Bioethics最新文献

There is mounting global interest in the revolutionary potential of AI tools. However, its use in healthcare carries certain risks. Some argue that opaque (‘black box’) AI systems in particular undermine patients' informed consent. While interpretable models offer an alternative, this approach may be impossible with generative AI and large language models (LLMs). Thus, we propose that AI tools should be evaluated for clinical use based on their implementation risk, rather than interpretability. We introduce a practical decision algorithm for the clinical implementation of black-box AI by evaluating its risk of implementation. Applied to the case of an LLM for surgical informed consent, we assess a system's implementation risk by evaluating: (1) technical robustness, (2) implementation feasibility and (3) analysis of harms and benefits. Accordingly, the system is categorised as minimal-risk (standard use), moderate-risk (innovative use) or high-risk (experimental use). Recommendations for implementation are proportional to risk, requiring more oversight for higher-risk categories. The algorithm also considers the system's cost-effectiveness and patients' informed consent.

This study examines the violence inflicted upon Palestinians in Israeli prisons during the initial phase of the "Iron Swords" war, which commenced following a Hamas attack on Israeli civilians on October 7, 2023. It investigates how wartime circumstances can intensify the use of torture and ill-treatment within prisons, with a particular focus on the impact on detainees who were not implicated in activities connected to the attack. Utilizing the case files of Palestinian security prisoners who lodged complaints of mistreatment with Israeli NGOs, the study uses descriptive analysis to categorize and quantify diverse forms of reported violence that could potentially constitute torture. The study's findings reveal a concerning pattern: all 19 subjects reported experiencing violence from prison staff, with 18 of these cases involving physical violence. Multiple claims referenced more than one instance of violence, and eleven claims additionally reported violence against other detainees. The claims of violence spanned seven different prisons, underscoring the systemic nature of the issue. Reported methods of violence encompassed beatings, forced positioning in painful postures, threats, and humiliation, sometimes with sexual undertones, among other forms of abuse. Seven subjects had visible bruises and wounds, two suffered broken limbs, and one sustained a fractured tooth. These findings suggest a correlation between war, a decline in ethical standards, and the abuse of prisoners. By bringing these issues to light, the study advocates for evaluating prison practices and a commitment to upholding human rights standards, even during violent conflict and war.

This paper argues that philosophical practice can complement existing medical ethics structures by offering a publicly accessible space for discourse and negotiation of basic concepts that are relevant to ethical decision making. The potential of collaboration becomes particularly evident by the example of assisted dying: it raises a wide range of philosophical questions which, however, tend to remain unarticulated where there is urgency for action and focus on ethical dilemma. In this paper, we first provide an analysis of the neglect of profound questions in ethics consultation and why these need to be considered and negotiated within a broader socio-philosophical framework and place. These reflections are grounded in conceptual approaches informed by Immanuel Kant, Charles Taylor, and the tradition of Hellenistic philosophy as interpreted by Pierre Hadot. These frameworks are not presented as final answers, but as productive starting points and historically significant philosophical thought figures for engaging with the complex philosophical dimensions of assisted suicide. Then, we draw upon insights from an ongoing research project on philosophical practice in palliative care and hospice work. Interim results indicate that people experience a need for a kind of dialogue that gives such philosophical considerations a space and a person who is capable of facilitating it. Synthesizing theoretical-philosophical and empirical insights, the paper provides an outlook for fruitful collaboration amongst medical ethics structures and philosophical practice.

The principle of (respect for) patient autonomy has traditionally emphasized independence in medical decision-making, reflecting a broader commitment to epistemic individualism. However, recent philosophical work has challenged this view, suggesting that autonomous decisions are inherently dependent on epistemic and social supports. Wilkinson and Levy's “scaffolded model” of autonomy demonstrates how our everyday decisions rely on distributed cognition and various forms of epistemic scaffolding—from consulting others to using technological aids like maps or calculators. This paper explores how Large Language Models (LLMs) could operationalize scaffolded autonomy in medical informed consent. We argue that rather than undermining patient autonomy, appropriately designed LLM systems could enhance it by providing flexible, personalized support for information processing and value clarification. Drawing on examples from clinical practice, we examine how LLMs might serve as cognitive scaffolds in three key areas: enhancing information accessibility and comprehension, supporting value clarification, and facilitating culturally appropriate decision-making processes. However, implementing LLMs in consent procedures raises important challenges regarding epistemic responsibility, authenticity of choice, and the maintenance of appropriate human oversight. We analyze these challenges through the lens of scaffolded autonomy, arguing that successful implementation requires moving beyond simple questions of information provision to consider how technological systems can support genuinely autonomous decision-making. The paper concludes by proposing practical guidelines for LLM implementation while highlighting broader philosophical questions about the nature of autonomous choice in technologically mediated environments.

The question whether or not patients ought to be involved in clinical ethics interventions (CEI) remains unresolved. While generally it has been recognized that patients’ active participation in health care decisions and processes is important, this is not unequivocally accepted for CEIs. Patient participation in CEI (PP) is common in the United States, but PP seems far from the prevailing practice in Europe. In Europe, CEIs often involve discussions of the ethics issue by the healthcare team only; the patient or proxy is not included, consulted or even informed about such an intervention. In this paper, we submit that policies or standards which resist PP and disable it as an option conflict with procedural and epistemic justice requirements in CEIs. We conceptually develop how the two concepts of procedural justice (PJ) and epistemic justice (EJ) relate to CEIs and to PP. We also engage with four cases to illustrate the risks of injustices and how PP facilitates CEIs to meet justice requirements. We conclude that in settings where CEIs systematically do not involve PP, and where patients are neither asked about the ethics issue nor informed about the intervention, policy and practice presumptions should be adjusted.

Drawing upon a deprivationist account of the badness of death, Ingemar Patrick Linden advocates for a hypothetical state called "contingent immortality." The future Linden champions is one in which every person would be able to live for as long as they would like, save for events like accidents or murder. We recognize Linden's foundational claims in defense of contingent immortality as weighty and reasonable, but consider whether there are defensible reasons to forgo the inhibition of aging and living well past a natural human lifespan. Drawing partly upon the work of Carter Snead and Alasdair MacIntyre, we outline the nature of self-giving love, how love provides for many persons a measure of meaning and purpose in life, and the ways in which given and self-imposed limitations can help imbue our actions as embodied beings with a particular and richer sense of that meaning and purpose. We conclude that love provides defensible grounds as to why one might reasonably choose to accept our shared human identity as creatures with naturally bounded lifespans. This conclusion takes into account both the benefits and costs of love, especially in light of our existence as embodied beings.

In this paper, we examine the potential effects of relationships with Large Language Model (LLM)-based digital doppelgängers (DDs) on users' values, concerns, and interests, that is, on their practical identity. DDs are artificially intelligent conversational agents trained on individuals' data to replicate their speech patterns, mannerisms, and personality traits. We start by showing that practical identity is largely defined by the relationships we find ourselves in or cultivate. Next, we discuss how DDs work and distinguish between task-specific and relational DDs, arguing that the latter are specifically created to take on the role of relational partners by imitating other people we care about. We then consider how relationships with DDs might shape individuals' practical identities, before concluding with some general thoughts regarding what we should be paying attention to before developing and deploying DDs.