Joint Interaction and Mutual Understanding in Social Robotics.

Social robotics aims at designing robots capable of joint interaction with humans. On a conceptual level, sufficient mutual understanding is usually said to be a necessary condition for joint interaction. Against this background, the following questions remain open: in which sense is it legitimate to speak of human-robot joint interaction? What exactly does it mean to speak of humans and robots sufficiently understanding each other to account for human-robot joint interaction? Is such joint interaction effectively possible by reference, e.g., to the mere ascription or simulation of understanding? To answer these questions, we first discuss technical approaches which aim at the implementation of certain aspects of human-human communication and interaction in social robots in order to make robots accessible and understandable to humans and, hence, human-robot joint interaction possible. Second, we examine the human tendency to anthropomorphize in this context, with a view to human understanding of and joint interaction with social robots. Third, we analyze the most prominent concepts of mutual understanding and their implications for human-robot joint interaction. We conclude that it is-at least for the time being-not legitimate to speak of human-robot joint interaction, which has relevant implications both morally and ethically.

[AI-Based Self-Tracking of the Mind: Philosophical-Ethical Implications]. / KI-gestützte Selbstvermessung der Psyche: Philosophisch-ethische Implikationen.

OBJECTIVE: AI-based applications are increasingly developed to support users to digitally record, manage and change their emotions, beliefs and behavior patterns. Such forms of self-tracking in the mental sphere are accompanied by a variety of medical benefits in diagnostics, prevention, and therapy. This article pursues the question of which philosophical-ethical implications must be taken into account when dealing with these advantages. METHODS: First, some AI-based applications for self-tracking of mental characteristics and processes are outlined. Subsequently, relevant philosophical-ethical implications are presented. RESULTS: The following aspects prove to be normatively relevant: improvement versus reduction of self-determination; improvement of self-knowledge versus alienation; positive versus negative aspects of self-responsible health care; epistemic challenges of AI applications; difficulties of conceptual and normative definitions in the applications.

Digital contact tracing and exposure notification: ethical guidance for trustworthy pandemic management.

There is growing interest in contact tracing apps (CT apps) for pandemic management. It is crucial to consider ethical requirements before, while, and after implementing such apps. In this paper, we illustrate the complexity and multiplicity of the ethical considerations by presenting an ethical framework for a responsible design and implementation of CT apps. Using this framework as a starting point, we briefly highlight the interconnection of social and political contexts, available measures of pandemic management, and a multi-layer assessment of CT apps. We will discuss some trade-offs that arise from this perspective. We then suggest that public trust is of major importance for population uptake of contact tracing apps. Hasty, ill-prepared or badly communicated implementations of CT apps will likely undermine public trust, and as such, risk impeding general effectiveness.

[Moral distress in medical students and young professionals: research desiderata in the context of the COVID-19 pandemic]. / Moralischer Stress bei Medizinstudierenden und ärztlichen Berufseinsteigenden: Forschungsdesiderate im Rahmen der COVID-19-Pandemie.

BACKGROUND: The COVID-19 pandemic poses particular challenges for people working in the medical sector. Some of the medical students and young medical professionals who are starting their work in healthcare facilities during this time are confronted with extraordinary moral challenges. A portion of them does not yet have sufficient coping skills to adequately deal with these challenges. This can lead to so-called moral distress (MoD). Permanent or intensive exposure to MoD can have serious consequences. Appropriate support services have the potential to improve the handling of MoD. OBJECTIVE: This article aims to provide an overview of the current state of research on MoD among medical students and young medical professionals in order to sensitize lecturers with responsibility for education and training and doctors in leading positions to the problem. MAIN PART: This article presents the scientific concept of MoD, known triggers, and options for prevention and intervention. The topic is presented with reference to the changes in patient care in the context of the COVID-19 pandemic and research needs are presented. CONCLUSION: The article illustrates the necessity of a German-language, interdisciplinary discourse on MoD among medical students and young professionals.

What is it like to use a BCI? - insights from an interview study with brain-computer interface users.

BACKGROUND: The neurotechnology behind brain-computer interfaces (BCIs) raises various ethical questions. The ethical literature has pinpointed several issues concerning safety, autonomy, responsibility and accountability, psychosocial identity, consent, privacy and data security. This study aims to assess BCI users' experiences, self-observations and attitudes in their own right and looks for social and ethical implications. METHODS: We conducted nine semi-structured interviews with BCI users, who used the technology for medical reasons. The transcribed interviews were analyzed according to the Grounded Theory coding method. RESULTS: BCI users perceive themselves as active operators of a technology that offers them social participation and impacts their self-definition. Each of these aspects bears its own opportunities and risks. BCIs can contribute to retaining or regaining human capabilities. At the same time, BCI use contains elements that challenge common experiences, for example when the technology is in conflict with the affective side of BCI users. The potential benefits of BCIs are regarded as outweighing the risks in that BCI use is considered to promote valuable qualities and capabilities. BCI users appreciate the opportunity to regain lost capabilities as well as to gain new ones. CONCLUSIONS: BCI users appreciate the technology for various reasons. The technology is highly appreciated in cases where it is beneficial in terms of agency, participation and self-definitions. Rather than questioning human nature, the technology can retain and restore characteristics and abilities which enrich our lives.

Wired Emotions: Ethical Issues of Affective Brain-Computer Interfaces.

Ethical issues concerning brain-computer interfaces (BCIs) have already received a considerable amount of attention. However, one particular form of BCI has not received the attention that it deserves: Affective BCIs that allow for the detection and stimulation of affective states. This paper brings the ethical issues of affective BCIs in sharper focus. The paper briefly reviews recent applications of affective BCIs and considers ethical issues that arise from these applications. Ethical issues that affective BCIs share with other neurotechnologies are presented and ethical concerns that are specific to affective BCIs are identified and discussed.

Brain-computer interfaces and personhood: interdisciplinary deliberations on neural technology.

OBJECTIVE: Scientists, engineers, and healthcare professionals are currently developing a variety of new devices under the category of brain-computer interfaces (BCIs). Current and future applications are both medical/assistive (e.g. for communication) and non-medical (e.g. for gaming). This array of possibilities has been met with both enthusiasm and ethical concern in various media, with no clear resolution of these conflicting sentiments. APPROACH: To better understand how BCIs may either harm or help the user, and to investigate whether ethical guidance is required, a meeting entitled 'BCIs and Personhood: A Deliberative Workshop' was held in May 2018. MAIN RESULTS: We argue that the hopes and fears associated with BCIs can be productively understood in terms of personhood, specifically the impact of BCIs on what it means to be a person and to be recognized as such by others. SIGNIFICANCE: Our findings suggest that the development of neural technologies raises important questions about the concept of personhood and its role in society. Accordingly, we propose recommendations for BCI development and governance.

Using brain-computer interfaces: a scoping review of studies employing social research methods.

BACKGROUND: The rapid expansion of research on Brain-Computer Interfaces (BCIs) is not only due to the promising solutions offered for persons with physical impairments. There is also a heightened need for understanding BCIs due to the challenges regarding ethics presented by new technology, especially in its impact on the relationship between man and machine. Here we endeavor to present a scoping review of current studies in the field to gain insight into the complexity of BCI use. By examining studies related to BCIs that employ social research methods, we seek to demonstrate the multitude of approaches and concerns from various angles in considering the social and human impact of BCI technology. METHODS: For this scoping review of research on BCIs' social and ethical implications, we systematically analyzed six databases, encompassing the fields of medicine, psychology, and the social sciences, in order to identify empirical studies on BCIs. The search yielded 73 publications that employ quantitative, qualitative, or mixed methods. RESULTS: Of the 73 publications, 71 studies address the user perspective. Some studies extend to consideration of other BCI stakeholders such as medical technology experts, caregivers, or health care professionals. The majority of the studies employ quantitative methods. Recurring themes across the studies examined were general user opinion towards BCI, central technical or social issues reported, requests/demands made by users of the technology, the potential/future of BCIs, and ethical aspects of BCIs. CONCLUSIONS: Our findings indicate that while technical aspects of BCIs such as usability or feasibility are being studied extensively, comparatively little in-depth research has been done on the self-image and self-experience of the BCI user. In general there is also a lack of focus or examination of the caregiver's perspective.

Brain-Computer Interfaces: Lessons to Be Learned from the Ethics of Algorithms.

Brain-computer interfaces (BCIs) are driven essentially by algorithms; however, the ethical role of such algorithms has so far been neglected in the ethical assessment of BCIs. The goal of this article is therefore twofold: First, it aims to offer insights into whether (and how) the problems related to the ethics of BCIs (e.g., responsibility) can be better grasped with the help of already existing work on the ethics of algorithms. As a second goal, the article explores what kinds of solutions are available in that body of scholarship, and how these solutions relate to some of the ethical questions around BCIs. In short, the article asks what lessons can be learned about the ethics of BCIs from looking at the ethics of algorithms. To achieve these goals, the article proceeds as follows. First, a brief introduction into the algorithmic background of BCIs is given. Second, the debate about epistemic concerns and the ethics of algorithms is sketched. Finally, this debate is transferred to the ethics of BCIs.

Do New Neuroimaging Findings Challenge the Ethical Basis of Advance Directives in Disorders of Consciousness?

Some authors have questioned the moral authority of advance directives (ADs) in cases in which it is not clear if the author of the AD is identical to the person to whom it later applies. This article focuses on the question of whether the latest results of neuroimaging studies have moral significance with regard to the moral authority of ADs in patients with disorders of consciousness (DOCs). Some neuroimaging findings could provide novel insights into the question of whether patients with DOCs exhibit sufficient psychological continuity to be ascribed diachronic personal identity. If those studies were to indicate that psychological continuity is present, they could justify the moral authority of ADs in patients with DOCs. This holds at least if respect for self-determination is considered as the foundation for the moral authority of ADs. The non-identity thesis in DOCs could no longer be applied, in line with clinical and social practice.

Principle-based structured case discussions: do they foster moral competence in medical students? - A pilot study.

BACKGROUND: Recent findings suggest that medical students' moral competence decreases throughout medical school. This pilot study gives preliminary insights into the effects of two educational interventions in ethics classes on moral competence among medical students in Munich, Germany. METHODS: Between 2012 and 2013, medical students were tested using Lind's Moral Competence Test (MCT) prior to and after completing different ethics classes. The experimental group (EG, N = 76) participated in principle-based structured case discussions (PBSCDs) and was compared with a control group with theory-based case discussions (TBCDs) (CG, N = 55). The pre/post C-scores were compared using a Wilcoxon Test, ANOVA and effect-size calculation. RESULTS: The C-score improved by around 3.2 C-points in the EG, and by 0.2 C-points in the CG. The mean C-score difference was not statistically significant for the EG (P = 0.14) or between the two groups (P = 0.34). There was no statistical significance for the teachers' influence (P = 0.54) on C-score. In both groups, students with below-average (M = 29.1) C-scores improved and students with above-average C-scores regressed. The increase of the C-Index was greater in the EG than in the CG. The absolute effect-size of the EG compared with the CG was 3.0 C-points, indicating a relevant effect. CONCLUSION: Teaching ethics with PBSCDs did not provide a statistically significant influence on students' moral competence, compared with TBCDs. Yet, the effect size suggests that PBSCDs may improve moral competence among medical students more effectively. Further research with larger and completely randomized samples is needed to gain definite explanations for the results.

Transapical approach to optimize left ventricular resynchronization in patients with dilated cardiomyopathy.

An alternative to coronary sinus implantation for a left ventricular pacing lead is frequently needed for cardiac resynchronization therapy. We have developed a transapical approach to implant an endocardial pacing lead that will reach the most delayed segment of the left ventricle. This method is easily combined with other transapical heart surgeries. After some technological improvement our technique should offer easier access and better results than other currently available implantation methods.

Transapical approach to optimize left ventricular resynchronization in patients with dilated cardiomyopathy.

An alternative to coronary sinus implantation for a left ventricular pacing lead is frequently needed for cardiac resynchronization therapy. We have developed a transapical approach to implant an endocardial pacing lead that will reach the most delayed segment of the left ventricle. This method is easily combined with other transapical heart surgeries. After some technological improvement, our technique should offer easier access and better results than other currently available implantation methods.

Knowledge of Partial Awareness in Disorders of Consciousness: Implications for Ethical Evaluations?

Recent results from neuroimaging appear to indicate that some patients in a vegetative state have partially intact awareness. These results may demonstrate misdiagnosis and suggest the need not only for alternative forms of treatment, but also for the reconsideration of end-of-life decisions in cases of disorders of consciousness. This article addresses the second consequence. First, I will discuss which aspects of consciousness may be involved in neuroimaging findings. I will then consider various factors relevant to ethical end-of-life decision-making, and analyse whether and to what extent the above consequence applies to these factors. It will be shown that knowledge of the existence of partial awareness in patients with disorders of consciousness only influences end-of-life decision-making if certain background assumptions are made.

Feasibility of percutaneous implantation of transapical endocardial left ventricular pacing electrode for cardiac resynchronization therapy.

Failure of coronary sinus lead implantation for resynchronization therapy requires alternative approaches. For such events we have developed a transapical implantation technique as a feasible alternative. We report the outcome of this technique and its evolution from a minithoracotomy to a percutaneous approach. Twenty patients underwent alternative resynchronization therapy with transapical endocardial left ventricular (LV) pacing lead implantation in a multicentre, international study between October 2007 and March 2010. Eighteen patients underwent minithoracotomy and transapical puncture under direct observation. Two recent patients had transthoracic echocardiography-guided percutaneous apical puncture to enter the LV cavity. A 19 or 21 ga needle and two-stage Seldinger dilatation with 4 and 7 Fr sheaths were then used to introduce the lead. In the two patients with closed-chest insertion of the electrode there was no puncture related bleeding or lung damage. Lead dislocation occurred in two minithoracotomy patients. Repositioning was performed without re-opening the pleural cavity. One patient developed right-sided implanted cardiac defibrillator lead endocarditis requiring complete system removal. Twelve patients have >1 year follow-up; all have sustained and significant improvement in LV dimensions (diastolic Δ4.2 ± 2.9, systolic Δ7.2 ± 5.8 mm), ejection fraction (Δ9.5 ± 9.6%), and functional status (Δ1.1 ± 0.3). Transapical placement of LV endocardial pacing lead is an effective alternative strategy for cardiac resynchronization. A closed-chest, percutaneous approach is feasible and should offer even less invasive intervention.

[Early complications and their treatment after heart transplantation in Hungary--experience of the first 16 years]. / A szívátültetések korai szövôdményei és kezelésük Magyarországon--az elsô 16 év tapasztalatai.

UNLABELLED: Heart transplantation is the most successful current long-term therapy of end stage cardiac failure. AIM: In order to improve the results of the Hungarian heart transplantation activity, all data from the first 16 years were retrospectively examined and matched with the relevant literature. METHODS: Between January 1992 and December 2007, 127 heart transplantations were performed in 125 patients in Hungary. Above the documentation of the Department of Cardiovascular Surgery, Semmelweis University, the archives of the Institute of Forensic Medicine, Semmelweis University, the Registry of Hungarian National Blood Transfusion Service, Organ Coordination Office and the data of the Gottsegen György National Institute of Cardiology were used. RESULTS: Early mortality has been approaching the international level recently. Graft failure was the primary cause of death in the Hungarian practice as well, followed by infection, uncontrollable bleeding during surgery and multiorgan failure. In one case successful acute retransplantation was performed, but the most effective, ventricular assist device therapy is completely missing from the armamentarium. Excellent results were achieved with medical treatment against acute rejection such as written in the international literature. CONCLUSIONS: For the sake of developing, regular usage of assist device therapy in Hungary is a prominent task. Development and application of standard protocols providing better quality in organ donor treatment and donation management have to be pressed.

[The first successful combined heart-kidney transplantation in Hungary]. / Az elso sikeres kombinált szív- és veseátültetés Magyarországon.

Combined heart-kidney transplantation has become a new therapeutic solution for patients with coexisting, irreversible heart and kidney failure. Though this combined approach has several theoretical advantages over sequential transplantation, it remains to be established whether it has a jeopardizing impact on patient and graft outcome. The authors report their experience of the first successful combined heart-kidney transplantation in Hungary from a single donor and review the literature in order to clarify this issue. Young male patient candidate for heart transplantation was suffering from concurrent end stage kidney disease. Donor was selected on the basis of weight and size matching, AB0 compatibility and negative T-cell cross-match. The heart was grafted first, and after the hemodynamic stabilization kidney from the same donor was transplanted. The surgical procedure was uneventful. Heart and kidney function recovered quickly, and the patient is doing very well with good cardiac and renal function even a year following the double organ transplantation. The first Hungarian experience showed that combined heart-kidney transplantation is a therapeutic solution for patients with end stage heart and kidney failure. The lower rate of rejection compared to single heart or kidney transplantation, known from the literature as well, supports their current approach to immunosuppression.