unavoidable ethical challenges within healthcare and argue that austerity creates additional avoidable ethical problems that exacerbate clinicians' moral distress. We suggest that moral resilience is a suitable response to clinician moral distress caused by unavoidable ethical challenges but additional responses are required to address those that are created due to austerity. We encourage clinicians to engage in critical resilience and activism to address problems created by austerity and we highlight the responsibility of institutions to support healthcare professionals in such challenging times.

Professionalism requires that physicians uphold the best interests of patients while simultaneously insuring just use of health care resources. Current articulations of these obligations like the American Board of Internal Medicine (ABIM) Foundation's Physician Charter do not reconcile how these obligations fit together when they conflict. This is the problem of dual agency. The most common ways of dealing with dual agency: "bunkering"--physicians act as though societal cost issues are not their problem; "bailing"--physicians assume that they are merely agents of society and deliver care typically based on a strongly consequentialist public health ethic; or "balancing"--a vaguely specified attempt to uphold both patient welfare and societal need for judicious resource use simultaneously--all fail. Here I propose how the problem of dual agency might begin to be addressed with rigor and consistency. Without dealing with the dual agency problem and getting more specific about how to reconcile its norms when they conflict, the expectations of professionalism risk being written off as cute, nonbinding aphorisms from the medical profession.

In France, since the approval of the first bioethics laws in 1994, the principle of the anonymity of sperm donors has prevailed. This choice is regularly challenged, namely by children who have been conceived under these conditions and have now reached adulthood. In this paper, we will briefly describe the reasons that led practitioners of assisted reproduction to endorse the anonymity principle in 1994. Secondly, we will elaborate on the reasons why this principle is becoming so controversial today. Finally, we shall examine two possible outcomes of the debate, highlighting their respective legitimacy as well as their consequences, as far as the rights of children, the notion of the family, and medical practice are concerned.

Is there a special Mediterranean approach to Bioethics and if so what are the roots of this approach? And why not a Bosphorus, or a 'lake Michigan' bioethics? The answer to such a question depends on the focus one takes on defining 'Mediterranean'? On the one hand one can refer to the Mediterranean region which includes the surrounding coasts, having Europe on its northern coast line, northern Africa on its southern coast line (and these will include the north and South West coasts), and in the Eastern region countries which border with Middle-Eastern countries. This approach is the approach currently being taken by European Parliamentarians when they speak about the Mediterranean, namely including countries like France, Italy and Libya. On the other hand there is the look upon the Mediterranean as 'Southern Europe'; this is a more 'traditional' way on how westerners view the Mediterranean. This common approach is often recognized when, for example, we speak of 'Mediterranean diet', or, 'Mediterranean Temperament'. It would include Eastern countries like Greece and Cyprus. This article focuses on these two approaches to Mediterranean ethics after discussing issues pertaining to the region which are important to define in this context. It then analyses the need for having a Mediterranean approach to bioethical issues.

In organic farming animal welfare is one important aspect included in the internationally agreed organic principles of health, ecology, fairness and care (IFOAM 2006), reflecting expectation of consumers and farmers. The definition of organic animal welfare includes-besides traditional terms of animal welfare-'regeneration' and 'naturalness'. Organic animal welfare assessment needs to reflect this and use complex parameters, include natural behaviour and a systemic view. Furthermore, various parties with seemingly conflicting interests are involved, causing ethical dilemmas, such as the use of nose rings for outdoor sows (impaired animal welfare vs. destruction of humus). Solutions can only be found when foundational concepts are translated and applied to practical situations. On-farm animal welfare assessment and implementation of improvement strategies are increasingly relevant scientific areas. They combine on-farm welfare assessment, identification of key problem areas and connected risk factors. Constant communication between all parties is crucial for success. Animal health and welfare planning is one application of this approach, which was carried out on Austrian organic pig farms as well as organic dairy farms in seven European countries. The projects included welfare assessment, feedback and benchmarking as a tool for communication between farmers, advisors and scientists. Finally goals were set by the farmer and improvement strategies applicable to organic farming were implemented. This included prevention of disease by management strategies instead of routine treatment with pharmaceutical products. It appeared that next to problem structuring, multidisciplinary problem solving demands good communications skills to relate animal welfare science to value reflections.

Just as human embryonic stem cell research has generated controversy about the uses of human embryos for research and therapeutic applications, human embryonic stem cell patents raise fundamental ethical issues. The United States Patent and Trademark Office has granted foundational patents, including a composition of matter (or product) patent to the Wisconsin Alumni Research Foundation (WARF), the University of Wisconsin-Madison's intellectual property office. In contrast, the European Patent Office rejected the same WARF patent application for ethical reasons. This article assesses the appropriateness of these patents placing the discussion in the context of the deontological and consequentialist ethical issues related to human embryonic stem cell patenting. It advocates for a patent system that explicitly takes ethical factors into account and explores options for new types of intellectual property arrangements consistent with ethical concerns.

The substantive safety of radiological and other medical procedures can be radically reduced by unconscious factors governing scientific thought. In addition, the historical exclusion of women from these disciplines has possibly skewed their development in directions that now need to be addressed. This paper focuses on three such factors: gendered libidos that privilege risk taking over prevention, fragmented forms of knowledge that encourage displaced forms of responsibility and group dynamics that discourage critique of accepted practices and limit the definition of one's group. The substantive safety of the practice and scientific contribution of radiologists might be considerably enhanced were the focus to switch from radiology to diagnosis. Such enlargement might redefine the brief of radiologists towards preventing as well as curing; evaluating some non-invasive and low-tech options, adopting some inclusive paradigms of clinical ecology and enlarging group identities to include those currently excluded through geography or social class from participating in the benefits of science.

This article discusses the relation between empirical and normative approaches in bioethics. The issue of dwarf tossing, while admittedly unusual, is chosen as a point of departure because it challenges the reader to look with fresh eyes upon several central bioethical themes, including human dignity, autonomy, and the protection of vulnerable people. After an overview of current approaches to the integration of empirical and normative ethics, we consider five ways that the empirical and normative can be brought together to speak to the problem of dwarf tossing: prescriptive applied ethics, theoretical ethics, critical applied ethics, particularist ethics and integrated empirical ethics. We defend a position of critical applied ethics that allows for a two-way relation between empirical and normative theories. Against efforts fully to integrate the normative and the empirical into one synthesis, we propose that the two should stand in tension and relation to one another. The approach we endorse acknowledges that a social practice can and should be judged both by the gathering of empirical data and by normative ethics. Critical applied ethics uses a five stage process that includes: (a) determination of the problem, (b) description of the problem, (c) empirical study of effects and alternatives, (d) normative weighing and (e) evaluation of the effects of a decision. In each stage, we explore the perspective from both the empirical (sociological) and the normative ethical point of view. We conclude by applying our five-stage critical applied ethics to the example of dwarf tossing.

In 1927, Fritz Jahr, a Protestant pastor, philosopher, and educator in Halle an der Saale, published an article entitled "Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants" and proposed a "Bioethical Imperative," extending Kant's moral imperative to all forms of life. Reviewing new physiological knowledge of his times and moral challenges associated with the development of secular and pluralistic societies, Jahr redefines moral obligations towards human and nonhuman forms of life, outlining the concept of bioethics as an academic discipline, principle, and virtue. Although he had no immediate long-lasting influence during politically and morally turbulent times, his argument that new science and technology requires new ethical and philosophical reflection and resolve may contribute toward clarification of terminology and of normative and practical visions of bioethics, including understanding of the geoethical dimensions of bioethics.

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well.

Therapeutic human cloning has the potential significantly to reduce human suffering and enhance human happiness. This is the main ethical argument in its favour. The main ethical arguments against it centre on questions to do with the moral status of the human embryo. A subsidiary set of arguments arises from the connections between therapeutic human cloning and reproductive cloning. Most of the ethical questions concerning the status of the human embryo have long been examined in the context of abortion, though they are being re-examined in the context of genetic screening and embryo research. A consensus on such matters seems extremely unlikely to result in the near future. The current role of ethicists may not, therefore, be so much to attempt to produce a definitive answer to the question of the status of the human embryo at the very early developmental stages at which therapeutic human cloning would take place, but more to help clarify arguments and indicate the implications of particular approaches. That is what this paper seeks to do.

Experimentation with embryonic stem (ES) cells has become an important breakthrough in medical research. However, it is also a source of controversy, because it requires the destruction of the human embryos used to derive ES cells. This paper deals with some of the ethical issues concerning ES cell research. To begin with, the terms used in the debate on the ethical status of the human embryo need to be defined. Apart from the presumed benefits of ES cell research, we should also consider such issues as the strong opposition to this research by a large part of society, who argue in favour of protecting and respecting human embryos; the fragility and defenseless of human embryos; and the contradiction in terms inherent in the statement that human embryos must be treated with respect. Secondly, we should focus on possible conflicts between the financial, scientific, and ethical aspects of this debate. Thirdly, the significance of social and political debate requires clear and complete information that takes all consequences into account. Finally, the paper suggests how multipotent adult stem cell research may be an optimal and realistic alternative to ES cell research.

On top of elaborate methods and approaches in research, diagnostics, and therapy, medicine is in need of a theory of its own thought and action; without theoretical reflection and referentiality, action becomes blind (and thus costly) and thought takes on a monotonous and circular character. Take the concept of health. The field of medicine, more and more taking its cues from evidence-based medicine (EBM), is onesidedly oriented to concepts of health which are based on notions of standard values for large populations or-in the shadow of the genome project-see health as the outcome of an intact genome, often turning a blind eye to the individual aspects of health. With an eye in particular to Friedrich Nietzsche's philosophy, the present paper looks into some continental European theories of individual health, seeking to determine to what extent they can contribute to reducing medicine's theory deficit and what consequences this may have for research, diagnostics, and therapy.

European biomedical ethics is often contrasted to American autonomy-based approaches, and both are usually distinguished as 'Western'. But at least three 'different voices' within European bioethics can be identified: the deontological codes of southern Europe (and Ireland), in which the patient has a positive duty to maximise his or her own health and to follow the doctor's instructions, whilst the physician is constrained more by professional norms than by patient rights; the liberal, rights-based models of Western Europe, in which the patient retains the negative right to override medical opinion, even if his or her mental capacity is in doubt; the social welfarist models of the Nordic countries, which concentrate on positive rights and entitlements to universal healthcare provision and entrust dispute resolution to non-elected administrative officials.

The scope of this essay is to introduce and explain the methodology underlying the Lanza Foundation Protocol for the analysis of clinical cases. The essay is divided in three parts. Part one examines the Protocol's methodology within the whole evolutionary framework of argumentation in bioethics. Particular attention is given to the most significant methodologies developed in European bioethics. Part two describes the system of argumentation which serves as a frame for both approaches, namely, the normative and the hermeneutical. Finally, the third part presents in an analytic fashion the operations which define the Protocol itself. The Protocol is the result of an interdisciplinary effort and it provides a detailed grid for analyzing and tackling the ethical components of clinical cases. The Protocol is primarily directed toward Ethics Committees in their consulting activity, yet it has been proven of considerable importance at an educational level also, particular in continuing education programs for health care professionals.

Can the bioethical theories that have served American bioethics so well, serve international bioethics as well? In two papers in the previous issue of the Kennedy Institute of Ethics Journal, I contend that the form of principlist fundamentalism endorsed by American bioethicists like Tom Beauchamp and Ruth Macklin will not play on an international stage. Deploying techniques of postmodern scholarship, I argue that principlist fundamentalism justifies neither the condemnation of the Nazi doctors at Nuremberg, nor, as the Report of the Advisory Committee on the Human Radiation Experiments (ACHRE) demonstrates, condemnation of Cold War radiation researchers. Principlist fundamentalism thus appears to be philosophy bankrupt. In this issue of the Journal, Beauchamp and Macklin reject this claim, arguing that I have misread the ACHRE report and misunderstood Nazism. They also argue that the form of post-postmodern negotiated human rights theory that I proffer is adequate only insofar as it is itself really fundamentalist; insofar as I take postmodernism seriously, however, I mire international bioethics in relativism. In this response, I reaffirm my anti-fundamentalism, provide further evidence in support of my reading of the ACHRE report, and defend my post-postmodern version of rights theory. I also develop criteria for a minimally adequate theoretical framework for international bioethics.

Bringing well-informed patients to the OR is a challenge for all who participate in surgical patients' care. Although the issue of informed consent has been around for a long time, it was not until the latter half of the twentieth century that health care professionals and patients began to focus on informed consent as a central concern in health care. This article explains the roots of informed consent, the path it has traveled, and the importance that health care professionals, especially perioperative nurses, play in ensuring that patients are fully informed about their impending procedures.

Today the Western world harbors, at least, three very different ethical traditions, each with its own characteristics: the Anglo-Saxon, the Northern (or Central) European, and the Mediterranean. Because modern bioethics made its appearance in the Anglo-American culture, Europeans in general, and Mediterraneans in particular, have attempted not simply to "import" or "translate" bioethics, but rather to "recreate" or "remake" the discipline according to their own cultural and ethical traditions. In my presentation, I would like to explain the peculiarities of Mediterranean bioethics, analyzing the following seven points: First, how they think bioethics should be philosophically founded; Second, the Mediterranean ethics of virtue and the doctor-patient relationship; Third, the relationship between Ethics and Law; Fourth, Health Care Systems and Ethics, Fifth, the problems concerning patient rights; Sixth, ethics by Committees; and finally, some general conclusions.

This paper reviews the current conclusions in medical ethics which have followed the 1969-1970 Medical Ethics Discontinuity, a break that challenged the Hippocratic way of thinking about ethics. The resulting dislocations in quality of care and the medical value system are discussed, and an alternative medical ethics is offered: Systems Ethics. A methodology for a Systems Ethics analysis of cases is presented and illustrated by the case of a physician-assisted suicide. The advantages, both theoretical and clinical, of a Systems Ethics approach to medicine, which is an expansion of the Hippocratic tradition in medical ethics, are developed. Using Systems Ethics, it is possible to avoid the dangers of legalism, bureaucratic ethics, utilitarian cost cutting, and "political correctness" in medical ethics.