Anticipatory gaps challenge the public governance of heritable human genome editing.

Considering public moral attitudes is a hallmark of the anticipatory governance of emerging biotechnologies, such as heritable human genome editing. However, such anticipatory governance often overlooks that future morality is open to change and that future generations may perform different moral assessments on the very biotechnologies we are trying to govern in the present. In this article, we identify an 'anticipatory gap' that has not been sufficiently addressed in the discussion on the public governance of heritable genome editing, namely, uncertainty about the moral visions of future generations about the emerging applications that we are currently attempting to govern now. This paper motivates the relevance of this anticipatory gap, identifying the challenges it generates and offering various recommendations so that moral uncertainty does not lead to governance paralysis with regard to human germline genome editing.

Evaluating ChatGPT's moral competence in health care-related ethical problems.

Objectives: Artificial intelligence tools such as Chat Generative Pre-trained Transformer (ChatGPT) have been used for many health care-related applications; however, there is a lack of research on their capabilities for evaluating morally and/or ethically complex medical decisions. The objective of this study was to assess the moral competence of ChatGPT. Materials and methods: This cross-sectional study was performed between May 2023 and July 2023 using scenarios from the Moral Competence Test (MCT). Numerical responses were collected from ChatGPT 3.5 and 4.0 to assess individual and overall stage scores, including C-index and overall moral stage preference. Descriptive analysis and 2-sided Student's t-test were used for all continuous data. Results: A total of 100 iterations of the MCT were performed and moral preference was found to be higher in the latter Kohlberg-derived arguments. ChatGPT 4.0 was found to have a higher overall moral stage preference (2.325 versus 1.755) when compared to ChatGPT 3.5. ChatGPT 4.0 was also found to have a statistically higher C-index score in comparison to ChatGPT 3.5 (29.03 ± 11.10 versus 19.32 ± 10.95, P =.0000275). Discussion: ChatGPT 3.5 and 4.0 trended towards higher moral preference for the latter stages of Kohlberg's theory for both dilemmas with C-indices suggesting medium moral competence. However, both models showed moderate variation in C-index scores indicating inconsistency and further training is recommended. Conclusion: ChatGPT demonstrates medium moral competence and can evaluate arguments based on Kohlberg's theory of moral development. These findings suggest that future revisions of ChatGPT and other large language models could assist physicians in the decision-making process when encountering complex ethical scenarios.

UK junior doctors' strikes and patients with cancer: a morally questionable association.

Doctors' strikes are legally permissible in the UK, with the situation differing in other countries. But are they morally permissible? Doug McConnell and Darren Mann have systematically attempted to dismiss the arguments for the moral impermissibility of doctors' strikes and creatively attempted to provide further moral justification for them. Unfortunately for striking doctors, they fail to achieve this. Meanwhile, junior doctors' strikes have continued in the UK through 2023 and have now extended into 2024. In this response, which focuses on the UK situation and specifically junior doctors' strikes in the National Health Service (NHS) in England, I will demonstrate a central problem with their arguments-namely that they underplay the harms caused by prolonged doctors' strikes by ignoring the harms to patients with cancer. This weakens their conclusion that strikes are morally permissible in terms of the conditions and thresholds they set. I then provide a psychological critique of their justification for strikes in terms of the interests of the public. It follows that invoking the controversial concept of supererogatory action is ungrounded but also absurd when you consider time-critical cancer care. If those representing striking doctors wish to maintain a modicum of moral respectability, they should mitigate for patients with cancer and negotiate reasonably and with urgency.

Commentary: Can an effective end-of-life intervention for advanced dementia be viewed as moral?

We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia.

The ethical canary: narrow reflective equilibrium as a source of moral justification in healthcare priority-setting.

Healthcare priority-setting institutions have good reason to want to demonstrate that their decisions are morally justified-and those who contribute to and use the health service have good reason to hope for the same. However, finding a moral basis on which to evaluate healthcare priority-setting is difficult. Substantive approaches are vulnerable to reasonable disagreement about the appropriate grounds for allocating resources, while procedural approaches may be indeterminate and insufficient to ensure a just distribution. In this paper, we set out a complementary, coherence-based approach to the evaluation of healthcare priority-setting. Drawing on Rawls, we argue that an institutional priority-setter's claim to moral justification can be assessed, in part, based on the extent to which its many normative commitments are mutually supportive and free from dissonance; that is, on the ability to establish narrow reflective equilibrium across the normative content of a priority-setter's policy and practice. While we do not suggest that the establishment of such equilibrium is sufficient for moral justification, we argue that failure to do so might-like the proverbial canary in the coalmine-act as a generalised warning that something is awry. We offer a theoretical argument in support of this view and briefly outline a practical method for systematically examining coherence across priority-setting policy and practice.

The relationship between subjective compliance with isolation precautions and moral sensitivity in novice nurses: cross-sectional study.

BACKGROUND: Increasing compliance with isolation precautions is important in reducing hospital-acquired infections and their consequences. It is not possible to achieve and maintain nurse compliance through supervision, control, pressure, or training. Therefore, nurses must personally demand compliance with isolation precautions. This study aimed to determine the relationship between compliance with isolation precautions and the moral sensitivity levels of nurses who have just started working. METHODS: This study employed a descriptive and cross-sectional research design. The study population consisted of 456 new nurses recruited during the pandemic. All of the new nurses who volunteered to participate in the study and completed the questionnaires completely were included in the study and 398 nurses constituted the sample of the study. Data were collected from 398 out of 456 novice nurses who agreed to participate in the study. The population coverage rate was 87.28%. Participants were selected using convenience sampling method. The data collection tools included an Introductory Information Form, The Isolation Compliance Precautions Scale (TIPCS), and the Moral Sensitivity Questionnaire (MSQ). Descriptive statistics, correlation analyses, and regression models were used to analyze data. FINDINGS: The mean score of the MSQ was high (mean ± SD = 90.49 ± 25.94; median (P25-P75) = 84 (range, 74-97), and the score for TIPCS was high (mean ± SD = 79.29 ± 7.68; median (P25-P75) = 82 (range, 76-85)). No correlation was found between MSQ and TIPCS (p > 0.05). According to the regression analysis, although the MSQ did not correlate with TIPCS, compliance with isolation measures was found to increase as the conflict subscale of moral sensitivity increased (ß= -0.36, CI= -0.55 to -0.16; p < 0.001). Choosing the profession willingly had a positive correlation with compliance with isolation measures (ß = 5.3, CI = 2.4 to 8.3; p < 0.001). In addition, starting the profession at an early age had a positive correlation with compliance with isolation measures (ß= -0.49, CI= -0.8 to -0.17; p = 0.002). CONCLUSION: The conflict sub-dimension of moral sensitivity is an important factor in nurses' compliance with isolation measures, and conducting necessary training and other studies to improve nurses' moral sensitivity may increase their compliance with isolation measures.

The Pitfalls of Ascribing Moral Agency to Corporations: Public Obligation and Political and Social Contexts in the Commercial Determinants of Health.

Policy Points Government and civil society should be held more accountable for creating food and beverage regulatory policies rather than assigning moral agency to the food and beverage industry. Nutrition policymaking institutions should ensure civil society's ability to design regulatory policy. Government policymaking institutions should be isolated from industry interference.

Does the Duty of Rescue support a moral obligation to vaccinate? Seasonal influenza and the Institutional Duty of Rescue.

Seasonal influenza poses a significant public health risk in many countries worldwide. Lower immunity and less influenza virus circulating during the pandemic has resulted in a significant increase in cases since the lifting of COVID-19 restrictions in 2022. The seasonal influenza vaccine offers effective protection and is safe for use in large numbers of the population. This article asserts that a moral obligation to vaccinate against influenza can be understood as an Institutional Duty of Rescue. The traditional understanding of the Duty of Rescue encounters issues with force and scope, making it difficult to apply to rescue cases in general, as well as being overdemanding for the individual agent. An Institutional view of the Duty of Rescue addresses these difficulties, looks at the wider context of rescue and leaves room for discussion on collective, preventative rescue measures. This makes the concept well suited to supporting a moral obligation to vaccinate against influenza as part of a collective effort on the part of institutional organisations.

Gene-environment interaction: why genetic enhancement might never be distributed fairly.

Ethical debates around genetic enhancement tend to include an argument that the technology will eventually be fairly accessible once available. That we can fairly distribute genetic enhancement has become a moral defence of genetic enhancement. Two distribution solutions are argued for, the first being equal distribution. Equality of access is generally believed to be the fairest and most just method of distribution. Second, equitable distribution: providing genetic enhancements to reduce social inequalities. In this paper, I make two claims. I first argue that the very assumption that genetic enhancements can be distributed fairly is problematic when considering our understanding of gene-environment interactions, for example, epigenetics. I then argue that arguments that genetic enhancements are permissible because the intended benefits can be distributed fairly as intended are misinformed. My first claim rests on the assertion that genetic enhancements do not enhance traits in a vacuum; genes are dependent on conducive environments for expression. If society cannot guarantee fair environments, then any benefit conferred from being genetically enhanced will be undermined. Thus, any argument that the distribution of genetic enhancements will be fair and that the technology is therefore morally permissible, is mistaken.

Moral sensitivity as a personal and work attribute of emergency care nurses: a cross-sectional study / Sensibilidade moral como atributo pessoal e de trabalho das enfermeiras nas urgências: estudo transversal / Sensibilidad moral como atributo personal y laboral de las enfermeras en urgencias: estudio transversal

Abstract Objective: to analyze the moral sensitivity of Brazilian emergency care nurses according to their personal and work characteristics. Method: this is a quantitative, descriptive, cross-sectional study with a convenience sample. A total of 422 nurses from emergency care services in the five regions of Brazil took part. Sociodemographic and work-related information was collected, as well as the Brazilian version of the Moral Sensitivity Questionnaire. After approval by the Research Ethics Committee, the data was collected using a self-administered form on the Google Forms Platform, organized using Excel software and analyzed using the R language. Results: nurses with longer experience in emergency care services showed higher levels in the interpersonal orientation, moral conflict and moral significance dimensions, while in the professional knowledge dimension, men showed higher levels, as evidenced by items that include confidence in nursing knowledge, intuition, experience and opinion. Conclusion: the differences in the nurses' moral sensitivity were due to their professional experience. It should be emphasized that valuing the sharing of intergenerational experiences in service could be a possible strategy for fostering moral competencies in the field of practice.

Resumo Objetivo: analisar a sensibilidade moral das enfermeiras que atuam em serviços brasileiros de urgência conforme suas características pessoais e de trabalho. Método: pesquisa quantitativa, descritiva, transversal e com amostra por conveniência. Participaram 422 enfermeiras dos serviços de atenção à urgência das cinco regiões do território brasileiro. Foram coletadas informações sociodemográficas e laborais, e a versão brasileira do Moral Sensitivity Questionnaire. Os dados foram coletados, após aprovação no Comitê de Ética, por meio de um formulário autoaplicado na Plataforma Google Forms, sendo submetidos à organização pelo software Excel e analisados via linguagem R. Resultados: as enfermeiras com maior tempo de experiências nos serviços de atenção às urgências apresentaram maiores níveis nas dimensões de orientação interpessoal, conflito moral e significado moral, já na dimensão conhecimento profissional, os homens apresentaram maiores níveis, evidenciado por itens que incluem a confiança no conhecimento de enfermagem, na intuição, experiência e opinião. Conclusão: as distinções da sensibilidade moral das enfermeiras se deu quanto à experiência profissional. Destaca-se que valorizar o compartilhamento de vivências e experiências intergeracionais em serviço, pode ser uma possível estratégia para fomentar competências morais no campo de prática.

Resumen Objetivo: analizar la sensibilidad moral de las enfermeras que trabajan en servicios brasileños de urgencia según sus características personales y laborales. Método: investigación cuantitativa, descriptiva, transversal y con muestra por conveniencia. Participaron 422 enfermeras de los servicios de atención a la urgencia de las cinco regiones del territorio brasileño. Se recopilaron información sociodemográfica y laboral, y la versión brasileña del Moral Sensitivity Questionnaire. Los datos fueron recogidos, tras la aprobación en el Comité de Ética, mediante un formulario autoaplicado en la Plataforma Google Forms y sometidos a organización por el software Excel y analizados vía lenguaje R. Resultados: las enfermeras con mayor tiempo de experiencias en los servicios de atención a las urgencias mostraron mayores niveles en las dimensiones orientación interpersonal, conflicto moral y significado moral; en la dimensión conocimiento profesional, los hombres mostraron mayores niveles, evidenciado por ítems que incluyen la confianza en el conocimiento de enfermería, en la intuición, experiencia y opinión. Conclusión: las distinciones de la sensibilidad moral de las enfermeras se dieron en cuanto a la experiencia profesional. Se destaca que valorar el compartir vivencias y experiencias intergeneracionales en servicio, puede ser una posible estrategia para fomentar competencias morales en el campo de práctica.

Bioética em odontologia: autonomia dos pacientes em clínicas de ensino / Bioethics in dentistry: patient autonomy in teaching clinics / Bioética en odontología: la autonomía del paciente en los centros docentes

Resumo Este artigo foi desenvolvido com o objetivo de analisar o respeito ao princípio da autonomia na assistência aos pacientes atendidos em clínicas odontológicas de ensino, do ponto de vista de professores e alunos. Com esse propósito, foram estudadas duas faculdades públicas do estado do Rio de Janeiro. Os dados das pesquisas foram obtidos por meio da realização de entrevistas individuais e grupos focais com alunos do último ano da graduação, entrevistas com professores e observação participante. Os resultados revelaram que os atendimentos nas instituições de ensino analisadas por vezes não contemplam o respeito ao princípio da autonomia dos pacientes. A formação profissional observada reproduz o modelo hegemônico de educação tecnicista e é regida pelo estabelecimento de uma relação paternalista entre profissionais e pacientes, o que contribui para uma constante, e indesejável, violação dos direitos dos pacientes.

Abstract This article analyzes the respect for patient autonomy in dental teaching clinics as perceived by professors and students. Data were obtained by means of individual interviews and focus groups with senior students, teachers interviews and participant observation in two public state universities. Results showed that care provision at the analyzed educational institutions oftentimes does not include respect for patient autonomy. The observed professional training reproduces the hegemonic technicist education and is informed by a paternalistic physician-patient relation that contributes to a constant and undesirable violation of patient rights.

Resumen Este artículo tiene el objetivo de analizar el respeto al principio de autonomía en la atención a los pacientes de los centros odontológicos docentes desde el punto de vista de profesores y estudiantes. Para ello, se analizaron dos universidades públicas del estado de Río de Janeiro. Los datos de la investigación se obtuvieron de entrevistas individuales y grupos focales realizadas a estudiantes en el último año de graduación, de entrevistas a docentes y observación participante. Los resultados revelaron que la atención en los centros educativos analizados, en ocasiones, no incluyen el respeto al principio de autonomía de los pacientes. La formación de los profesionales reproduce el modelo hegemónico tecnicista y se rige por el establecimiento de una relación paternalista entre los profesionales y los pacientes, lo que contribuye a una constante e indeseable violación de los derechos de los pacientes.

Ethics, Abortion Access, and Emergency Care Post-Dobbs: The Gray Areas.

Clinical management of emergency pregnancy care, such as ectopic pregnancy or heavy bleeding with pregnancy of unknown location, includes upholding legal and ethical standards. For health care providers unwilling to provide evidence-based life-saving abortion care due to personal beliefs, clear guidance dictates disclosure of these limitations to the patient and colleagues, followed by immediate referral for appropriate care. However, this decision-making pathway may not be engaged due to a variety of factors: providers' beliefs preclude adherence to referral responsibilities, political discourse confuses patients as to their options and rights, and a constantly changing state and national legal landscape leads providers to question their ability to practice to their full scope of clinical care. Although this disruption of evidence-based standard of care existed pre-Dobbs, the moral disorder is now heightened. This Clinical Rounds highlights a patient vignette describing the risks of abortion restrictions for patients and providers alike, particularly when an individual provider's concerns for violating institutional guidelines sets a precedent for nursing response and forecloses on collaborative input or ethics consultation. The history of physician-only abortion exceptionalism and exclusion of nurses and midwives despite a significant history of nurses and midwives in abortion care grounds an argument for focusing on the impact of unethical and substandard care on the interprofessional care team leading to moral distress and negative patient outcomes. Patient-centered models of care, such as frameworks common in nursing and midwifery, offer opportunities to consider how all providers practicing to their full scope in interprofessional and collaborative ways, such as in emergency rooms and labor departments, might mitigate obstructions to abortion care that risk pregnant people's lives.

Perception of professors and nurses about sexism in nursing / Percepção de enfermeiros e enfermeiras sobre o machismo na enfermagem

Know the perception of professors of a higher education institution who work in nursing care about sexism in their work environment. Therefore, the guiding question of this research was: What is the perception of professors and nurses about sexism in their work environment? Methodology: Descriptive and exploratory research, with a qualitative approach, carried out with nursing professionals and professors at a private college in the capital of Alagoas. Data were primarily collected through an electronic form developed by the researchers for qualitative analysis of the information, Bardin's content analysis was adopted. The research was approved by the Ethics Committee with opinion number: 4,719,368 Results: The study included 16 professors from the nursing course, who mostly reported having already suffered or witnessed sexist situations during care. Conclusion: From this research, it was observed that despite the predominance of women in nursing, there is still sexism present in care on the part of professionals and patients. Part of the professors participating in this study claimed to have suffered or witnessed situations of sexism and all agreed on the interference in the effectiveness of care. Awareness actions are needed for these professionals and the general public, including patients (AU).

Conhecer a percepção dos(as) docentes de uma instituição de ensino superior, que atuam na assistência de enfermagem sobre o machismo no seu ambiente de trabalho. Diante disso a questão norteadora desta pesquisa foi: Qual a percepção dos(as) docentes sobre o machismo no seu ambiente de trabalho? Métodos: Pesquisa descritiva e exploratória, de abordagem qualitativa, realizada com profissionais da enfermagem, docentes de uma faculdade particular da capital de Alagoas. Os dados foram primários, coletados através de um formulário eletrônico, elaborado pelas pesquisadoras, para análise qualitativa das informações foi adotada a análise de conteúdo de Bardin. Pesquisa aprovada pelo Comitê de Ética com nº de parecer: 4.719.368 Resultados: Foram participantes do estudo 16 docen-tes do curso de enfermagem, que referiram em sua maioria já ter sofrido ou presenciado situações machistas durante a assistência. Conclusão: A partir dessa pesquisa observou-se que ainda existe machismo na assistência, por parte de profissionais e pacientes. Parte dos docentes participantes deste estudo alegaram já ter sofrido ou presenciados situações de sexismo e todos acordaram em relação a interferência na eficácia da assistência. Sendo necessárias ações de conscientização destes profissionais e do público em geral, abrangendo também os pacientes (AU).

Ethics and Morality.

Introduction: Ethics and morality are a branch of philosophy dealing with moral principles. Morals conceptualise the tenets of human character or behaviour as good or bad, right or wrong. However, morals are an individual and subjective concept which vary across individuals, cultures and time. Intentions, decisions and actions which may be considered moral by one individual or society may be considered amoral by another. The need for an organised system of guidelines, which can be universally applicable to all members of a society and against which all moral or immoral actions can be judged is the driving factor behind foundation of ethics. History of Ethics: A study of ancient Mesopotamian, Greek and Indian cultures over the millennia give a unique insight into ethics as a structural foundation of civilised society. The historical aspect of ethics and ethical systems helps guide present and future generations towards a harmonious and secure society across regional, organizational and global stages. Study of Ethics: A study of moral philosophy endeavours to classify ethical systems based on various schools of thought which act as the guiding principle on which an ethical system is structured. The major branches of ethical philosophy include descriptive ethics which studies the prevalent ethical and moral standards, normative ethics which evaluates the prevalent moral norms and their interpretation and application, meta-ethics which reevaluates the prevalent ethical systems and applied ethics dealing with ethical considerations specific to a particular field. Importance in Life and Clinical Orthopaedics: In this chapter, the authors have attempted to outline the importance of a structured ethical system in various walks of life, including personal, professional and social. A sound ethical system clearly outlines moral versus amoral behaviour, provides an objective means for judging the morality of decisions and actions, provides aids to teaching moral behaviour to new members of a society, defines behaviour of individuals professionally and personally, guides individuals in making decisions over issues of moral conflict or ambiguity and helps maintain structure and order in society so as to achieve the greatest good for the greatest number. The authors also discuss the essential role played by ethics in the life and practice of the modern-day Clinical Orthopaedician.

An educational program of reducing moral distress (PRMD) in nurses; designing and evaluating.

BACKGROUND: Moral distress is common phenomenon that has negative consequences on nurses, patients, and healthcare systems. This study aims to design and evaluate an educational program to reduce moral distress in nurses. METHODS: This multiphase mixed-method study was done in three stage on February 2021 in Shiraz/Iran. In pre-implementation stage, a content analysis study was conducted on 12 participants were interviewed using purposive sampling and then the program was designed according to qualitative data, panel of expertise and literature review according the seven steps of Ewles and Sminett's model and implemented in one group on 40 nurses using a quasi-experimental design. In Post-Implementation stage, effectiveness of program was evaluated through quantitative and qualitative methods. Quantitative data were gathered by Hamric's 21-question moral distress questionnaire analyzed via SPSS v.25 and analysis of variance repeated measures test. Also, a content analysis study was conducted on 6 PRMD participants using purposive sampling. In Program evaluation stage, convergence of quantitative and qualitative data and the effects of the program were examined. Trustworthiness of qualitative data was accomplished by Lincoln and Guba criteria. RESULTS: First quantitative study revealed the causes of moral distress consisted of deficiency in professional competency, unsuitable organizational culture, personal factors, environmental and organizational factors, management factors, insufficiencies in proficient and efficient communication and nurses' observation of moral dilemma. Results of quantitative stage showed that there was a significant difference (p < 0.05) between the mean score of moral distress before, after, 1 and 2 months after the intervention. The participants in secondary qualitative stage, reported increasing their moral knowledge and skills, improving ethical climate, and moral empowerment. CONCLUSION: The use of different educational tools and teaching methods and the participation of managers in designing strategies had a very effective role in the effectiveness of this educational program.

Humans feel too special for machines to score their morals.

Artificial intelligence (AI) can be harnessed to create sophisticated social and moral scoring systems-enabling people and organizations to form judgments of others at scale. However, it also poses significant ethical challenges and is, subsequently, the subject of wide debate. As these technologies are developed and governing bodies face regulatory decisions, it is crucial that we understand the attraction or resistance that people have for AI moral scoring. Across four experiments, we show that the acceptability of moral scoring by AI is related to expectations about the quality of those scores, but that expectations about quality are compromised by people's tendency to see themselves as morally peculiar. We demonstrate that people overestimate the peculiarity of their moral profile, believe that AI will neglect this peculiarity, and resist for this reason the introduction of moral scoring by AI.

In critique of moral resilience: UK healthcare professionals' experiences working with asylum applicants housed in contingency accommodation during the COVID-19 pandemic.

This research explores the experiences of UK NHS healthcare professionals working with asylum applicants housed in contingency accommodation during the COVID-19 pandemic. Using a critical understanding of the concept of moral resilience as a theoretical framework, we explore how the difficult circumstances in which they worked were navigated, and the extent to which moral suffering led to moral transformation. Ten staff from a general practice participated in semistructured interviews. Encountering the harms endured by people seeking asylum prior to arrival in the UK and through the UK's 'Hostile Environment' caused healthcare staff moral suffering. They responded to this in several ways, including: (1) feeling grateful for their own fortunes; (2) defining the limitations of their professional obligations; (3) focusing on the rewards of work and (4) going above and beyond usual care. Although moral resilience is reflected in much of the data, some participants described how the work caused ideological transformations and motivated challenges to systems of oppression. We show how current moral resilience theory fails to capture these transformative political and social responses, warning of how, instead, it might encourage healthcare staff to maintain the status quo. We caution against the widespread endorsement of current formulations of moral resilience in contemporary social and political climates, where the hostile and austere systems causing suffering are the result of ideological political decisions. Future work should instead focus on enabling working conditions to support, and developing theory to capture, collective resistance.