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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Bioethics. Show all posts
Showing posts with label Bioethics. Show all posts

Monday, November 27, 2023

Synthetic human embryos created in groundbreaking advance

Hannah Devlin
The Guardian
Originally posted 14 JUNE 23

Here is an excerpt:

“Our human model is the first three-lineage human embryo model that specifies amnion and germ cells, precursor cells of egg and sperm,” Żernicka-Goetz told the Guardian before the talk. “It’s beautiful and created entirely from embryonic stem cells.”

The development highlights how rapidly the science in this field has outpaced the law, and scientists in the UK and elsewhere are already moving to draw up voluntary guidelines to govern work on synthetic embryos. “If the whole intention is that these models are very much like normal embryos, then in a way they should be treated the same,” Lovell-Badge said. “Currently in legislation they’re not. People are worried about this.”

There is also a significant unanswered question on whether these structures, in theory, have the potential to grow into a living creature. The synthetic embryos grown from mouse cells were reported to appear almost identical to natural embryos. But when they were implanted into the wombs of female mice, they did not develop into live animals. In April, researchers in China created synthetic embryos from monkey cells and implanted them into the wombs of adult monkeys, a few of which showed the initial signs of pregnancy but none of which continued to develop beyond a few days. Scientists say it is not clear whether the barrier to more advanced development is merely technical or has a more fundamental biological cause.

Here is my summary:

Researchers used stem cells to create structures that resembled early-stage human embryos, with a beating heart and primitive brain-like structures.

The synthetic embryos could be used to study human development and to develop new treatments for infertility and miscarriage. However, the research also raises ethical concerns, as it is not clear whether the synthetic embryos should be considered the same as natural embryos.

Some bioethicists have argued that the synthetic embryos should be treated with the same respect as natural embryos, as they have the potential to develop into human beings. Others have argued that the synthetic embryos are not the same as natural embryos, as they were not created through the union of an egg and sperm.

The research has been welcomed by some scientists, who believe it has the potential to revolutionize our understanding of human development. However, other scientists have expressed concern about the ethical implications of the research.

Wednesday, November 8, 2023

Everything you need to know about artificial wombs

Cassandra Willyard
MIT Technology Review
Originally posted 29 SEPT 23

Here is an excerpt:

What is an artificial womb?

An artificial womb is an experimental medical device intended to provide a womblike environment for extremely premature infants. In most of the technologies, the infant would float in a clear “biobag,” surrounded by fluid. The idea is that preemies could spend a few weeks continuing to develop in this device after birth, so that “when they’re transitioned from the device, they’re more capable of surviving and having fewer complications with conventional treatment,” says George Mychaliska, a pediatric surgeon at the University of Michigan.

One of the main limiting factors for survival in extremely premature babies is lung development. Rather than breathing air, babies in an artificial womb would have their lungs filled with lab-made amniotic fluid, that mimics the amniotic fluid they would have hadjust like they would in utero. Neonatologists would insert tubes into blood vessels in the umbilical cord so that the infant’s blood could cycle through an artificial lung to pick up oxygen. 

The device closest to being ready to be tested in humans, called the EXTrauterine Environment for Newborn Development, or EXTEND, encases the baby in a container filled with lab-made amniotic fluid. It was invented by Alan Flake and Marcus Davey at the Children’s Hospital of Philadelphia and is being developed by Vitara Biomedical.

Here is my take:

Artificial wombs are experimental medical devices that aim to provide a womb-like environment for extremely premature infants. The technology is still in its early stages of development, but it has the potential to save the lives of many babies who would otherwise not survive.

Overall, artificial wombs are a promising new technology with the potential to revolutionize the care of premature infants. However, more research is needed to fully understand the risks and benefits of the technology before it can be widely used.

Here are some additional ethical concerns that have been raised about artificial wombs:
  • The potential for artificial wombs to be used to create designer babies or to prolong the lives of fetuses with severe disabilities.
  • The potential for artificial wombs to be used to exploit or traffick babies.
  • The potential for artificial wombs to exacerbate existing social and economic inequalities.
It is important to have a public conversation about these ethical concerns before artificial wombs become widely available. We need to develop clear guidelines for how the technology should be used and ensure that it is used in a way that benefits all of society.

Sunday, July 16, 2023

Gender-Affirming Care for Cisgender People

Theodore E. Schall and Jacob D. Moses
Hastings Center Report 53, no. 3 (2023): 15-24.
DOI: 10.1002/hast.1486 


Gender-affirming care is almost exclusively discussed in connection with transgender medicine. However, this article argues that such care predominates among cisgender patients, people whose gender identity matches their sex assigned at birth. To advance this argument, we trace historical shifts in transgender medicine since the 1950s to identify central components of "gender-affirming care" that distinguish it from previous therapeutic models, such as "sex reassignment." Next, we sketch two historical cases-reconstructive mammoplasty and testicular implants-to show how cisgender patients offered justifications grounded in authenticity and gender affirmation that closely mirror rationales supporting gender-affirming care for transgender people. The comparison exposes significant disparities in contemporary health policy regarding care for cis and trans patients. We consider two possible objections to the analogy we draw, but ultimately argue that these disparities are rooted in "trans exceptionalism" that produces demonstrable harm.

Here is my summary:

The authors cite several examples of gender-affirming care for cisgender people, such as breast reconstruction following mastectomy, penile implants following testicular cancer, hormone replacement therapy, and hair removal. They argue that these interventions can be just as important for cisgender people's mental and physical health as they are for transgender people.

The authors also note that gender-affirming care for cisgender people is often less scrutinized and less stigmatized than such care for transgender people. Cisgender people do not need special letters of permission from mental health providers to access care whose primary purpose is to affirm their gender identity. And insurance companies are less likely to exclude gender-affirming care for cisgender people from their coverage.

The authors argue that the differences in the conceptualization and treatment of gender-affirming care for cisgender and transgender people reflect broad anti-trans bias in society and health care. They call for a more inclusive view of gender-affirming care that recognizes the needs of all people, regardless of their gender identity.

Final thoughts:
  1. Gender-affirming care can be lifesaving. It can help reduce anxiety, depression, and suicidal thoughts.  Gender-affirming care can be framed as suicide prevention.
  2. Gender-affirming care is not experimental. It has been studied extensively and is safe and effective. See other posts on this site for more comprehensive examples.
  3. All people deserve access to gender-affirming care, regardless of their gender identity. This is basic equality and fairness in terms of access to medical care.

Tuesday, May 16, 2023

Approaches to Muslim Biomedical Ethics: A Classification and Critique

Dabbagh, H., Mirdamadi, S.Y. & Ajani, R.R.
Bioethical Inquiry (2023).


This paper provides a perspective on where contemporary Muslim responses to biomedical-ethical issues stand to date. There are several ways in which Muslim responses to biomedical ethics can and have been studied in academia. The responses are commonly divided along denominational lines or under the schools of jurisprudence. All such efforts classify the responses along the lines of communities of interpretation rather than the methods of interpretation. This research is interested in the latter. Thus, our criterion for classification is the underlying methodology behind the responses. The proposed classification divides Muslim biomedical-ethical reasoning into three methodological categories: 1) textual, 2) contextual, and 3) para-textual.


There is widespread recognition among Muslim scholars dealing with biomedical ethical issues that context plays an essential role in forming ethical principles and judgements. The context-sensitive approaches in Muslim biomedical ethics respond to the requirements of modern biomedical issues by recognizing the contexts in which scriptural text has been formed and developed through the course of Muslim intellectual history. This paves the way for bringing in different context-sensitive interpretations of the sacred texts through different reasoning tools and methods, whether they are rooted in the uṣūl al-fiqh tradition for the contextualists, or in moral philosophy for the para-textualists. For the textualists, reasoning outside of the textual boundaries is not acceptable. While contextualists tend to believe that contextual considerations make sense only in light of Sharīʿa law and should not be understood independently of Sharīʿa law, para-textualists believe that moral perceptions and contextual considerations are valid irrespective of Sharīʿa law, insofar as they do not neglect the moral vision of the scriptures. The common ground between the majority of the textualists and the contextualists lies in giving primacy to the Sharīʿa law. Moral requirements for both the textualists and the contextualists are only determined by Sharīʿa commandments, and Sharīʿa commandments are the only basis on which to decide what is morally permissible or impermissible in biomedical ethical issues. This is an Ashʿarī-inspired approach to biomedical ethics with respect to human moral reasoning (Sachedina 2005; Aramesh 2020; Reinhart 2004; Moosa 2004; Moosapour et al. 2018).

Para-textualists, on the other hand, do not deny the relevance of Sharīʿa, but treat the reasoning embedded in Sharīʿa as being on a par with moral reasoning in general. Thus, if there are contending strands of moral reasoning on a particular biomedical ethical issue, Sharīʿa-based reasoning will need to compete with other moral reasoning on the issue. If the aḥkām (religious judgements) are deemed to be reasonably sound, then for para-textualists there are no grounds for not accepting them. Although using and referring to Sharīʿa might work in many cases, it is not the case that Sharīʿa is enough in every case to judge on moral issues. For instance, morally speaking, it is not enough to refer to Sharīʿa when someone is choosing or refusing euthansia or abortion. For para-textualists what matters most is how Sharīʿa morally reasons about the permissibility or impermissibility of an action. If it is morally justified to euthanize or abort, we are rationally (and morally) bound to accept it, and if it is not morally justified, we will then either have to leave our judgement about choosing or refusing euthanasia or abortion or find another context-sensitive interpretation to rationalize the relevant commandment derived from Sharīʿa. Thus, the departure point for the para-textualist approach is moral reasoning, whether it is found in moral philosophy, Muslim jurisprudence, or elsewhere (Soroush 2009; Shahrur 1990, 2009; Hallaq 1997; An-Na’im 2008). Para-textualist methodology tries to remain open to the possibility of morally criticizing religious judgements (aḥkām), while remaining true to the moral vision of the scriptures. This is a Muʿtazilī-inspired approach to biomedical ethics (Hourani 1976; Vasalou 2008; Sheikh 2019; Farahat 2019; Reinhart 1995; Al-Bar and Chamsi-Pasha 2015; Hallaq 2014).

Sunday, March 5, 2023

Four Recommendations for Ethical AI in Healthcare

Lindsey Jarrett
Center for Practical Bioethics

For several decades now, we have been having conversations about the impact that technology, from the voyage into space to the devices in our pockets, will have on society. The force with which technology alters our lives at times feels abrupt. It has us feeling excited one day and fearful the next.

If your experiences in life are not dependent on the use of technology — especially if your work still allows for you to disconnect from the virtual world – it may feel like technology is working at a decent pace. However, many of us require some sort of technology to work, to communicate with others, to develop relationships, and to disseminate ideas into the world. Further, we also increasingly need technology to help us make decisions. These decisions vary in complexity from auto-correcting our messages to connecting to someone on a dating app, and without access to a piece of technology, it is increasingly challenging to rely on anything but technology.

Is the use of technology for decision making a problem in and of itself due to its entrenched use across our lives, or are there particular components and contexts that need attention? Your answer may depend on what you want to use it for, how you want others to use it to know you, and why the technology is needed over other tools. These considerations are widely discussed in the areas of criminal justice, finance, security, hiring practices, and conversations are developing in other sectors as issues of inequity, injustice and power differentials begin to emerge.

Issues emerging in the healthcare sector is of particular interest to many, especially since the coronavirus pandemic. As these conversations unfold, people start to unpack the various dilemmas that exist within the intersection of technology and healthcare. Scholars have engaged in theoretical rhetoric to examine ethical implications, researchers have worked to evaluate the decision-making processes of data scientists who build clinical algorithms, and healthcare executives have tried to stay ahead of regulation that is looming over their hospital systems.

However, recommendations tend to focus exclusively on those involved with algorithm creation and offer little support to other stakeholders across the healthcare industry. While this guidance turns into practice across data science teams building algorithms, especially those building machine learning based tools, the Ethical AI Initiative sees opportunities to examine decisions that are made regarding these tools before they get to a data scientist’s queue and after they are ready for production. These opportunities are where systemic change can occur, and without that level of change, we will continue to build products to put on the shelf and more products to fill the shelf when those fail.

Healthcare is not unique in facing these types of challenges, and I will outline a few recommendations on how an adapted, augmented system of healthcare technology can operate, as the industry prepares for more forceful regulation of the use of machine learning-based tools in healthcare practice.

Thursday, October 13, 2022

This company is about to grow new organs in a person for the first time

Jessica Hamzelou
MIT Technology Review
Originally posted 25 AUG 22

Here is an excerpt:

Livers have a unique ability to regenerate. Cut away half an animal’s liver, and it will grow back. Human livers damaged by toxins or alcohol can usually regrow too. But some diseases can cause extensive damage from which the liver can’t recover. For these diseases, the treatment of choice is usually a liver transplant.

Transplants aren’t always an option for people who are very unwell, however. That’s why Eric Lagasse and his colleagues at LyGenesis have taken this different approach. Lagasse, a stem-cell biologist at the University of Pittsburgh, has spent years researching cell-based treatments for liver disease. Around 10 years ago, he was experimenting with the idea of injecting cells from healthy livers into diseased ones in mice.

It is difficult to access the livers of small, 25-gram mice, which Lagasse was studying, so instead he and his colleagues injected the cells into the spleens of mice with liver disease. They found that the cells were able to migrate from the spleen to the liver. To find out if they could migrate from other organs, Lagasse’s team injected liver cells at various sites in the mice’s bodies.

Only a small number of mice survived. When Lagasse and his colleagues later performed autopsies on those survivors, “I was very surprised,” he recalls. “We had a mini liver present … where the lymph node would be.”

Little incubators

Lymph nodes are small, bean-shaped structures found throughout the body. They play a crucial role in our immune health, making cells that help fight infections. And while Lagasse was initially surprised that liver cells could multiply and grow in lymph nodes, it makes sense, he says. 

Lymph nodes are natural homes for rapidly dividing cells, even if those are usually immune cells. Lymph nodes also have a good blood supply, which can aid the growth of new tissue.

Wednesday, August 31, 2022

Narrative Capacity

Toomey, James, (August 31, 2021).
100 N.C. L. Rev. 1073
Available at SSRN: https://ssrn.com/abstract=3914839


The doctrine of capacity is a fundamental threshold to the protections of private law. The law only recognizes private decision-making—from exercising the right to transfer or bequeath property and entering into a contract to getting married or divorced—made with the level of cognitive functioning that the capacity doctrine demands. When the doctrine goes wrong, it denies individuals, particularly older adults, access to basic private-law rights on the one hand and ratifies decision-making that may tear apart families and tarnish legacies on the other.

The capacity doctrine in private law is built on a fundamental philosophical mismatch. It is grounded in a cognitive theory of personhood, and determines whether to recognize private decisions based on the cognitive abilities thought by philosophers to entitle persons in general to unique moral status. But to align with the purposes of the substantive doctrines of property and contract, private-law capacity should instead be grounded in a narrative theory of personal identity. Rather than asking whether a decision-maker is a person by measuring their cognitive abilities, the doctrine should ask whether they are the same person by looking to the story of their life.

This Article argues for a new doctrine of capacity under which the law would recognize personal decision-making if and only if it is linked by a coherent narrative structure to the story of the decision-maker’s life. Moreover, the Article offers a test for determining which decisions meet this criterion and explains how the doctrine would work in practice.


Scholars and courts have long recognized that the threshold doctrine of capacity in private law requires reform to meet the needs of our aging society.  What they have not clearly seen is the doctrine’s fundamental error—a philosophical misalignment between the legal test, based on the construct of personhood, and its purposes, which are concerned with personal identity. This Article has excavated this distinction. And it has articulated and evaluated an alternative.

We think of ourselves as stories and we make meaning of our lives through our stories. That is what is at stake in the doctrine of capacity—whether an individual may continue to write their story by making decisions and choices.  Concern for the stories of our lives should be a paramount guiding principle of the capacity doctrine. In short, courts should only intervene in our decision-making where the story we would tell with our choices ceases to be our story at all.

Sunday, October 24, 2021

Evaluating Tradeoffs between Autonomy and Wellbeing in Supported Decision Making

Veit, W., Earp, B.D., Browning, H., Savulescu, J.
American Journal of Bioethics 

A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict (Notini  et  al.  2020).  This  tension  is  often  reflected  in  discussions  of  the  ethical  status  of guardianship and other surrogate decision-making regimes for individuals with different kinds or degrees of cognitive ability and (hence) decision-making capacity (Earp and Grunt-Mejer 2021), specifically when these capacities are regarded as diminished or impaired along certain dimensions (or with respect to certain domains). The notion or practice of guardianship, wherein a guardian is legally appointed to make decisions on behalf of someone with different/diminished capacities, has been particularly controversial. For example, many people see guardianship as unjust, taking too  much  decisional  authority  away  from  the  person  under  the  guardian’s  care  (often  due  to prejudiced attitudes, as when people with certain disabilities are wrongly assumed to lack decision-making capacity); and as too rigid, for example, in making a blanket judgment about someone’s (lack of) capacity, thereby preventing them from making decisions even in areas where they have the requisite abilities (Glen 2015).

It is  against  this  backdrop that  Peterson,  Karlawish, and  Largent (2021) offer  a  useful philosophical framework for the notion of ‘supported decision-making’ as a compelling alternative for  individuals  with  ‘dynamic  impairments’  (i.e.,  non-static  or  domain-variant  perceived mpairments  in  decision-making  capacity).  In  a  similar spirit,  we  have  previously  argued  that bioethics would benefit from a more case-sensitive rather than a ‘one-size-fits-all’ approach when it comes to issues of cognitive diversity (Veit et al. 2020; Chapman and Veit 2020). We therefore agree with most of the authors’ defence of supported decision-making, as this approach allows for case- and context-sensitivity. We also agree with the authors that the categorical condemnation of guardianships  or  similar  arrangements  is  not  justified,  as  this  precludes  such  sensitivity.  For instance, as the authors note, if a patient is in a permanent unaware/unresponsive state – i.e., with no  current  or  foreseeable  decision-making  capacity  or  ability  to  exercise  autonomy  –  then  a guardianship-like regime may be the most appropriate means of promoting this person’s interests. A similar point can be made in relation to debates about intended human enhancement of embryos and children.  Although some critics  claim that  such interventions  violate the autonomy  of the enhanced person, proponents may argue that respect for autonomy and consent do not apply in certain cases, for example, when dealing with embryos (see Veit 2018); alternatively, they may argue that interventions to enhance the (future) autonomy of a currently pre-autonomous (or partially autonomous) being can be justified on an enhancement framework without falling prey to such objections (see Earp 2019, Maslen et al. 2014). 

Friday, October 1, 2021

The prisoner’s dilemma: The role of medical professionals in executions

Elisabeth Armstrong
Journal of Medical Ethics
Originally posted 7 Sept 21

Here is an excerpt:

Clinician Participation in Executions is Either Wrong or Misguided

Clinicians might participate in executions out of an inappropriate commitment to capital punishment; this position of leveraging medical education and credentials to punish or harm has no grounding in ethical conversation. It is entirely inappropriate to undermine trust in the medical profession in service of one’s political or philosophical beliefs – those ought to be relegated to the voting booths.

However, some practitioners might be present at an execution out of a well-intentioned, but misguided commitment to preventing suffering. Their reasoning is along the lines, “If states are proceeding with an execution, shouldn’t a clinician be present to ensure there is no undue harm or suffering?” Writing on lethal injections, Dr. Sandeep Jahaur writes in the New York Times, “Barring physicians from executions will only increase the risk that prisoners will unduly suffer,” in violation of the Hippocratic Oath and the 8th Amendment of the US Constitution. He points out that no ethics board would allow the testing of execution drugs on human participants, therefore, in the absence of a “controlled investigation” it is important that a doctor is present to assist when things go awry.

Dr. Jahaur adds that if doctors (or other clinicians) do not assist, people with less experience are often called upon to insert catheters, assess and insert the IVs, mix and administer the drugs, monitor a patient’s vital signs, then confirm death; and of course, step in if anything goes wrong. Dr. Atul Gawande agrees that it is unlikely that a lethal injection could be performed without a physician without the occasional tragic mistake. As recently as October of 2014, the lack of involvement from clinicians resulted in the administration of an incorrect drug to an inmate – resulting in forty-three minutes of writhing and groaning before he died.

The Case for Ending Practitioner Participation

There is no denying that these cases of suffering are disturbing and compelling. Ultimately, however, the bioethical case for participation is grossly outweighed by the case against it: medical involvement on any level intrinsically violates the ethical principles of autonomy, beneficence, non-maleficence, and justice – compromising the foundations of the medical system. (Underline added.)

Wednesday, August 4, 2021

A taxonomy of conscientious objection in healthcare

Gamble, N., & Saad, T. (2021). 
Clinical Ethics. 


Conscientious Objection (CO) has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited.


The ethical analysis and framework we have presented demonstrate that conscience is intertwined with practical wisdom and is an intrinsic part of the work of healthcare professionals. The species of CO we have enumerated reveal that morality and values in healthcare are not only related to a few controversial ends, but to all ends and means in medicine, and the relationships between them.

The taxonomy we have presented will feasibly permit a more nuanced discussion of CO, where the issues surrounding and policy solutions for each species of CO can be discussed separately. Such a conversation
is an important task. After all, CO will not go away, even if specific belief systems rise or fall. CO exists
because humans have an innate awareness of the need to seek good and avoid evil, yet still arrive at disparate intellectual conclusions about what is right and wrong. Thus, if tolerant and amicable solutions
are to be developed for CO, conversations on CO in healthcare need to continue with a more integrated
understanding of practical reason and an awareness of broad involvement of conscience in medicine. We
hope our paper contributes to this end.

Wednesday, May 12, 2021

How pills undermine skills: Moralization of cognitive enhancement and causal selection

E. Mihailov, B. R. López, F. Cova & I. R. Hannikainen
Consciousness and Cognition
Volume 91, May 2021, 103120


Despite the promise to boost human potential and wellbeing, enhancement drugs face recurring ethical scrutiny. The present studies examined attitudes toward cognitive enhancement in order to learn more about these ethical concerns, who has them, and the circumstances in which they arise. Fairness-based concerns underlay opposition to competitive use—even though enhancement drugs were described as legal, accessible and affordable. Moral values also influenced how subsequent rewards were causally explained: Opposition to competitive use reduced the causal contribution of the enhanced winner’s skill, particularly among fairness-minded individuals. In a follow-up study, we asked: Would the normalization of enhancement practices alleviate concerns about their unfairness? Indeed, proliferation of competitive cognitive enhancement eradicated fairness-based concerns, and boosted the perceived causal role of the winner’s skill. In contrast, purity-based concerns emerged in both recreational and competitive contexts, and were not assuaged by normalization.


• Views on cognitive enhancement reflect both purity and fairness concerns.

• Fairness, but not purity, concerns are surmounted by normalizing use.

• Moral opposition to pills undermines user’s perceived skills.

From the Discussion

In line with a growing literature on causal selection (Alicke, 1992; Icard et al., 2017; Kominsky et al. 2015), judgments of the enhanced user’s skill aligned with participants’ moral attitudes. Participants who held permissive attitudes were more likely to causally attribute success to agents’ skill and effort, while participants who held restrictive attitudes were more likely to view the pill as causally responsible. This association resulted in stronger denial of competitive users’ talent and ability, particularly among fairness-minded individuals. 

The moral foundation of purity, comprising norms related to spiritual sanctity and bodily propriety, and which appeals predominantly to political conservatives (Graham et al., 2009), also predicted attitudes toward enhancement. Purity-minded individuals were more likely to condemn enhancement users, regardless of whether cognitive enhancement was normal or rare. This categorical opposition may elucidate the origin of conservative bioethicists’ (e.g., Kass, 2003) attitudes toward human enhancement: i.e., in self-directed norms regulating the proper care of one’s own body (see also Koverola et al., 2021). Finally, whereas explicit reasoning about interpersonal concerns and the unjust treatment of others accompanied fairness-based opposition, our qualitative analyses data did not reveal a cogent, purity-based rationale—which could be interpreted as evidence that purity-based opposition is not guided by moral reasoning to the same degree (Mihailov, 2016). 

Saturday, March 27, 2021

Veil-of-ignorance reasoning mitigates self-serving bias in resource allocation during the COVID-19 crisis

Huang, K. et al.
Judgment and Decision Making
Vol. 16, No. 1, pp 1-19.


The COVID-19 crisis has forced healthcare professionals to make tragic decisions concerning which patients to save. Furthermore, The COVID-19 crisis has foregrounded the influence of self-serving bias in debates on how to allocate scarce resources. A utilitarian principle favors allocating scarce resources such as ventilators toward younger patients, as this is expected to save more years of life. Some view this as ageist, instead favoring age-neutral principles, such as “first come, first served”. Which approach is fairer? The “veil of ignorance” is a moral reasoning device designed to promote impartial decision-making by reducing decision-makers’ use of potentially biasing information about who will benefit most or least from the available options. Veil-of-ignorance reasoning was originally applied by philosophers and economists to foundational questions concerning the overall organization of society. Here we apply veil-of-ignorance reasoning to the COVID-19 ventilator dilemma, asking participants which policy they would prefer if they did not know whether they are younger or older. Two studies (pre-registered; online samples; Study 1, N=414; Study 2 replication, N=1,276) show that veil-of-ignorance reasoning shifts preferences toward saving younger patients. The effect on older participants is dramatic, reversing their opposition toward favoring the young, thereby eliminating self-serving bias. These findings provide guidance on how to remove self-serving biases to healthcare policymakers and frontline personnel charged with allocating scarce medical resources during times of crisis.

Saturday, December 5, 2020

The epidemiology of moral bioenhancement

R. B. Gibson
Medicine, Health Care and Philosophy 


In their 2008 paper, Persson and Savulescu suggest that for moral bioenhancement (MBE) to be effective at eliminating the danger of ‘ultimate harm’ the intervention would need to be compulsory. This is because those most in need of MBE would be least likely to undergo the intervention voluntarily. By drawing on concepts and theories from epidemiology, this paper will suggest that MBE may not need to be universal and compulsory to be effective at significantly improving the collective moral standing of a human populace and reducing the threat of ultimate harm. It will identify similarities between the mechanisms that allow biological contagions (such as a virus) and behaviours (such as those concerned with ethical and unethical actions) to develop, spread, and be reinforced within a population. It will then go onto suggest that, just as with the epidemiological principle of herd immunity, if enough people underwent MBE to reach a minimum threshold then the incidence and spread of immoral behaviours could be significantly reduced, even in those who have not received MBE.


The phenomenon of herd immunity is one that is critical in the field of vaccine epidemiology and public health. Once it takes effect, even those individuals who are unable to undergo vaccination are still able to benefit from a functional immunity from a biological agent. As such, a compulsory and universal programme of vaccination is not always necessary to achieve a sufficient protection rate against a contagious biological agent. It is this same line of reasoning which this paper has sought to employ, envisioning MBE as a form of vaccination against those types of behaviour that would lead to the realisation of UH (Ultimate Harm). Consequentially, this allows for the possibility of sufficient protection against the undesirable behaviours that would lead to UH without a need for a universal and compulsory enhancement programme.

Sunday, September 20, 2020

Financial Conflicts of Interest are of Higher Ethical Priority than “Intellectual” Conflicts of Interest

Goldberg, D.S.
Bioethical Inquiry 17, 217–227 (2020).


The primary claim of this paper is that intellectual conflicts of interest (COIs) exist but are of lower ethical priority than COIs flowing from relationships between health professionals and commercial industry characterized by financial exchange. The paper begins by defining intellectual COIs and framing them in the context of scholarship on non-financial COIs. However, the paper explains that the crucial distinction is not between financial and non-financial COIs but is rather between motivations for bias that flow from relationships and those that do not. While commitments to particular ideas or perspectives can cause all manner of cognitive bias, that fact does not justify denying the enormous power that relationships featuring pecuniary gain have on professional behaviour in term of care, policy, or both. Sufficient reason exists to take both intellectual COIs and financial COIs seriously, but this paper demonstrates why the latter is of higher ethical priority. Multiple reasons will be provided, but the primary rationale grounding the claim is that intellectual COIs may provide reasons to suspect cognitive bias but they do not typically involve a loss of trust in a social role. The same cannot be said for COIs flowing from relationships between health professionals and commercial industries involving financial exchange. The paper then assumes arguendo that the primary rationale is mistaken and proceeds to show why the claims that intellectual COIs are more significant than relationship-based COIs are dubious on their own merits. The final section of the paper summarizes and concludes.


iCOIs exist and they should be taken seriously. Nevertheless, fCOIs are of greater ethical priority. The latter diminish trust in a social role to a much greater extent than do the former, at least in the broad run of cases. Moreover, it is not clear how providers could avoid developing intellectual commitments and preferences regarding particular therapeutic modalities or interventions—and even if we could prevent this from occurring, it is far from evident that we should. We can easily imagine cases where a studied determination to remain neutral regarding interventions would be an abdication of moral responsibility, would be decidedly unvirtuous, and would likely result in harm to care- and service-seekers. While we also have evidence that some intellectual commitments can motivate bias in ways that likely result in harm to care- or service-seekers, this premise only justifies taking iCOIs seriously—it is literally no argument for deprioritizing fCOIs. Although the fact that iCOIs are in many cases unavoidable is a weak justification for ignoring iCOIs, the comparable avoidability of the vast majority of fCOIs is indeed a reason for prioritizing the latter over the former.

A pdf is here.

Sunday, May 31, 2020

The Answer to a COVID-19 Vaccine May Lie in Our Genes, But ...

Ifeoma Ajunwa & Forrest Briscoe
Scientific American
Originally posted 13 May 2020

Here is an excerpt:

Although the rationale for expanded genetic testing is obviously meant for the greater good, such testing could also bring with it a host of privacy and economic harms. In the past, genetic testing has also been associated with employment discrimination. Even before the current crisis, companies like 23andMe and Ancestry assembled and started operating their own private long-term large-scale databases of U.S. citizens’ genetic and health data. 23andMe and Ancestry recently announced they would use their databases to identify genetic factors that predict COVID-19 susceptibility.

Other companies are growing similar databases, for a range of purposes. And the NIH’s AllofUs program is constructing a genetic database, owned by the federal government, in which data from one million people will be used to study various diseases. These new developments indicate an urgent need for appropriate genetic data governance.

Leaders from the biomedical research community recently proposed a voluntary code of conduct for organizations constructing and sharing genetic databases. We believe that the public has a right to understand the risks of genetic databases and a right to have a say in how those databases will be governed. To ascertain public expectations about genetic data governance, we surveyed over two thousand (n=2,020) individuals who altogether are representative of the general U.S. population. After educating respondents about the key benefits and risks associated with DNA databases—using information from recent mainstream news reports—we asked how willing they would be to provide their DNA data for such a database.

The info is here.

Thursday, May 21, 2020

Discussing the ethics of hydroxychloroquine prescriptions for COVID-19 prevention

Sharon Yoo
Originally published 19 May 20

President Donald Trump said on Monday that he's been taking hydroxychloroquine to protect himself against the coronavirus. It is a drug typically used to treat malaria and lupus.

The Federal Drug Administration issued warnings that the drug should only be used in clinical trials or for patients at a hospital under the Emergency Use Authorization.

"Yeah, a White House doctor, didn't recommend—I asked him what do you think—and he said well, if you'd like it and I said yeah, I'd like it, I'd like to take it," President Trump said, when a reporter asked him if a White House doctor recommended that he take hydroxychloroquine on Monday.

In a statement, the President's physician, Dr. Sean Conley said after discussions, they've concluded the potential benefit from treatment outweighed the relative risks. All this, despite the FDA warnings.

University of Minnesota bioethics professor Joel Wu said this is problematic.

"It's ethically problematic if the President is being treated for COVID specifically by hydroxychloroquine because our understanding based on the current evidence is not safe or effective in treating or preventing COVID," Wu said.

The info is here.

Sunday, May 17, 2020

Veil-of-Ignorance Reasoning Favors Allocating Resources to Younger Patients During the COVID-19 Crisis

Huang, K., Bernhard, R., and others
(2020, April 22).


The COVID-19 crisis has forced healthcare professionals to make tragic decisions concerning which patients to save. A utilitarian principle favors allocating scarce resources such as ventilators toward younger patients, as this is expected to save more years of life. Some view this as ageist, instead favoring age-neutral principles, such as “first come, first served”. Which approach is fairer? Veil-of-ignorance reasoning is a decision procedure designed to produce fair outcomes. Here we apply veil-of-ignorance reasoning to the COVID-19 ventilator dilemma, asking participants which policy they would prefer if they did not know whether they are younger or older. Two studies (pre-registered; online samples; Study 1, N=414; Study 2 replication, N=1,276) show that veil-of-ignorance reasoning shifts preferences toward saving younger patients. The effect on older participants is dramatic, reversing their opposition toward favoring the young. These findings provide concrete guidance to healthcare policymakers and front line personnel charged with allocating scarce medical resources during times of crisis.

From the General Discussion

In two pre-registered studies, we show that veil-of-ignorance reasoning favors allocating scarce medical resources to younger patients during the COVID-19 crisis. A strong majority of participants who engaged in veil-of-ignorance reasoning concluded that a policy of maximizing the number of life-years saved is what they would want for themselves if they did not know whom they were going to be.Importantly, engaging in veil-of-ignorance reasoning subsequently produced increased moral approval of this utilitarian policy. These findings, though predicted based on prior research(Huang, Greene, &Bazerman, 2019), make three new contributions. First, they apply directly to an ongoing crisis in which competing claims to fairness must be resolved. While the ventilator shortage in the developed world has been less acute than many feared, it may reemerge in greater force as the COVID-19 crisis spreads to the developing world (Woodyatt, 2020). Second, the dilemma considered here differs from those considered previously because it concerns maximizing the number of life-years saved, rather than the number of lives saved.Finally, the results show the power of the veil to eliminate self-serving bias. In the control condition, few older participants (33%) favored prioritizing younger patients. But after engaging in veil-of-ignorance reasoning, most older participants (62%) favored doing so, just like younger participants.

The research is here.

Wednesday, May 6, 2020

What do we mean by 'killing' and 'letting die'?

Ivar R. Hannikainen, Anibal Monasterio-Astobiza, & David Rodríguez-Arias
Originally published 22 Feb 20

Bioethicists have long asked how to distinguish killing from letting die. Opponents of the legalization of euthanasia routinely invoke this distinction to explain why withholding life-sustaining treatment may be morally permissible, while euthanasia is not. The underlying assumption is that, when physicians refrain from applying life-sustaining treatment, they merely let the patient die. In contrast, a doctor who provided a lethal injection would thereby be 'killing' them. At a broader level, this view implies that 'killing' and 'letting die' are terms we use to distinguish actions from omissions that result in death.

Theorists such as Gert, Culver and Clouser (1998/2015) advanced a radically different understanding of this fundamental bioethical distinction. In a germinal paper, they argue that to 'kill' involves a contextual assessment of whether the doctor violated a prior duty. In turn, whether the doctor violated their duty—namely, to preserve the patient's life—depends on the patient's preferences. (They actually argued for a more sophisticated view according to which only some preferences, i.e., refusals, constrain a doctor's duty—while others, i.e., requests, do not.) This view is qualitatively different from the first (what we call commissive) view. On this alternative view, which we refer to as deontic, 'killing' and 'letting die' serve to differentiate patient deaths that result from breaches of medical duty from those that do not.

How well does each of these theoretical perspectives capture people's use of the killing versus letting die distinction? In a recent paper published in Bioethics, our goal was to develop an understanding of the considerations that carve this bioethical distinction in non-philosophers' minds.

We invited a group of laypeople, unfamiliar with this bioethical debate and lacking any formal training in the health sciences, to take part in a short study. Each participant was asked to consider a set of three hypothetical scenarios in which a terminally ill patient dies, while we manipulated two features of the scenario: (1) the physician's involvement, and (2) the patient's wishes.

The info is here.

Saturday, April 18, 2020

Experimental Philosophical Bioethics

Brain Earp, and others
AJOB Empirical Bioethics (2020), 11:1, 30-33
DOI: 10.1080/23294515.2020.1714792

There is a rich tradition in bioethics of gathering empirical data to inform, supplement, or test the implications of normative ethical analysis. To this end, bioethicists have drawn on diverse methods, including qualitative interviews, focus groups, ethnographic studies, and opinion surveys to advance understanding of key issues in bioethics. In so doing, they have developed strong ties with neighboring disciplines such as anthropology, history, law, and sociology.  Collectively, these lines of research have flourished in the broader field of “empirical bioethics” for more than 30 years (Sugarman and Sulmasy 2010).

More recently, philosophers from outside the field of bioethics have similarly employed empirical
methods—drawn primarily from psychology, the cognitive sciences, economics, and related disciplines—to advance theoretical debates. This approach, which has come to be called experimental philosophy (or x-phi), relies primarily on controlled experiments to interrogate the concepts, intuitions, reasoning, implicit mental processes, and empirical assumptions about the mind that play a role in traditional philosophical arguments (Knobe et al. 2012). Within the moral domain, for example, experimental philosophy has begun to contribute to long-standing debates about the nature of moral judgment and reasoning; the sources of our moral emotions and biases; the qualities of a good person or a good life; and the psychological basis of moral theory itself (Alfano, Loeb, and Plakias 2018). We believe that experimental philosophical bioethics—or “bioxphi”—can similarly contribute to bioethical scholarship and debate.1 Here, we introduce this emerging discipline, explain how it is distinct from empirical bioethics more broadly construed, and attempt to characterize how it might advance theory and practice in this area.

The paper is here.

Saturday, March 21, 2020

Moral Courage in the Coronavirus: A Guide for Medical Providers and Institutions

Holly Tabor & Alyssa Burgard
Just Security
Originally published 18 March 20

Times of crisis generate extreme moral dilemmas: situations we can’t begin to imagine, unthinkable choices emerging between options that all seem bad, each with harms and negative outcomes. During the COVID-19 pandemic, these moral dilemmas are experienced across the healthcare landscape — from bedside encounters to executive suites of hospitals and health systems. Who gets put on a ventilator? Who transitions to comfort care? What does end of life care look like when high flow oxygen can’t be used because of viral spread? Who gets a hospital bed? How do we choose which sick person, with or without COVID-19, gets treated? Which patients should be enrolled in research? How do we support patients when their families cannot visit them? We will turn away people who, in any other circumstance in a U.S. medical facility, we would have been obliged to treat. We will second guess these decisions, and perhaps be haunted by them forever. We only know one thing for sure: people will suffer and die regardless of which decisions we make.

How should we confront these intense challenges? Many institutions are doing what they can to provide guidance. But “guidelines” by design are intended to provide broad parameters to aid in decision making, and therefore rarely address the exact situations clinicians face. Certainly no guidelines can reduce the pain of having to actually carry out recommendations that affect an individual patient.  For other decisions, front line providers will have no guidance at all, or will have ill-informed, or even potentially harmful guidance. In perhaps the worst case scenario, they may even be encouraged to keep quiet about their concerns or observations rather than raise them to others’ attention.

As bioethicists, we know that moral dilemmas require personal moral courage, that is, the ability to take action for moral reasons, despite the risk of adverse consequences. We have already seen several stark examples of moral courage from doctors, nurses, and researchers in this outbreak. In late December in Wuhan, China, a 34 year-old ophthalmologist, Dr. Li Wenliang, raised the alarm in a chat group of doctors about a new virus he was seeing. He was subsequently punished by the Chinese government. He continued to share his story via social media, even from his hospital bed, and was repeatedly censored. Dr. Wenliang died of the virus on February 7.

The info is here.