Toward a new clinical pragmatism: method in clinical ethics consultation.

In this paper, I leverage the pragmatist tradition in philosophy, the collective wisdom of scholarship in clinical ethics consultation, and earlier attempts to apply pragmatism in clinical ethics to develop a new vision of clinical ethics practice called New Clinical Pragmatism. It argues that clinical ethics methodology, from the New Clinical Pragmatist's perspective, amounts to the recommendation that consultants should customize a methodological approach, drawing on the various available methods, depending on the demands of the specific case, and should avoid attempts to identify a 'true' methodology but to the incoherence and inevitable failure of those attempts. I argue that pragmatism's emphasis on practical wisdom and experimentation allow the New Clinical Pragmatist to do this while avoiding irrationality in choosing methods. I discuss how the New Clinical Pragmatist gives a unique, constructive perspective on key aspects of clinical ethics consultation such as the choice of common morality vs. internal morality of medicine approaches, process standards, bioethics mediation, and narrative ethics, and suggest how New Clinical Pragmatism's relaxed approach to choice of methodology encourages consultants to balance attention to the particulars of the case with knowledge of what the many insightful scholars of clinical ethics methodology have found useful in the past. I also argue that New Clinical Pragmatism is consistent with efforts to professionalize clinical ethics consultation.

Coming to Terms with the Black Box Problem: How to Justify AI Systems in Health Care.

The use of opaque, uninterpretable artificial intelligence systems in health care can be medically beneficial, but it is often viewed as potentially morally problematic on account of this opacity-because the systems are black boxes. Alex John London has recently argued that opacity is not generally problematic, given that many standard therapies are explanatorily opaque and that we can rely on statistical validation of the systems in deciding whether to implement them. But is statistical validation sufficient to justify implementation of these AI systems in health care, or is it merely one of the necessary criteria? I argue that accountability, which holds an important role in preserving the patient-physician trust that allows the institution of medicine to function, contributes further to an account of AI system justification. Hence, I endorse the vanishing accountability principle: accountability in medicine, in addition to statistical validation, must be preserved. AI systems that introduce problematic gaps in accountability should not be implemented.

Software Piracy in Research: A Moral Analysis.

Researchers in virtually every discipline rely on sophisticated proprietary software for their work. However, some researchers are unable to afford the licenses and instead procure the software illegally. We discuss the prohibition of software piracy by intellectual property laws, and argue that the moral basis for the copyright law offers the possibility of cases where software piracy may be morally justified. The ethics codes that scientific institutions abide by are informed by a rule-consequentialist logic: by preserving personal rights to authored works, people able to do so will be incentivized to create. By showing that the law has this rule-consequentialist grounding, we suggest that scientists who blindly adopt their institutional ethics codes will commit themselves to accepting that software piracy could be morally justified, in some cases. We hope that this conclusion will spark debate over important tensions between ethics codes, copyright law, and the underlying moral basis for these regulations. We conclude by offering practical solutions (other than piracy) for researchers.