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The language of antibiotic stewardship is often used to capture the moral importance of individual prescribers doing their part to combat antibiotic resistance. "Stewardship" as an ethics concept borrows from collective action problems-those that cannot be solved by individuals only-like those discussed in the environmental ethics literature. This article suggests that hyper focus on stewardship, however, risks misunderstanding individual prescribers' reasons to limit antibiotic use.
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Antibacterianos , Gestão de Antimicrobianos , Médicos , Humanos , Gestão de Antimicrobianos/ética , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Médicos/ética , Padrões de Prática Médica/ética , Padrões de Prática Médica/normas , Resistência Microbiana a Medicamentos , Obrigações MoraisRESUMO
This article describes key challenges in creating an ethics "for" robots. Robot ethics is not only a matter of the effects caused by robotic systems or the uses to which they may be put, but also the ethical rules and principles that these systems ought to follow-what we call "Ethics for Robots." We suggest that the Principle of Nonmaleficence, or "do no harm," is one of the basic elements of an ethics for robots-especially robots that will be used in a healthcare setting. We argue, however, that the implementation of even this basic principle will raise significant challenges for robot designers. In addition to technical challenges, such as ensuring that robots are able to detect salient harms and dangers in the environment, designers will need to determine an appropriate sphere of responsibility for robots and to specify which of various types of harms must be avoided or prevented. These challenges are amplified by the fact that the robots we are currently able to design possess a form of semi-autonomy that differs from other more familiar semi-autonomous agents such as animals or young children. In short, robot designers must identify and overcome the key challenges of an ethics for robots before they may ethically utilize robots in practice.
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This essay argues for the importance of formalizing public engagement efforts around bioethics as something we might call "bioethics communication," and it outlines the Johns Hopkins Berman Institute of Bioethics' plans for engaging in this effort. Because science is complex and difficult to explain to nonexperts, the field of science communication has arisen to meet this need. The field involves both a practice and a subject of empirical research. Like science, bioethics is also complex and difficult to explain, which is why the world needs bioethics communication. The authors are engaged in a brand-new effort to establish the sort of public bioethics efforts that would constitute bioethics communication, through a program which they call the Dracopoulos-Bloomberg iDeas Lab. The authors invite colleagues to experiment and learn with them as they invest in the development of bioethics communicators and their products.
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Bioética , Humanos , Pesquisa Empírica , Comunicação , Academias e Institutos , AprendizagemRESUMO
This paper argues that individuals in many high-income countries typically have moral reasons to limit their beef consumption and consume plant-based protein instead, given the negative effects of beef production and consumption. Beef production is a significant source of agricultural greenhouse gas emissions and other environmental impacts, high levels of beef consumption are associated with health risks, and some cattle production systems raise animal welfare concerns. These negative effects matter, from a variety of moral perspectives, and give us collective moral reasons to reduce beef production and consumption. But, as some ethicists have argued, we cannot draw a straight line from the ethics of production to the ethics of consumption: even if a production system is morally impermissible, this does not mean that any given individual has moral reasons to stop consuming the products of that system, given how miniscule one individual's contributions are. This paper considers how to connect those dots. We consider three distinct lines of argument in support of the conclusion that individuals have moral reasons to limit their beef consumption and shift to plant-based protein, and we consider objections to each argument. This argument applies to individuals in high beef-consuming and high greenhouse gas-emitting high-income countries, though we make this argument with a specific focus on the United States. Supplementary Information: The online version contains supplementary material available at 10.1007/s41055-022-00100-8.
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What responsibilities do individuals have when it comes to combating large-scale public health crises such as racism? A seductive argument borrowed from the climate ethics literature suggests that focusing on individual morality for a structural problem such as racism is at best unhelpful and at worst actively harmful. In response, we argue that individuals have good moral reasons to modify their own behaviors to help in the fight against large, structural public health emergencies in general, and that the public health crisis of racism, in particular, demands heightened moral responsiveness from individual white people to resist white supremacy. The moral reasons that support white engagement in antiracist work extend above and beyond those regarding individual involvement in the fight against other collectively created public health challenges. Our conclusions help to defend the claim that racial literacy and antiracist education aimed at individuals are vital.
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Racismo , Humanos , Princípios Morais , Saúde Pública , Grupos RaciaisRESUMO
The question about how to resume typical orthopaedic care during a pandemic, such as coronavirus disease 2019, should be framed not only as a logistic or safety question but also as an ethical question. The current published guidelines from surgical societies do not explicitly address ethical dilemmas, such as why public health ethics requires a cessation of nonemergency surgery or how to fairly allocate limited resources for delayed surgical care. We propose ethical guidance for the resumption of care on the basis of public health ethics with a focus on clinical equipoise, triage tiers, and flexibility. We then provide orthopaedic surgery examples to guide physicians in the ethical resumption of care.
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COVID-19 , Procedimentos Ortopédicos/ética , Administração em Saúde Pública/ética , Adolescente , Idoso , Artroplastia de Quadril , Artroplastia do Joelho , COVID-19/epidemiologia , Clavícula/lesões , Clavícula/cirurgia , Tomada de Decisão Clínica , Feminino , Neoplasias Femorais/cirurgia , Fraturas Ósseas/cirurgia , Tumores de Células Gigantes/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia , Pandemias , Guias de Prática Clínica como Assunto , Lesões do Manguito Rotador/cirurgia , SARS-CoV-2 , Equipolência Terapêutica , TriagemRESUMO
This case considers a so-called legacy patient, one whose behaviors and symptoms express a legacy of past, aggressive opioid prescribing by a clinician. Some prescribers might feel pressured to taper doses of opioids for such patients, but this article argues that nonconsensual dose reductions for stable opioid therapy patients is impermissible because it both puts a patient at risk and wrongs an individual in a misdirected attempt to ameliorate a systemic wrong. Although perhaps surprising, this argument is supported by current evidence and recommendations for patient-centered pain care.
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Analgésicos Opioides , Dor Crônica , Humanos , Dor/tratamento farmacológico , Assistência Centrada no Paciente , Padrões de Prática MédicaAssuntos
Analgésicos Opioides/efeitos adversos , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/complicações , Analgésicos Opioides/farmacologia , Analgésicos Opioides/uso terapêutico , Humanos , Epidemia de Opioides/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, greenhouse gas emissions, and other externalities. We consider potential conflicts between health promotion and environmental protection and why and how the healthcare industry might promote health while protecting environments. After probing conflicts between promoting health and protecting the environment we highlight the essential role that environmental resources play in health and healthcare to show that environmental protection is a form of health promotion. We then explore relationships between three radical forms of health promotion and the environment: (1) lowering the human birth rate; (2) transforming the food system; and (3) genetically modifying mosquitos. We conclude that healthcare and other industries and their institutions and leaders have responsibilities to re-consider and modify their priorities, policies, and practices.
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Temas Bioéticos , Conservação dos Recursos Naturais , Saúde Ambiental/ética , Promoção da Saúde/ética , Saúde Pública/ética , Bioética , Abastecimento de Alimentos/ética , Setor de Assistência à Saúde/ética , Humanos , Controle de Mosquitos/ética , Controle da População/éticaRESUMO
The Coronavirus disease 2019 pandemic has been an unprecedented challenge to healthcare systems and clinicians around the globe. As the virus has spread, critical questions arose about how to best deliver health care in emergency situations where material and personnel resources become scarce. Clinicians who excel at caring for the individual patient at the bedside are now being reoriented into a system where they are being asked to see the collective public as their responsibility. As such, the clinical ethics that clinicians are accustomed to practicing are being modified by a framework of public health ethics defined by the presence of a global pandemic. There are many unknowns about Coronavirus disease 2019, which makes it difficult to provide consistent recommendations and guidelines that uniformly apply to all situations. This lack of consensus leads to the clinicians' confusion and distress. Real-life dilemmas about how to allocate resources and provide care in hotspot cities make explicit the need for careful ethical analysis, but the need runs far deeper than that; even when not trading some lives against others, the responsibilities of both individual clinicians and the broader healthcare system are changing in the face of this crisis.
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Betacoronavirus , Infecções por Coronavirus , Atenção à Saúde/ética , Procedimentos Ortopédicos/ética , Pandemias/ética , Pneumonia Viral , Temas Bioéticos , COVID-19 , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , SARS-CoV-2 , Estados UnidosRESUMO
The ethics of robots and artificial intelligence (AI) typically centers on "giving ethics" to as-yet imaginary AI with human-levels of autonomy in order to protect us from their potentially destructive power. It is often assumed that to do that, we should program AI with the true moral theory (whatever that might be), much as we teach morality to our children. This paper argues that the focus on AI with human-level autonomy is misguided. The robots and AI that we have now and in the near future are "semi-autonomous" in that their ability to make choices and to act is limited across a number of dimensions. Further, it may be morally problematic to create AI with human-level autonomy, even if it becomes possible. As such, any useful approach to AI ethics should begin with a theory of giving ethics to semi-autonomous agents (SAAs). In this paper, we work toward such a theory by evaluating our obligations to and for "natural" SAAs, including nonhuman animals and humans with developing and diminished capacities. Drawing on research in neuroscience, bioethics, and philosophy, we identify the ways in which AI semi-autonomy differs from semi-autonomy in humans and nonhuman animals. We conclude on the basis of these comparisons that when giving ethics to SAAs, we should focus on principles and restrictions that protect human interests, but that we can only permissibly maintain this approach so long as we do not aim at developing technology with human-level autonomy.
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Inteligência Artificial/ética , Bioética , Autonomia Pessoal , Animais , Humanos , Robótica/éticaAssuntos
COVID-19/prevenção & controle , Dor Lombar/terapia , Manejo da Dor/ética , Pandemias/ética , Membro Fantasma/terapia , Radiculopatia/terapia , Idoso , COVID-19/epidemiologia , Feminino , Humanos , Injeções Epidurais/ética , Dor Lombar/diagnóstico , Masculino , Bloqueio Nervoso/ética , Manejo da Dor/métodos , Membro Fantasma/diagnóstico , Radiculopatia/diagnósticoRESUMO
Among those who discuss America's opioid crisis, it is popular to claim that we know what we, as a society, ought to do to solve the problem-we simply don't want it badly enough. We don't lack knowledge; we lack the will to act and to fund the right policies. In fact, I've heard two versions of this. Among those who focus on prescription opioids, it is clear that we ought to stop prescribing so many powerful opioid painkillers. And among my public health colleagues focusing on illicit drug use, it is clear that we ought to expand addiction treatment and harm-reduction services. The problem, however, is that the second claim is not obvious (and, indeed, is denied by many Americans), and the first claim probably isn't even true (at least, not in so crude a form). In short, the opioid crisis presents not only a problem of political will but also one of ethics. It will take work to discover or justify our normative claims in this arena.