The ethics of artificial intelligence systems in healthcare and medicine: from a local to a global perspective, and back.

Artificial intelligence systems (ai-systems) (e.g. machine learning, generative artificial intelligence), in healthcare and medicine, have been received with hopes of better care quality, more efficiency, lower care costs, etc. Simultaneously, these systems have been met with reservations regarding their impacts on stakeholders' privacy, on changing power dynamics, on systemic biases, etc. Fortunately, healthcare and medicine have been guided by a multitude of ethical principles, frameworks, or approaches, which also guide the use of ai-systems in healthcare and medicine, in one form or another. Nevertheless, in this article, I argue that most of these approaches are inspired by a local isolationist view on ai-systems, here exemplified by the principlist approach. Despite positive contributions to laying out the ethical landscape of ai-systems in healthcare and medicine, such ethics approaches are too focused on a specific local healthcare and medical setting, be it a particular care relationship, a particular care organisation, or a particular society or region. By doing so, they lose sight of the global impacts ai-systems have, especially environmental impacts and related social impacts, such as increased health risks. To meet this gap, this article presents a global approach to the ethics of ai-systems in healthcare and medicine which consists of five levels of ethical impacts and analysis: individual-relational, organisational, societal, global, and historical. As such, this global approach incorporates the local isolationist view by integrating it in a wider landscape of ethical consideration so to ensure ai-systems meet the needs of everyone everywhere.

Thinking like a mountain: A land ethical approach to healthcare resource.

Human activity is now having a defining influence on global systems. The Anthropocene epoch requires revisiting our ethical presuppositions to understand our relationship to the earth's life support systems. The Land Ethic of Aldo Leopold proposes an ethic that is diachronic, holistic, and biocentric, in contrast to the synchronic, individualist, and anthropocentric axioms of mainstream bioethics. I argue that these features of the Land Ethic make it more suitable to engage with the ethics of healthcare resource allocation in the Anthropocene; that understanding sustainability in a Land Ethical fashion requires that we view it as placing a side-constraint on all permissible healthcare resource use such that this use remains within planetary boundaries; and outline how this might re-shape debates around healthcare resource allocation.

Advancing eco-excellence: Integrating stakeholders' pressures, environmental awareness, and ethics for green innovation and performance.

The environment is a major issue for both society and industry. Stakeholder demands, environmental ethics and environmental awareness may all have a substantial impact on a company's environmental performance. In this research, we investigate the impact of stakeholders' pressures, environmental ethics, and environmental awareness on environmental performance, which is mediated through the concept of green innovation. A survey questionnaire is used in the study to gather information from 410 managers working in different Chinese manufacturing firms. Structural equation modeling (SEM) is used to assess the data and test the assumptions that have been put forward. According to the study's results, stakeholders' pressures in terms of regulatory pressures, customer pressures, and competitor pressures; environmental ethics, and environmental awareness all had a positive effect on both green product innovation and green process innovation, which in turn had a favorable impact on environmental performance. Moreover, both green product and process innovation partially mediated the link between stakeholders' pressures, environmental ethics, and environmental performance except in the case of environmental awareness. These findings provide light on the significance of stakeholder demands, environmental ethics, and environmental awareness in encouraging green innovation and increasing environmental performance.

Enabling a Smooth Transition: Responsible Chemistry Competencies for the European Green Deal.

Chemists are a vital part of the research and innovation (R&I) landscape. With their expertise, they shape progress and, thus, society. In order to live up to this responsibility, it is suggested to prepare young chemists for their future role as innovators with proper training. Here, it is important to go beyond the good scientific practice dimension of research integrity and add discourse performance and value assessments to the class outline of a "responsible chemistry" course. This becomes especially relevant in view of changing demands on chemical research and innovation as envisioned by the European Green Deal through its Horizon Europe funding scheme. This paper outlines the necessity of preparing chemists for the requirements of a green transition R&I policy and shows what that would mean for "ethics in chemistry" education.

Revisiting two dogmas of conservation science.

Conservation science is a morally motivated field, with implicit and explicit values built into its practice. As such, conservationists must engage with conservation ethics to interrogate underlying values. We examine cutting-edge ecological science and contemporary ethics to revisit two conservation norms that have become dogmatic in the field: ecological collectives, but not individual animals, are valuable and anthropomorphism should be staunchly avoided. Emerging studies demonstrate that individuals and their intraspecific variation can be instrumentally valuable for conservation science, and there is an emerging consensus within environmental philosophy around the moral worth of individuals. Thus, we suggest conservation science should explicitly recognize the value of individuals. We also argue that avoiding anthropomorphism is detrimental to conservation because critical anthropomorphism enables a more nuanced scientific approach-allowing conservationists to ask enlightened questions with creativity and compassion. We provide evidence that both dogmatic norms are scientifically and morally outdated and propose new normative values to push conservation towards more robust science and ethical practice.

Revisión de dos dogmas de las ciencias de la conservación Resumen Las ciencias de la conservación son un campo con motivaciones morales y valores implícitos y explícitos integrados en su práctica. Por lo tanto, los conservacionistas deben trabajar con la ética de la conservación para interrogar los valores subyacentes. Analizamos la ecología de vanguardia y la ética contemporánea para revisar dos normas que se han convertido en dogmas dentro del campo: los colectivos ecológicos, pero no los animales individuales, son valiosos y el antropomorfismo debe evitarse a toda costa. Los estudios emergentes demuestran que los individuos y sus variaciones intraespecíficas pueden tener un valor instrumental para las ciencias de la conservación y que existe un consenso emergente dentro de la filosofía ambiental en torno al valor moral de los individuos. Por lo tanto, sugerimos que las ciencias de la conservación deberían reconocer de forma explícita el valor de los individuos. También discutimos que evitar el antropomorfismo daña a la conservación pues el antropomorfismo crítico permite una estrategia científica más matizada-lo que permite que los conservacionistas hagan preguntas informadas con creatividad y compasión. Proporcionamos evidencias de que ambos dogmas son científica y moralmente obsoletos y proponemos nuevos valores normativos para guiar a la conservación hacia una ciencia más sólida y una práctica más ética.

Public attitudes toward the use of technology to create new types of animals and animal products.

Philosophers have used thought experiments to examine contentious examples of genetic modification. We hypothesised that these examples would prove useful in provoking responses from lay participants concerning technological interventions used to address welfare concerns. We asked 747 US and Canadian citizens to respond to two scenarios based on these thought experiments: genetically modifying chickens to produce blind progeny that are less likely to engage in feather-pecking (BC); and genetically modifying animals to create progeny that do not experience any subjective state (i.e. incapable of experiencing pain or fear; IA). For contrast, we assessed a third scenario that also resulted in the production of animal protein with no risk of suffering but did not involve genetically modifying animals: the development of cultured meat (CM). Participants indicated on a seven-point scale how acceptable they considered the technology (1 = very wrong to do; 7 = very right to do), and provided a text-based, open-ended explanation of their response. The creation of cultured meat was judged more acceptable than the creation of blind chickens and insentient animals. Qualitative responses indicated that some participants accepted the constraints imposed by the thought experiment, for example, by accepting perceived harms of the technology to achieve perceived benefits in reducing animal suffering. Others expressed discomfort with such trade-offs, advocating for other approaches to reducing harm. We conclude that people vary in their acceptance of interventions within existing systems, with some calling for transformational change.

Consensus and controversy in the discipline of invasion science.

Approaches, values, and perceptions in invasion science are highly dynamic, and like in other disciplines, views among different people can diverge. This has led to debate in the field specifically surrounding the core themes of values, management, impacts, and terminology. Considering these debates, we surveyed 698 scientists and practitioners globally to assess levels of polarization (opposing views) on core and contentious topics. The survey was distributed online (via Google Forms) and promoted through listservs and social media. Although there were generally high levels of consensus among respondents, there was some polarization (scores of ≥0.39 [top quartile]). Relating to values, there was high polarization regarding claims of invasive species denialism, whether invasive species contribute to biodiversity, and how biodiversity reporting should be conducted. With regard to management, there were polarized views on banning the commercial use of beneficial invasive species, the extent to which stakeholders' perceptions should influence management, whether invasive species use alone is an appropriate control strategy, and whether eradication of invasive plants is possible. For impacts, there was high polarization concerning whether invasive species drive or are a side effect of degradation and whether invasive species benefits are understated. For terminology, polarized views related to defining invasive species based only on spread, whether species can be labeled as invasive in their native ranges, and whether language used is too xenophobic. Factor and regression analysis revealed that views were particularly divergent between people working on different invasive taxa (plants and mammals) and in different disciplines (between biologists and social scientists), between academics and practitioners, and between world regions (between Africa and the Global North). Unlike in other studies, age and gender had a limited influence on response patterns. Better integration globally and between disciplines, taxa, and sectors (e.g., academic vs. practitioners) could help build broader understanding and consensus.

Los enfoques, valores y percepciones en el campo de las invasiones biológicas son muy dinámicos, y como en otras disciplinas científicas, los expertos pueden tener distintas opiniones. Esto ha creado debates, especialmente sobre temas relacionados con valores, gestión, impactos y terminología. Considerando estos debates, encuestamos a 698 científicos y gestores de todo el mundo para evaluar sus niveles de polarización (opiniones opuestas) sobre una serie de temas fundamentales y polémicos. La encuesta fue distribuida a través de internet (a través de Google Forms) y promovida por medio de listas de correo electrónico y redes sociales. Aunque, en general, hubo consenso entre los encuestados, hubo cierta polarización (puntuaciones de ≥ 0.39 [cuartil más alto]). En relación con valores, hubo una gran polarización sobre aquellas declaraciones relacionadas con el negacionismo de especies invasoras, si las especies invasoras contribuyen a aumentar la biodiversidad y cómo se deberían llevar a cabo los informes sobre biodiversidad. En relación con la gestión, hubo opiniones polarizadas sobre la prohibición del uso comercial de especies invasoras beneficiosas, si la opinión de las partes interesadas debería influir en la gestión, si el uso de especies invasoras por sí solo es una estrategia de control adecuada y si la erradicación de plantas invasoras es factible. En cuanto a impactos, hubo gran polarización en cuanto a sí las especies invasoras conducen a o son un efecto lateral de la degradación de ecosistemas y ssi los beneficios de las especies invasoras están subestimados. En cuanto a terminología, encontramos opiniones polarizadas relacionadas con definir especies invasoras exclusivamente en base a su expansión, si las especies se pueden considerar invasoras en sus rangos de distribución nativos y si el lenguaje utilizado en el campo de las invasiones biológicas es xenofóbico. Los análisis factoriales y de regresión revelaron que las opiniones de los expertos encuestados fueron particularmente divergentes entre personas que trabajan con diferentes taxones (plantas y mamíferos) en diferentes disciplinas (entre biólogos y sociólogos), entre científicos y gestores y entre regiones del mundo (entre países de África y del hemisferio Norte). A diferencia de otros estudios, la edad y el género tuvieron una influencia limitada sobre lass respuestas obtenidas. Una mejor integración global y entre disciplinas, taxones y sectores (o. e., investigadores vs. gestores) podría contribuir a alcanzar un mayor entendimiento y consenso.

A critical review of the compassionate conservation debate.

Compassionate conservation holds that compassion should transform conservation. It has prompted heated debate and has been criticized strongly. We reviewed the debate to characterize compassionate conservation and to philosophically analyze critiques that are recurring and that warrant further critical attention. The necessary elements of compassionate conservation relate to the moral value of sentient animals and conservation and to science and conservation practice. Although compassionate conservation has several nontraditional necessary conditions, it also importantly allows a degree of pluralism in values and scientific judgment regarding animals and conservation practice. We identified 52 specific criticisms from 11 articles that directly critique compassionate conservation. We closely examined 33 of these because they recurred regularly or included substantial questions that required further response. Critics criticized compassionate conservation's ethical foundations, scientific credentials, clarity of application, understanding of compassion, its alleged threat to conservation and biodiversity. Some criticisms, we found, are question begging, confused, or overlook conceptual complexity. These criticisms raise questions for critics and proponents, regarding, for example, equal versus differential intrinsic moral value of different sentient animals (including humans), problems of natural and human-caused suffering of wild animals and predation, and the acceptability of specific conservation practices within compassionate conservation. By addressing recurring and faulty critiques of compassionate conservation and identifying issues for compassionate conservation to address, this review provides a clearer basis for crucial ongoing interdisciplinary dialogue about ethics, values, and conservation.

Una Revisión Crítica del Debate sobre la Conservación Compasiva Resumen La conservación compasiva sostiene que la compasión debería transformar la conservación. Esta idea ha impulsado un debate acalorado y ha sido criticada fuertemente. Revisamos el debate para caracterizar la conservación compasiva y para analizar filosóficamente las críticas recurrentes y que ameritan una mayor atención crítica. Los elementos necesarios de la conservación compasiva están relacionados con el valor moral de los animales sensibles y de la conservación y con la ciencia y la práctica de la conservación. Aunque la conservación compasiva tiene varias condiciones no tradicionales necesarias, también permite de manera muy importante un cierto grado de pluralismo en los valores y el juicio científico con respecto a los animales y a la práctica de la conservación. Identificamos 52 críticas específicas en once artículos que criticaban directamente a la conservación compasiva. Analizamos minuciosamente 33 de estas críticas porque aparecieron regularmente o porque incluían preguntas sustanciales que requerían de una respuesta más profunda. Las críticas se centraban en las razones éticas de la conservación compasiva, sus credenciales científicas, la claridad de su aplicación, el entendimiento del concepto compasión y su presunta amenaza para la conservación y la biodiversidad. Notamos que algunas críticas dejan preguntas pendientes, son confusas o ignoran la complejidad conceptual. Estas críticas generan preguntas para los críticos y para los partidarios de la conservación compasiva con respecto al valor moral intrínseco igual o diferencial de distintos animales sensibles (incluyendo a los humanos), problemas relacionados con el sufrimiento natural y causado por humanos y con la depredación que sufren los animales silvestres y la aceptabilidad de prácticas específicas de conservación dentro de la conservación compasiva. Con la identificación de las críticas recurrentes y fallidas que se le hacen a la conservación compasiva y los temas que ésta debe abordar, esta revisión proporciona una base más clara para el importante diálogo interdisciplinario que existe sobre la ética, los valores y la conservación.

Environmental sustainability and the carbon emissions of pharmaceuticals.

The US healthcare industry emits an estimated 479 million tonnes of carbon dioxide each year; nearly 8% of the country's total emissions. When assessed by sector, hospital care, clinical services, medical structures, and pharmaceuticals are the top emitters. For 15 years, research has been dedicated to the medical structures and equipment that contribute to carbon emissions. More recently, hospital care and clinical services have been examined. However, the carbon of pharmaceuticals is understudied. This article will focus on the carbon emissions of pharmaceuticals since they are consistently calculated to be among the top contributors to healthcare carbon and assess the factors that contribute to pharmaceutical carbon emissions. Specifically, overprescription, pharmaceutical waste, antibiotic resistance, routine prescriptions, non-adherence, drug dependency, lifestyle prescriptions, and drugs given due to a lack of preventive healthcare will be identified. Prescribing practices have environmental ramifications. Carbon reduction, when focused on pharmaceuticals, can lead to cleaner, more sustainable healthcare.

Ecocentrism and Biosphere Life Extension.

The biosphere represents the global sum of all ecosystems. According to a prominent view in environmental ethics, ecocentrism, these ecosystems matter for their own sake, and not only because they contribute to human ends. As such, some ecocentrists are critical of the modern industrial civilization, and a few even argue that an irreversible collapse of the modern industrial civilization would be a good thing. However, taking a longer view and considering the eventual destruction of the biosphere by astronomical processes, we argue that humans, a species with considerable technological know-how and industrial capacity could intervene to extend the lifespan of Earth's biosphere, perhaps by several billion years. We argue that human civilization, despite its flaws and harmful impacts on many ecosystems, is the biosphere's best hope of avoiding premature destruction. We argue that proponents of ecocentrism, even those who wholly disregard anthropocentric values, have a strong moral reason preserve the modern industrial civilization, for as long as needed to ensure biosphere survival.

Nonhuman Value: A Survey of the Intrinsic Valuation of Natural and Artificial Nonhuman Entities.

To be intrinsically valuable means to be valuable for its own sake. Moral philosophy is often ethically anthropocentric, meaning that it locates intrinsic value within humans. This paper rejects ethical anthropocentrism and asks, in what ways might nonhumans be intrinsically valuable? The paper answers this question with a wide-ranging survey of theories of nonhuman intrinsic value. The survey includes both moral subjects and moral objects, and both natural and artificial nonhumans. Literatures from environmental ethics, philosophy of technology, philosophy of art, moral psychology, and related fields are reviewed, and gaps in these literatures are identified. Although the gaps are significant and much work remains to be done, the survey nonetheless demonstrates that those who reject ethical anthropocentrism have considerable resources available to develop their moral views. Given the many very high-stakes issues involving both natural and artificial nonhumans, and the sensitivity of these issues to how nonhumans are intrinsically valued, this is a vital project to pursue.

Ethical failings: The problematic history of cancer risk assessment.

This paper demonstrates that unethical conduct by the US National Academy of Sciences (NAS) Biological Effects of Atomic Radiation (BEAR) I Genetics Panel led to their recommendation of the Linear Non-Threshold (LNT) Model for radiation risk assessment and its subsequent adoption by the US and the world community. The analysis, which is based largely on preserved communications of the US NAS Genetics Panel members, reveals that Panel members and their administrative leadership at the NAS displayed an integrated series of unethical actions designed to ensure, (1) the acceptance of the LNT and (2) funding to radiation geneticist panel members and professional colleagues. These findings are significant because major public policies in open democracies, such as cancer risk assessment and other issues impacted by public fears of radiation or chemical exposures, require ethical foundations. Recognition of these ethical failures of the BEAR I Genetics Panel should require a high level administrative, legislative and scientific reassessment of the scientific foundations of cancer risk assessment, with the likely result necessitating revision of current policies and practices. The BEAR I Genetics Panel, 1956 Science journal publication should immediately be retracted because it contains deliberate misrepresentations of the scientific record that were designed to manipulate scientific and public opinion on radiation risk assessment in a dishonest manner.

Research on developing environmental ethics in pharmacists' activities.

BACKGROUND: Authors of various backgrounds are preoccupied with the meaning of environmental ethics, which refers to specific values, norms, attitudes, and practices with respect to all beings and elements of nature. Many international organizations have adopted important documents proclaiming the ethical obligation to protect the environment in all professional activities. At the national level, professional associations should include and develop this obligation in their codes of conduct. This study aimed to analyze and compare elements of environmental protection included in codes of conduct for pharmacists, to find ways to integrate environmental ethics into their activities. METHODS: Seven codes of conduct for pharmacists were analyzed using the comparative method and methods of legal interpretation. Based on acknowledged values and principles of environmental ethics, a framework model for developing environmental protection in pharmacists' activities was created via an iterative process of reflection and discussion. RESULTS: Explicit provisions for environmental ethics were found in codes in force in three countries and in a Romanian project. These provisions refer, in general, to an ethical duty of environmental protection in pharmacists' activities. Regarding the other codes, the study could only interpret stipulations of public health ethics to deduce an ethical environmental obligation. Considering the need for developing such provisions, an ethical framework was proposed as a model for professional associations of pharmacists. CONCLUSIONS: The studied codes demonstrate a preoccupation of the professional associations with environmental protection in pharmacists' activities, with different degrees of interest in developing environmental ethics. To this end, the codes of conduct for pharmacists should include environmental values, principles, and ethics guidelines. Those guidelines should indicate the ethical attitude in relation to the environment for each activity. Further research is needed to stimulate, shape, and develop an environmental ethical behavior in pharmacists' practice.

Sustainability principle for the ethics of healthcare resource allocation.

We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose.

African Environmental Ethics: Keys to Sustainable Development Through Agroecological Villages.

This essay proposes African-based ethical solutions to profound human problems and a working African model to address those problems. The model promotes sustainability through advanced agroecological and information communication technologies. The essay's first section reviews the ethical ground of that model in the work of the Senegalese scholar, Cheikh Anta Diop. The essay's second section examines an applied African model for translating African ethical speculation into practice. Deeply immersed in European and African ethics, Godfrey Nzamujo developed the Songhaï Centers to solve the problem of rural poverty in seventeen African countries. Harnessing advanced technologies within a holistic agroecological ecosystem, Nzamujo's villages furnish education spanning the fields of ethics, information communication technology, microbiology, international development, and mechanical, electrical, civil and biological engineering in a community-based and centered development enterprise. The essay proposes a global consortium of ecovillages based on Nzamujo's model. The final section explores funding methods for the consortium. The conclusion contemplates a return to Africa to supplement environmental ethics that enhance life's future on earth.

Health justice in the Anthropocene: medical ethics and the Land Ethic.

Industrialisation, urbanisation and economic development have produced unprecedented (if unevenly distributed) improvements in human health. They have also produced unprecedented exploitation of Earth's life support systems, moving the planet into a new geological epoch, the Anthropocene-one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role-the environmental threats that will shape human health in this century represent a 'perfect moral storm' challenging the ethical theories of the last. The US conservationist Aldo Leopold saw this gathering storm more clearly than many, and in his Land Ethic describes the beginnings of a route to safe passage. Its starting point is a reinterpretation of the ethical relationship between humanity and the 'land community', the ecosystems we live within and depend upon; moving us from 'conqueror' to 'plain member and citizen' of that community. The justice of the Land Ethic questions many presuppositions implicit to discussions of the topic in biomedical ethics. By valuing the community in itself-in a way irreducible to the welfare of its members-it steps away from the individualism axiomatic in contemporary bioethics. Viewing ourselves as citizens of the land community also extends the moral horizons of healthcare from a solely human focus. Taking into account the 'stability' of the community requires intergenerational justice. The resulting vision of justice in healthcare-one that takes climate and environmental justice seriously-could offer health workers an ethic fit for the future.

One health ethics: a response to pragmatism.

Johnson and Degeling have recently enquired whether one health (OH) requires a comprehensive normative framework, concluding that such a framework, while not necessary, may be helpful. In this commentary, we provide a context for this debate, and describe how pragmatism has been predominant in the OH literature. We nevertheless argue that articulating a comprehensive normative theory to ground OH practice might clear existing vagueness and provide stronger guidance in relevant health dilemmas. A comprehensive theory will also be needed eventually to ground notions such as universal good. We, thus, call for the systematic articulation of a comprehensive, metaethical theory, concomitantly with already ongoing normative work.

Do private German health insurers invest their capital reserves of €353 billion according to environmental, social and governance criteria?

BACKGROUND: To prevent the planet from catastrophic global warming a reduction of greenhouse gas emissions to net zero is required. Thus, divestment from fossil fuels must be a strategic interest for health insurers. The aim of this study was to analyse the implementation of environmental, social and governance (ESG) criteria in German private health insurers' investments. METHODS: In 2019 a survey about ESG strategies was sent to German private health insurance companies. The survey evaluated investment strategies and thresholds for the exclusion of sectors and business practices, as well as company strategies for sustainable business development. FINDINGS: Given their business reports, German private health insurers manage assets of more than €350 billion. 11 of 40 insurance companies provided quantitative data, 10 refused to answer. According to quantitative data, €66 billion of assets is managed according to any ESG criteria; this equals an average of 76% of each company's bonds. None of these insurers excluded the production and sale of fossil fuels. All excluded coal mining but only at high thresholds. For €226 billion, no data were provided. INTERPRETATION: The findings are in contrast to the expected intrinsic economic interest of the insurers to stop global warming and improve public health. The majority of assets are managed in a highly problematic manner, especially the absence of capital allocated in fields contrary to medical ethics (eg, firearms, armour) cannot be presumed. Lack of transparency is a major problem that limits clients in choosing the insurer who has the most advanced ESG criteria.

Does clinical ethics need a Land Ethic?

A clinical ethics fit for the Anthropocene-our current geological era in which human activity is the primary determinant of environmental change-needs to incorporate environmental ethics to be fit for clinical practice. Conservationist Aldo Leopold's essay 'The Land Ethic' is probably the most widely-cited source in environmental philosophy; but Leopold's work, and environmental ethics generally, has made little impression on clinical ethics. The Land Ethic holds that "A thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise." I argue that a Land Ethic helps to re-frame problems in clinical ethics that more common philosophical approaches struggle to handle, and that it can be incorporated into clinical ethics without succumbing to "environmental fascism". I motivate viewing problems in clinical ethics from the perspective of the 'integrity of the biotic community', then illustrate how this perspective can offer guidance where more commonly-invoked theories-such as consequentialism and Kantian-inspired approaches-struggle, using antimicrobial resistance in nosocomial infection as a case study. The Land Ethic equips us to understand human values as arising within and inseparable from a social-ecological context, and by treating communities (both human and biotic) as valuable in themselves rather than just through the aggregate welfare of their individual participants, we can avoid problems with the 'repugnant conclusion' and utility monster that plague utilitarian accounts.

The Value of Darkness: A Moral Framework for Urban Nighttime Lighting.

The adverse effects of artificial nighttime lighting, known as light pollution, are emerging as an important environmental issue. To address these effects, current scientific research focuses mainly on identifying what is bad or undesirable about certain types and uses of lighting at night. This paper adopts a value-sensitive approach, focusing instead on what is good about darkness at night. In doing so, it offers a first comprehensive analysis of the environmental value of darkness at night from within applied ethics. A design for values orientation is utilized to conceptualize, define, and categorize the ways in which value is derived from darkness. Nine values are identified and categorized via their type of good, temporal outlook, and spatial characteristics. Furthermore, these nine values are translated into prima facie moral obligations that should be incorporated into future design choices, policy-making, and innovations to nighttime lighting. Thus, the value of darkness is analyzed with the practical goal of informing future decision-making about urban nighttime lighting.