Sham surgery: An ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Teaching ethical analysis in environmental management decisions: A process-oriented approach

The general public and environmental policy makers often perceive management actions of environmental managers as “science,” when such actions are, in fact, value judgments about when to intervene in natural processes. The choice of action requires ethical as well as scientific analysis because managers must choose a normative outcome to direct their intervention. I examine a management case study involving prescribed burning of sagebrush (Artemisia tridentata) communities in south-central Montana (USA) to illustrate how to teach students to ethically evaluate a management action by precisely identifying: 1) the proposed management action, 2) the deficiency of the system to be remedied by the action, 3) the stakeholders affected by the action, and 4) the category and type of values affirmed in the management action. Through such analysis, students are taught to recognize implicit and explicit value judgments associated with management actions, identify stakeholders to whom managers have legitimate ethical obligations, and practice a general method of ethical analysis applicable to many forms of environmental management. An earlier version of this paper was presented at the Fourteenth Annual Meeting, Association for Practical and Professional Ethics, February 24–27, 2005.     

An architecture for ethical robots inspired by the simulation theory of cognition

The expanding ability of robots to take unsupervised decisions renders it imperative that mechanisms are in place to guarantee the safety of their behaviour. Moreover, intelligent autonomous robots should be more than safe; arguably they should also be explicitly ethical. In this paper, we put forward a method for implementing ethical behaviour in robots inspired by the simulation theory of cognition. In contrast to existing frameworks for robot ethics, our approach does not rely on the verification of logic statements. Rather, it utilises internal simulations which allow the robot to simulate actions and predict their consequences. Therefore, our method is a form of robotic imagery. To demonstrate the proposed architecture, we implement a version of this architecture on a humanoid NAO robot so that it behaves according to Asimov’s laws of robotics. In a series of four experiments, using a second NAO robot as a proxy for the human, we demonstrate that the Ethical Layer enables the robot to prevent the human from coming to harm in simple test scenarios.     

The physician and the pharmaceutical detail man: An ethical analysis

The relationship between the physician and the pharmaceutical detail man is discussed. Specific emphasis is given to an analysis of the ethical implications that this relationship has for patient care.     

Imagining ethical globalization: The contributions of a care ethic

Approaches to global ethics have drawn on a number of diverse theoretical traditions, such as Kantianism and utilitarianism. While emerging frameworks contribute to a growing awareness of and interest in ethics within a global society, the values that they prioritize are not adequate for realizing a just, equitable and fair system of global governance. This article considers the possibilities of an alternative ethic—a feminist ethic of care—and explores how it can bear on present circumstances, including global inequity and injustice. This care ethic has been put forward as a viable normative approach to politics and policy. Little attention, however, has been paid to the potential of a care ethic within the globalization and ethics debate. This article illustrates how the values and corresponding principles of care, grounded in relationships and responsibilities, are essential to responding adequately to the current challenges of globalization. By examining the relevance of care in this context, the article seeks to broaden dominant ethical worldviews and contribute to the articulation of normative tools for examining globalization while at the same time avoiding the trappings of conventional universality—the abstract and a priori thinking typically associated with conceptions of global ethics.     

Gene therapy: ethical issues

To discern the ethical issues involved incurrent gene therapy research, to explore theproblems inherent in possible future genetherapies, and to encourage debate within thescientific community about ethical questionsrelevant to both, we surveyed American Societyof Human Genetics scientists who engage inhuman genetics research. This study of theopinions of U.S. scientific experts about theethical issues discussed in the literature ongene therapy contributes systematic data on theattitudes of those working in the field as wellas elaborative comments. Our survey finds thatrespondents are highly supportive of thepotential use of somatic cell gene therapy tocure serious diseases in adults and children aswell as prospective offspring. A clearmajority, however, believe that using suchgenetic techniques for enhancement purposes isunacceptable. Delineating the line betweendisease/disorder and improvement/enhancementposes a problem not easily resolved and oneconducive to the growth of slippery-slopeapprehensions. The majority of respondents alsoadvocate germ-line therapy, in theory at least,and under similar restrictions, but theyrecognize the roadblock that the existence ofunanticipated negative consequences currentlypresents. Another complex matter involvestrying to determine appropriate reasons forchoosing target diseases for research, forwhich the dichotomy between rare single-geneand common multifactorial diseases reveals anongoing dilemma.     

Rethinking technology, revitalizing ethics: Overcoming barriers to ethical design

This paper explores the role of ethics in design. Traditionally, ethical questions have been seen as marginal issues in the design of technology. Part of the reason for this stems from the widely held notion of technology being “out of control.” This notion is a barrier to what I call “ethical design” because it implies that ethics has no role to play in the development of technology. This view, however, is challenged by recent work in the field of Science and Technology Studies (STS). Looking into the dynamics of technological change, STS scholars argue that human choices are present at every stage of a technology’s development and, furthermore, that human values are reflected in the very design of artifacts. This alternative view suggests that ethics can and should be included in the design process. Drawing on examples from the privacy arena. I point to some of the potential advantages of addressing ethical concerns early on in the design of a technology. I conclude with some general strategies for bringing ethics back into design. A version of this paper was presented at ETHICOMP98, the Fourth International Conference on Ethical Issues of Information Technology, March 25–27, 1998, Erasmus University, the Netherlands. Patrick Feng is a Ph.D. student in the Science and Technology Studies Department at Rensselaer. His research focuses on the development of technical standards that are designed to address social values such as privacy and trust.     

Developing an ethical code for engineers: The discursive approach

From the Hippocratic Oath on, deontological codes and other professional self-regulation mechanisms have been used to legitimize and identify professional groups. New technological challenges and, above all, changes in the socioeconomic environment require adaptable codes which can respond to new demands. We assume that ethical codes for professionals should not simply focus on regulative functions, but must also consider ideological and educative functions. Any adaptations should take into account both contents (values, norms and recommendations) and the drafting process itself. In this article we propose a process for developing a professional ethical code for an official professional association (Colegio Oficial de Ingenieros Industriales de Valencia (COIIV) starting from the philosophical assumptions of discursive ethics but adapting them to critical hermeneutics. Our proposal is based on the Integrity Approach rather than the Compliance Approach. A process aiming to achieve an effective ethical document that fulfils regulative and ideological functions requires a participative, dialogical and reflexive methodology. This process must respond to moral exigencies and demands for efficiency and professional effectiveness. In addition to the methodological proposal we present our experience of producing an ethical code for the industrial engineers’ association in Valencia (Spain) where this methodology was applied, and we evaluate the detected problems and future potential. An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.     

Content analysis of food advertising strategies and ethical implications on South African television

The study aimed to investigate strategies and ethical implications of food advertising in South African television. The sample included 343 food advertisements recorded over two weeks and 224 hours from two major South African TV channels. Results indicate 45 products of food advertisements. Fast food, restaurant and convenience food type had the highest number of products (17), followed by “beverage, drink and juice” (6), and “candy and sweets” group (6). Conceptual consumption (people are as interested in consuming ideas, information, and concepts as they are physically consuming things) was used as the main strategy (76.2%) for advertising food, while only 7% focused on physical consumption (fiber, energy and vitality). The majority of food advertisement used human models (78.5%), adults only (38%) and about half used both sexes. White models were used twice as often as Black models. Other advertisement strategies included claims to having fun (majority), being perceived of a higher status, acquiring a superior of products and adding social worth to the quality of person who consume the products. A few claims related to the physical benefit to the consumer, such as high fibre, whole grain, and weight loss.     

Doing as they would do: How the perceived ethical preferences of third-party beneficiaries impact ethical decision-making

Although unethical behavior often benefits third-parties not directly complicit in the misconduct, not all beneficiaries welcome these ill-gotten benefits. We investigate whether actors consider the ethical preferences of potential beneficiaries or rely solely on their own ethical predispositions when making decisions that affect others. Three studies demonstrate that the perceived ethical preferences of these beneficiaries can substantially influence the likelihood that actors behave unethically on their behalves. These studies show that actors consider the ethical preferences of beneficiaries only when their own ethical disposition is outcome-based.     

Medical education: The training of ethical physicians

This paper suggests that medical education be revised to assist in diffusing potential ethical dilemmas that arise during health care provision. A revised medical education would emphasize the role of the humanities in the training of physicians, especially in light of recent critiques of the canonical scientific model in general, and more specifically in the use of that model for medical training and practice.I wish to thank Dr. Mary Ann Cutter and Melissa M. Amaro for their critical suggestions.     

Delimiting the concept of research: an ethical perspective

It is important to be able to offer an account of which activities count as scientific research, given our current interest in promoting research as a means to benefit humankind and in ethically regulating it. We attempt to offer such an account, arguing that we need to consider both the procedural and functional dimensions of an activity before we can establish whether it is a genuine instance of scientific research. By placing research in a broader schema of activities, the similarities and differences between research activities and other activities become visible. It is also easier to show why some activities that do not count as research can sometimes be confused with research and why some other activities can be regarded only partially as research. Although the concept of research is important to delimit a class of activities which we might be morally obliged to promote, we observe that the class of activities which are regarded as subject to ethical regulation is not exhausted by research activities. We argue that, whether they be research or not, all the activities that are likely to affect the rights and interests of the individuals involved and impact on the rights and interests of other individuals raise ethical issues and might be in need of ethical regulation.     

Scientific limitations and ethical ramifications of a non-representative Human Genome Project: African American response

The Human Genome Project (HGP) represents a massive merging of science and technology in the name of all humanity. While the disease aspects of HGP-generated data have received the greatest publicity and are the strongest rationale for the project, it should be remembered that the HGP has, as its goal the sequencing of all 100,000 human genes and the accurate depiction of the ancestral and functional relationships among these genes. The HGP will thus be constructing the molecular taxonomic norm for humanity. Currently the HGP genomic baseline is almost exclusively skewed toward North Atlantic European lineages through the extensive use of the Centre d’études du Polymorphisme Humaine (CEPH) data set. More recently, the HGP has shifted to the use of volunteer donors since adequate informed consent had not been secured from the CEPH families. No evidence exists that either the CEPH families or the current volunteers are the most appropriate demographic or evolutionary lineages for the functional genomic studies that will guide production of new DNA based drugs, targeted therapeutics and gene-based diagnostics. The lack of scientific representativeness of the HGP is a serious impediment to its broad applicability. Yet this can be remedied, and five alternative sampling strategies are presented. In response to the current exclusionary design of the HGP, there is noteworthy caution and skepticism in the African American community concerning genetic studies. The Manifesto on Genomic Studies Among African Americans reflects both a desire to be systematically included in federally funded genomic studies and a desire to maintain some control over the interpretation and application of research results. Representative sampling in the HGP is seen as an international human rights issue with domestic ethical implications.     

器官移植的临床决策难题——医务人员面临的伦理尴尬

器官移植技术在临床的推广应用,在有效救治病人同时,也面临着复杂的伦理问题,医务人员身处诸多两难的尴尬境地,已成为临床决策过程中亟待解决的难题。     

Evidence-Based Ethical Problem Solving: An Idea Whose Time Has Come

This is an account of the evolution of ideas and the confluence of support and vision that has eventuated in the founding of the Journal of Empirical Research on Human Research Ethics (JERHRE). Many factors have contributed to the creation of this rather atypical academic journal, including a scientific and administrative culture that finally saw the need for it, modern electronic technology, individuals across the world who were committed to somehow finding common ground between researchers and those charged with ethical oversight of research, a network of helpful colleagues, and a university whose administration gave moral support to the endeavor in a time of fiscal austerity. Perhaps equally important were the decisions to make JERHRE a nonprofit undertaking, to emphasize the implications of empirical research for specific best practices, to serve the educational needs of those concerned with human research, and to seek to stimulate the interest of students in gaining an evidence-based understanding of the research contexts in which they decide to work. This article explores the ‘chemistry’ that has made it possible to develop a somewhat unorthodox journal and set of related activities.     

Justified ethicality: Observing desired counterfactuals modifies ethical perceptions and behavior

Employing a die-under-cup paradigm, we study the extent to which people lie when it is transparently clear they cannot be caught. We asked participants to report the outcome of a private die roll and gain money according to their reports. Results suggest that the degree of lying depends on the extent to which self-justifications are available. Specifically, when people are allowed to roll the die three times to ensure its legitimacy, but only the first roll is supposed to “count,” we find evidence that the highest outcome of the three rolls is reported. Eliminating the ability to observe more than one roll reduces lying. Additional results suggest that observing desired counterfactuals, in the form of additional rolls not meant to determine pay, attenuates the degree to which people perceive lies as unethical. People seem to derive value from self-justifications allowing them to lie for money while feeling honest.     

Conflict of interest in medicine in Lithuania: legal and ethical aspects

The current legal framework within the Lithuanian health system is described including a review of the physician’s autonomy, rights and duties, and patients’ rights including the right to reimbursement. The role of ethical codes and the law are discussed. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Medical Decision-Making: An Argument for Narrative and Metaphor

This study examines the processes ofdecision-making used by intensive care(critical care) specialists. Ninety-ninespecialists completed a questionnaire involvingthree clinical cases, using a novel methodologyinvestigating the role of uncertainty andtemporal-related factors, and exploring a rangeof ethical issues. Validation and triangulationof the results was done via a comparison studywith a medically lay, but highly informed groupof 37 law students. For both study groups,constructing reasons for a decision was largelyan interpretative and imaginative exercise thatwent beyond the data (as presented), commonlyresulting in different reasons supporting thesame conclusions and similar reasons supportingopposite conclusions. The skills of ethicalimagination and interpretation were related toan individual's prior lived experience,construed in the broadest sense. Application ofthese skills of ethical imagination andinterpretation always occurred, to some degree,in a state of uncertainty and almost alwaysinvolved temporal relationships.Using these results, a theory of ethicaldecision-making is proffered. Three levels ortypes of reasoning processes may be present.Type I decision-making involves the applicationof rules, usually in a deductive fashion. TypeII decision-making is characterised by aprocess where a plurality of reasons arebalanced, weighed and sifted with each other.Type III decision-making is intimately linkedwith respondents lived experiences and `crafts'the content of type I and II reasoningprocesses, via the application of ethicalimagination and interpretation. Relationshipsbetween these three types of reasoningprocesses, and with narrative ethics, are alsodiscussed.     

An effective strategy for integrating ethics across the curriculum in engineering: An ABET 2000 challenge

This paper describes a one-day workshop format for introducing ethics into the engineering curriculum prepared at the University of Puerto Rico at Mayagüez (UPRM). It responds to the ethics criteria newly integrated into the accreditation process by the Accreditation Board of Engineering and Technology (ABET). It also employs an ethics across the curriculum (EAC) approach; engineers identify the ethical issues, write cases that dramatize these issues, and then develop exercises making use of these cases that are specially tailored to mainstream engineering classes.The different activities and strategies employed in this workshop are set forth. Specific references are made to the cases and exercises developed as a result of these workshops. The paper ends by summarizing the different assessments made of the workshop by addressing the following questions: how did it contribute to the overall ABET effort at UPRM; could other universities benefit from a similar activity; and how did the participants evaluate the workshop?