Healthy and Happy? An Ethical Investigation of Emotion Recognition and Regulation Technologies (ERR) within Ambient Assisted Living (AAL).

Ambient Assisted Living (AAL) refers to technologies that track daily activities of persons in need of care to enhance their autonomy and minimise their need for assistance. New technological developments show an increasing effort to integrate automated emotion recognition and regulation (ERR) into AAL systems. These technologies aim to recognise emotions via different sensors and, eventually, to regulate emotions defined as "negative" via different forms of intervention. Although these technologies are already implemented in other areas, AAL stands out by its tendency to enable an inconspicuous 24-hour surveillance in the private living space of users who rely on the technology to maintain a certain degree of independence in their daily activities. The combination of both technologies represents a new dimension of emotion recognition in a potentially vulnerable group of users. Our paper aims to provide an ethical contextualisation of the novel combination of both technologies. We discuss different concepts of emotions, namely Basic Emotion Theory (BET) and the Circumplex Model of Affect (CMA), that form the basis of ERR and provide an overview over the current technological developments in AAL. We highlight four ethical issues that specifically arise in the context of ERR in AAL systems, namely concerns regarding (1) the reductionist view of emotions, (2) solutionism as an underlying assumption of these technologies, (3) the privacy and autonomy of users and their emotions, (4) the tendency of machine learning techniques to normalise and generalise human behaviour and emotional reactions.

Mapping trust relationships in organ donation and transplantation: a conceptual model.

The organ donation and transplantation (ODT) system heavily relies on the willingness of individuals to donate their organs. While it is widely believed that public trust plays a crucial role in shaping donation rates, the empirical support for this assumption remains limited. In order to bridge this knowledge gap, this article takes a foundational approach by elucidating the concept of trust within the context of ODT. By examining the stakeholders involved, identifying influential factors, and mapping the intricate trust relationships among trustors, trustees, and objects of trust, we aim to provide a comprehensive understanding of trust dynamics in ODT. We employ maps and graphs to illustrate the functioning of these trust relationships, enabling a visual representation of the complex interactions within the ODT system. Through this conceptual groundwork, we pave the way for future empirical research to investigate the link between trust and organ donation rates, informed by a clarified understanding of trust in ODT. This study can also provide valuable insights to inform interventions and policies aimed at enhancing organ donation rates.

A typology of nurses' interaction with relatives in emergency situations.

BACKGROUND: In nursing homes, residents' relatives represent important sources of support for nurses. However, in the heightened stress of emergency situations, interaction between nurses and relatives can raise ethical challenges. RESEARCH OBJECTIVES: The present analysis aimed at elaborating a typology of nurses' experience of ethical support and challenges in their interaction with relatives in emergency situations. RESEARCH DESIGN: Thirty-three semi-structured interviews and six focus groups were conducted with nurses from different nursing homes in Germany. Data were analysed according to Mayring's method of qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Participants were licensed nurses working in nursing homes. ETHICAL CONSIDERATIONS: Ethical approval was granted by Ostfalia University of Applied Sciences (02.07.2020) and the Ethics Committee of Hannover Medical School (Nr. 8866_BO_K_2020; 27.01.2020). Interviewees were anonymised and focus group were pseudonymised during transcription. All participants provided written consent. FINDINGS/RESULTS: In emergency situations, relatives can represent important sources of support for nurses. However, they may also give rise to different challenges, relating to four ethical conflicts: (1) the challenge of meeting the information needs of relatives while providing appropriate care to all residents; (2) the challenge of managing relatives' demands for hospitalisation when hospitalisation is not deemed necessary by nurses; (3) the challenge of managing relatives' demands for lifesaving treatment when such treatment contradicts the will of the resident; and (4) the challenge of attempting to initiate hospitalisation when relatives oppose this course of action. Several external factors make these conflicts especially challenging for nurses: fear of legal consequences, a low staffing ratio, and a lack of qualified nursing staff. CONCLUSIONS: Conflict between nurses and relatives typically revolves around hospitalisation and the initiation of lifesaving treatment. Whether nurses perceive interaction with relatives as supportive or conflictual essentially depends on the quality of the relationship, which may be negatively influenced by a number of external factors.

[Support of treatment safety by nursing personnel when dealing with emergency situations in long-term care facilities : Results of a qualitative empirical study]. / Unterstützung der Handlungssicherheit von Pflegefachpersonen im Umgang mit Notfallsituationen in Pflegeheimen : Ergebnisse einer qualitativ-empirischen Studie.

A significant number of emergency responses and hospitalizations of nursing home residents are considered avoidable and result in an unnecessary burden or health risk for residents. One cause of these unnecessary emergency responses lies in the lack of confidence of nursing personnel in their own actions and decisions. The goal of the NOVELLE project is to develop recommendations for action for certain emergency situations that enable nursing personnel to make operationalized decisions and empower them to take confident action. The challenges for nursing professionals to act with confidence in emergency situations were collated and assessed through a qualitative interview study. The results of this study are presented.

Should responsibility be used as a tiebreaker in allocation of deceased donor organs for patients suffering from alcohol-related end-stage liver disease?

There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third option was proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns.

'You have to put a lot of trust in me': autonomy, trust, and trustworthiness in the context of mobile apps for mental health.

Trust and trustworthiness are essential for good healthcare, especially in mental healthcare. New technologies, such as mobile health apps, can affect trust relationships. In mental health, some apps need the trust of their users for therapeutic efficacy and explicitly ask for it, for example, through an avatar. Suppose an artificial character in an app delivers healthcare. In that case, the following questions arise: Whom does the user direct their trust to? Whether and when can an avatar be considered trustworthy? Our study aims to analyze different dimensions of trustworthiness in the context of mobile health app use. We integrate O'Neill's account of autonomy, trust, and trustworthiness into a model of trustworthiness as a relational concept with four relata: B is trustworthy with respect to A regarding the performance of Z because of C. Together with O'Neill's criteria of trustworthiness (honesty, competence, and reliability), this four-sided model is used to analyze different dimensions of trustworthiness in an exemplary case of mobile health app use. Our example focuses on an app that uses an avatar and is intended to treat sleep difficulties. The conceptual analysis shows that interpreting trust and trustworthiness in health app use is multi-layered and involves a net of interwoven universal obligations. At the same time, O'Neill's approach to autonomy, trust, and trustworthiness offers a normative account to structure and analyze these complex relations of trust and trustworthiness using mobile health apps.

Lost in translation? Conceptions of privacy and independence in the technical development of AI-based AAL.

AAL encompasses smart home technologies that are installed in the personal living environment in order to support older, disabled, as well as chronically ill people with the goal of delaying or reducing their need for nursing care in a care facility. Artificial intelligence (AI) is seen as an important tool for assisting the target group in their daily lives. A literature search and qualitative content analysis of 255 articles from computer science and engineering was conducted to explore the usage of ethical concepts. From an ethical point of view, the concept of independence and self-determination on the one hand and the possible loss of privacy on the other hand are widely discussed in the context of AAL. These concepts are adopted by the technical discourse in the sense that independence, self-determination and privacy are recognized as important values. Nevertheless, our research shows that these concepts have different usages and meanings in the ethical and the technical discourses. In the paper, we aim to map the different meanings of independence, self-determination and privacy as they can be found in the context of technological research on AI-based AAL systems. It investigates the interpretation of these ethical and social concepts which technicians try to build into AAL systems. In a second step, these interpretations are contextualized with concepts from the ethical discourse on AI-based assistive technologies.

Nurses' perspectives on the role of relatives in emergency situations in nursing homes: a qualitative study from Germany.

BACKGROUND: In nursing homes, emergencies often result in unnecessary hospital transfers, which may negatively affect residents' health. Emergency management in nursing homes is complicated by structural conditions, uncertainties and difficulties communicating with the treating healthcare professionals. The present study investigated the role played by relatives in this emergency management, as perceived by nursing staff. METHODS: Within the context of a larger multi-method, interdisciplinary research project, we conducted six focus group discussions and 33 semi-structured interviews with nurses at nursing homes in northern Germany between September 2020 and April 2021. Discussions and interviews focused on emergency management in nursing homes, and were recorded, transcribed and analysed using qualitative content analysis, according to Mayring. RESULTS: Nurses reported that relatives were actively involved in emergency management in the nursing homes. Relatives were informed when there was an emergency situation, and they participated in decision making around the resident's care. Nurses sometimes perceived the involvement of relatives as challenging, due to a lack of time or staff, the opposing views of relatives and/or uncertain communication structures; however, they were willing to involve relatives according to the relatives' preferences. The role played by relatives was seen to range from that of an active supporter to that of a troublemaker. On the one hand, relatives were reported to support nurses in emergency management (i.e. by identifying residents' preferences and advocating for residents' interests). On the other hand, relatives were often perceived by the nurses as overstrained and unprepared in emergency situations, leading them to override residents' wishes, question the emergency plan and put pressure on the nurses' decision making. CONCLUSIONS: Nurses perceive the roles played by relatives in emergency situations in nursing homes as relatively supportive or, alternatively, demanding and troublesome. The timely involvement of relatives in emergency planning, the establishment of clear agreements with general practitioners and the development of trusting relationships between nursing staff and relatives may improve emergency management for nurses.

Do we have a right to an unmanipulated genome? The human genome as the common heritage of mankind.

The human genome is commonly regarded as a 'natural' connection between all human beings, as it has been handed down to us by our predecessors. As such, it is believed to represent common heritage of humanity, e.g. a resource of outstanding value that should be the object of special protection and international concern. Some critics argue that germline manipulation would disrupt this natural heritage and that we have a duty to preserve the integrity of the human germline. However, a closer look reveals that the concept of common heritage of humanity does not necessarily imply the impermissibility of germline manipulation. If it is restricted to the prevention of severe diseases, germline manipulation does not represent a threat to the unity and identity of the human species, even though this would create a new form of relationship between human beings, namely that between a designer and a genetically designed person.

Is there an ethical obligation to split every donor liver? Scarce resources, medical factors, and ethical reasoning.

SLT has the potential to counter the worldwide shortage of donor organs. Although the preferred recipients of SLT are usually pediatric patients, a more stringent ethical argument than the fundamental prioritization of children is to demonstrate that SLT of deceased donor organs could increase access to this potentially lifesaving resource for all patients, including children. Several empirical studies show that SLT also makes it possible to achieve similar outcomes to WLT in adults if several factors are observed. In general, it can be regarded as ethically permissible to insist on splitting a donor liver if, in an individual case, SLT is expected to have a similar outcome to that of WLT. The question is therefore no longer whether, but under what conditions SLT is able to achieve similar results to WLT. One of the main challenges of the current debate is the restricted comparability of the available data. We therefore have an ethical obligation to improve the available empirical data by implementing prospective clinical studies, SLT programs, and national registries. The introduction of 2 modes of allocation-one for patients willing to accept both SLT and WLT, and a second for patients only willing to accept WLT-would help to resolve the issue of patient autonomy in the case of mandatory splitting policy.