How is clinical ethics reasoning done in practice? A review of the empirical literature

Feldman, S., Gillam, L., McDougall, R. J., 

& Delany, C. (2025).

Journal of Medical Ethics, jme-110569. 

https://doi.org/10.1136/jme-2024-110569

Abstract

Background Clinical ethics reasoning is one of the unique contributions of clinical ethicists to healthcare, and is common to all models of clinical ethics support and methods of case analysis. Despite being a fundamental aspect of clinical ethics practice, the phenomenon of clinical ethics reasoning is not well understood. There are no formal definitions or models of clinical ethics reasoning, and it is unclear whether there is a shared understanding of this phenomenon among those who perform and encounter it.

Methods A scoping review of empirical literature was conducted across four databases in July 2024 to capture papers that shed light on how clinical ethicists undertake or facilitate clinical ethics reasoning in practice in individual patient cases. The review process was guided by the Arksey and O’Malley framework for scoping reviews.

Results 16 publications were included in this review. These publications reveal four thinking strategies used to advance ethical thinking, and three strategies for resolving clinical ethics challenges in individual patient cases. The literature also highlights a number of other influences on clinical ethics reasoning in practice.

Conclusion While this review has allowed us to start sketching the outlines of an account of clinical ethics reasoning in practice, the body of relevant literature is limited in quantity and in specificity. Further work is needed to better understand and evaluate the complex phenomenon of clinical ethics reasoning as it is done in clinical ethics practice.

The article is, unfortunately, paywalled. Follow the link above and contact the main author.

Here are some thoughts:

This scoping review examined how clinical ethicists undertake or facilitate clinical ethics reasoning in practice, focusing on individual patient cases.  The review identified four thinking strategies used to advance ethical thinking: consideration of ethical values, principles, and concepts; consideration of empirical evidence; imaginative identification; and risk/benefit analyses.  Three strategies for resolving clinical ethics challenges were also identified: time-limited trial, integrating patient values and clinical information, and perspective gathering.  Other factors influencing clinical ethics reasoning included intuition, emotion, power imbalances, and the professional background of the ethicist.  The authors highlight that the literature on clinical ethics reasoning is limited and further research is needed to fully understand this complex phenomenon.

Preliminaries to artificial consciousness: a multidimensional heuristic approach.

Evers, K., et al. (2025).

arXiv.org.

https://arxiv.org/abs/2403.20177

Abstract

The pursuit of artificial consciousness requires conceptual clarity to navigate its theoretical and empirical challenges. This paper introduces a composite, multilevel, and multidimensional model of consciousness as a heuristic framework to guide research in this field. Consciousness is treated as a complex phenomenon, with distinct constituents and dimensions that can be operationalized for study and for evaluating their replication. We argue that this model provides a balanced approach to artificial consciousness research by avoiding binary thinking (e.g., conscious vs. non-conscious) and offering a structured basis for testable hypotheses. To illustrate its utility, we focus on "awareness" as a case study,

demonstrating how specific dimensions of consciousness can be pragmatically analyzed and targeted for potential artificial instantiation. By breaking down the conceptual intricacies of consciousness and aligning them with practical research goals, this paper lays the groundwork for a robust strategy to advance the scientific and technical understanding of artificial consciousness.

The paper is here.

Here are some thoughts:

The paper introduces a comprehensive approach to understanding artificial consciousness by proposing a composite, multilevel, and multidimensional model that aims to provide conceptual clarity in this complex field. The authors argue that the pursuit of artificial consciousness requires a nuanced framework that moves beyond simplistic binary thinking of "conscious versus non-conscious" systems.

The research emphasizes the importance of analytical clarity and logical coherence when exploring artificial consciousness. They highlight a critical challenge in the field - the "analytical fallacy" - which occurs when researchers inappropriately derive empirical findings directly from theoretical premises without sufficient independent validation. This approach can lead to circular reasoning and potentially misleading conclusions about consciousness.

A key contribution of the paper is its treatment of consciousness as a complex phenomenon with distinct constituents and dimensions that can be systematically studied and potentially replicated. By focusing on "awareness" as a case study, the authors demonstrate how specific dimensions of consciousness can be pragmatically analyzed and targeted for potential artificial instantiation1

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The model proposed seeks to address the multifaceted nature of consciousness, acknowledging the field's current pre-scientific state and the need for a balanced, empirically informed approach. It aims to provide researchers with a structured framework for developing testable hypotheses about artificial consciousness, ultimately advancing both scientific understanding and technical exploration of this profound concept.