Journal of Bioethical Inquiry最新文献

Recent artificial intelligence (AI) advancements have precipitated profound ethical deliberations and societal concerns. These developments redefine the parameters of technology's role in our daily lives and challenge our understanding of ethics in the context of AI-enabled processes. As AI systems become more integrated into various facets of human activity, from healthcare to finance and from social interactions to governance, the ethical implications of these technologies have become increasingly complex and pressing. In this paper, we aim to facilitate the understanding of intelligence and Artificial Intelligence and delve into the transformative impact of the AI revolution on societal norms and ethical frameworks. We spotlight the critical ethical questions and concerns that arise as AI technologies become increasingly embedded in various aspects of human life. We provide a brief overview of ethical strategies in AI development and explore how implementing these strategies can mitigate potential risks, promote responsible innovation, and ensure the alignment of AI technologies with societal values.

The impact of AI on liberal democratic social and political systems has emerged as the crucial issue of our times. So is the need to regulate general AI systems. The alliance of newly elected president Trump with the owners and CEOs of the technological sector of the U.S. economy-Elon Musk first and foremost-adds extra urgency to the issue. Digital or platform capitalism has engendered what is known as "surveillance" societies. The centralized and unchecked business model it relies on poses serious existential threats to our collective futures. There is widespread consensus today, not only in academia but also in progressive social circles, that we need both traditional and algorithmic sources of resistance to monopolies and the centralization of technological powers. We also need more experimentation with alternative ways of developing and governing the AI dimension of our lives.

In British Columbia, Canada, many physicians providing care to individuals with high-risk opioid use disorder adopted safer supply (SS) opioid prescribing in the spring of 2020 with the goal of facilitating public health measures for COVID-19. This prescribing practice continued after measures were lifted. This study aimed to explore prescribers' perspectives following several years of local experience in prescribing SS opioids, primarily in the form of hydromorphone tablets, and to apply ethical concepts to explore current challenges and ongoing sources of provider distress. Addiction medicine SS prescribers participated in individual or small group semi-structured interviews. Each interview was transcribed and analysed for recurrent themes. Themes were then integrated into a narrative ethics discussion. Eleven addiction medicine physicians practicing in various settings within Vancouver participated in this study. Six themes were identified: clinical assessment, clinician distress, gaps in care, models of safer supply, research, and special populations. Ethical dilemmas in prescribing SS are identified and explored through a discussion of biomedical ethics principles and the physician role.

This theoretical essay offers a critical exploration of the ethics involved in interacting with and talking about large language models (LLMs) of artificial intelligence (AI). The discussion is framed within philosophical post-humanist conceptualizations of the ethical agent, which is understood as a sociocognitive assemblage of human-machine interactions at various scales. The central argument asserts that the morality of texts generated by AI cannot be determined by extracting moral properties from the natural language used in the training corpus. There are inherent limits to how much analysing moral language can contribute to establishing a moral theory or a "language of mores" among humans. The essay also examines the ethical implications of current public discourse surrounding the capabilities of LLMs, as well as the ways in which LLM outputs personify the AI model itself. It is proposed that the ethics of LLMs should be approached as an ethics of translating informational patterns of linguistic symbols into multi-layered cultural meanings and vice versa. This includes addressing the opacity of the inner workings of these translations in the model, as well as the public relations practices of the creators. Ultimately, the discussion encourages rethinking the ethical agent as a human-machine sociocognitive hybrid, suggesting the need for a reassessment of what it means to be human and ethical in current AI ethics debates.

As a field, ethics is driven by the desire to help guide human life and human activities. Yet, what are the standards or guideposts indicating that a given policy or practice change actually contributes meaningfully to such desires and aspirations? In other words, how do we know if we have achieved meaningful ethical outcomes and enactment processes? Unfortunately, there are many examples of ethically oriented actions that were well intentioned but carried out in a way that undermined some of the values they intended on promoting or led to unexpected undesirable outcomes. In this paper, building on an account of ethics as a pragmatist pursuit of deliberative wisdom, I identify and discuss four procedural guideposts which can help evaluate if a process of inquiry is an ethical one oriented toward human flourishing. First, situational awareness and continuity designates the need to keep in sight the nature of the situation at stake to ensure that the enactment process does not derail from a cardinal human flourishing orientation. Second, a meaningful ethical enactment should distribute opportunities for participation such that it is not only one's autonomy (e.g., the ethicist) that is developed and exercised but that positive relationships are also fostered through the growth of others. Third, enactments must strive for more than simple avoidance of encroachment of wrongs but aim for the promotion of praiseworthy practices that pursue what is envisioned as being the better and most compelling vision. Fourth, an ethics process should be conducive of personal growth and mutual learning.

A lot of the language we use to refer to AI, including in healthcare, uses terminology that originally and literally applies to humans and human relationships. Such terminology includes both non-evaluative terms, like "learning," "memory," or "intelligence," and evaluative terms, like "trust" or "responsibility." In this article I focus on the latter type and the way it is applied specifically to the case of medical AI. Focusing on the discussion of "responsibility gaps" that, according to some, AI generates, I will suggest that such terminology is revealing of the nature of healthcare professional obligations and responsibility prior to and independently of the assessment of the use of AI tools in healthcare. The point I make is generalizable to AI as used and discussed more broadly: the language used to refer to AI often tells more about humans and human relationships than about AI itself and our relationship with it. In healthcare, whatever else AI will allow us to do, it can prompt us to reflect more thoroughly on professional responsibility and professional obligations.

There has been much discussion about the tactics used by the Israeli Defence Forces (IDF) and government in the conflict in Gaza following October 7, 2023, which have caused, among other things, systematic destruction of hospitals and schools, the deaths of large numbers of civilians, including women and children, mass starvation, and denial of humanitarian aid. The Israeli government and IDF have sought to justify their actions using ethical arguments, many of which relate to their proclaimed role as the representatives of the Jewish state and of Jewish culture and history. Arguing from the extensive corpus of Jewish ethical thought, extending back thousands of years, this article poses a simple question: Are the above actions by the Israeli government and IDF in Gaza consistent with the ethical tradition of Judaism and the obligations that flow from it? To answer this question, key texts are analysed, especially the Hebrew Bible and the Talmud, and multiple arguments are examined, taking into account the complexities of context and diverse interpretive theories. The paper is presented in two parts, the first discussing the question and methodological issues and the second providing the data and conclusions. We conclude that the alleged acts of the Israeli government and IDF in Gaza are clearly and directly contrary to the Judaic tradition of ethics as it has developed over the millennia. The conduct of the war cannot truthfully be presented in any meaningful sense as representing, or indeed, consistent with, Jewish culture or ethics. These findings have potentially far-reaching consequences, including for the claimed status of Israel as a Jewish state, the relationship between criticism of the government of Israel and the scourge of antisemitism, and the identity of Jewish people both within and outside Israel.

Objective: Approved medicines are not always sufficient to address the needs of patients so several legal pathways exist to enable access to unapproved medicines for treatment purposes. This article is the first to provide an in-depth analysis of this regulatory framework that governs access to unapproved medicines in Australia with a specific focus on affordability-motivated access.

Methods: Legislation, regulations, and guidelines were critically analysed to identify the de jure basis for importation and supply of unapproved medicines in Australia.

Results: Most pathways for accessing unapproved medicines do not permit importation or supply for non-clinical justifications such as affordability. This is problematic as it fails to recognize that a medicine being unavailable is equivalent to a medicine being unaffordable for a patient. Better alignment can be achieved by permitting importation and supply of unapproved medicines if justified by good medical practice, which includes considerations of equity and access. It is also shown that the provisions of the Special Access Scheme Category A could be interpreted broadly to expand its use.

Conclusions: As medicines become more expensive and cost-barriers to treatment are more prevalent, ignoring affordability as a valid criterion for importing medicines is a significant oversight of current regulation.

Suffering is an elusive aspect of healthcare, erroneously assumed to be located solely within the patient in the clinical encounter-an assumption that fails to acknowledge the pervasiveness of suffering endured by the physician. This flawed perception is morally problematic in the context of treating contested invisible disabilities (CIDs), which are often associated with medical ambiguity and uncertainty. In this paper, we argue for a relational reconceptualization of suffering in the context of CID to promote more effective care and improved physician-patient relationships. We propose, through the lens of an ethics of care, that a relational ontology of suffering makes salient certain aspects of patient-physician relationships that co-produce suffering, such as professional incompetence, empathetic distress, and epistemic and hermeneutic injustice, rendering the experience of having and treating a CID more visible. We then discuss the important implications of this understanding for this invisibly disabled identity and the therapeutic alliance between physician and patient and explore the potential of narrative-based medicine to better equip physicians with the knowledge, guidance, and skill to fulfil their ethical responsibility to care for and respond to not only the suffering of this population, but their own suffering as well.