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Much legal and ethical attention in the area of eHealth focuses on the risks of health data processing ‘going wrong’ – a breach of privacy occurs, data is misused in an unauthorised way, or the analysis of data gives a faulty result. However, significant challenges are also posed by such processing where the data processing ‘goes to plan’ – the analysis gives the correct result in the way intended. Such challenges stem both from the nature of the information generated, and the new contexts in which this occurs. Thus, Big Data analysis may produce ever more information in relation to a person’s future health, usually of a probabilistic nature. In what situations should such information be returned to the subject (bearing in mind also that the decision-maker increasingly will be an entity outside the traditional health care context)? This chapter considers key ethical considerations that arise in such cases, and how well the law – through liability rules for harm, caused by failure to disclose, or by unjustified disclosure – is equipped to respond.
This chapter explore human factors, also known as ergonomics, which is an established scientific discipline that has become integral in healthcare in recent years. The catalyst for this in the UK was the Clinical Human Factors Group led by Martin Bromiley. Martin’s wife Elaine died following errors made during a routine operation when the theatre team failed to respond appropriately to an unanticipated anaesthetic emergency in part because of a variety of human factors. There is still confusion around the term ‘human factors’. This is partly because human factors cannot be explored in isolation but need to be understood in the context of human activity, error, and the culture around error.
Attention on harmful effects of psychological interventions for adult post-traumatic stress disorder (PTSD) has increased, yet a comprehensive meta-analysis is lacking.
To summarise incidences and relative risks of deterioration, adverse events (AEs) and serious adverse events (SAEs) in trials of psychological interventions for adult PTSD.
We searched MEDLINE, PsycInfo, Web of Science and PTSDpubs from inception to 21 April 2022 for sufficiently large (n ≥ 20) randomised controlled trials (RCTs) reporting on the incidence of harms.
We included 56 RCTs (4230 patients). Incidences of harms were generally low (0–5%). Psychological interventions were associated with decreased risk of deterioration relative to passive (RR = 0.21, 95% CI 0.15–0.28) and active control conditions (RR = 0.36, 95% CI 0.14–0.92). Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive–behavioural therapy (TF-CBT) was associated with decreased risk of SAEs (RR = 0.54, 95% CI 0.31–0.95) and with no differential risk of deterioration and AEs.
The current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format. However, more data are needed to draw firmer conclusions. We encourage research teams to routinely and thoroughly assess and report the incidence of harms and their causes.
Nearly everyone considers death to be a terrible harm and mortality a very sad feature of human existence. Consistent with this attitude, most people seem to believe that getting older (at least once we have grown up) is regrettable insofar as it brings us closer to death. Is it sensible to fear death and the ageing process that brings us closer to it? After rejecting one philosophical strategy for stoicism about death, I will contend that it is most reasonable not to fear death and ageing if we reach, or are likely to reach, the age of life expectancy with a decent quality of life. My first argument for this thesis appeals to what we can reasonably expect out of human life. My second argument appeals to the wisdom of overcoming what I will call our tendency towards “cosmic narcissism.”
If the arguments of the preceding chapters are to be practically useful, it is necessary to move beyond claims about ‘personal bioinformation’ as a broad category, to locate how and why different bioinformation encounters may impact our identities in a variety of ways. It is also necessary to unpack further what attending to identity interests adds to the ethical and regulatory landscape. The chapter addresses each of these aims. It starts by reviewing the nature and strength of our identity-related interests – both in accessing personal bioinformation that supports the development and maintenance of inhabitable embodied self-narratives and in doing so in waysthat support this inhabitability. The discussion then explores the factors affecting when and why different information encounters engage or serve this fundamental interest. This entails examining why some kinds of bioinformation are experienced as having particular identity-significance at all and the factors shaping whether it then supports or undermines the inhabitability of our self-narratives. The chapter concludes by demonstrating that our narrative identity interests are neither coextensive nor reducible to the kinds of ethical concerns that currently dominate bioethical debates and information disclosure policies and the need to attend to identity impacts in their own right.
This Element examines the main ethical aspects of consciousness It argues that consciousness is not intrinsically valuable but has value or disvalue for individuals depending on its phenomenology (what it is like to be aware) and content (what one is aware of). These two components of awareness shape normative judgments about how ordered, disordered, altered, restored, diminished and suppressed conscious states can benefit or harm individuals. They also influence moral judgments about whether intentionally causing these states is permissible or impermissible and how these states can affect behavior. After describing its neurobiological basis, this Element discusses ethical and legal issues in six categories of consciousness: phenomenal and access consciousness; intraoperative awareness; prolonged disorders of consciousness, dissociative disorders, the role of consciousness in determining death; and altering and suppressing awareness near the end of life.
Discussions of the nonidentity problem presuppose a widely shared intuition that actions or policies that change who comes into existence do not, thereby, become morally unproblematic. We hypothesize that this intuition is not generally shared by the public, which could have widespread implications concerning how to generate support for large-scale, identity-affecting policies relating to matters like climate change. To test this, we ran a version of the well-known dictator game designed to mimic the public's behavior over identity-affecting choices. We found the public does seem to behave more selfishly when making identity-affecting choices, which should be concerning. We further hypothesized that one possible mechanism is the notion of harm the public uses in their decision making and find that substantial portions of the population seem to each employ distinct notions of harm in their normative thinking. These findings raise puzzling features about the public's normative thinking that call out for further empirical examination.
Proponents of nonviolent tactics often highlight the extent to which they rival arms as effective means of resistance. Erica Chenoweth and Maria Stephan, for instance, compare civil resistance favorably to armed insurrection as means of bringing about progressive political change. In Ethics, Security, and the War-Machine, Ned Dobos cites their work in support of the claim that similar methods—organized according to Gene Sharp's idea of “civilian-based defense”—may be substituted for regular armed forces in the face of international aggression. I deconstruct this line of pacifist thought by arguing that it builds on the wrong binary. Turning away from a violence-nonviolence dichotomy structured around harmfulness, I look to Richard B. Gregg and Hannah Arendt for an account of nonviolent power defined by non-coercion. Whereas nonviolent coercion in the wrong hands still has the potential to subvert democratic institutions—just as armed methods can—Gregg's and Arendt's conceptions of nonviolent power identify a necessary bulwark against both forms of subversion. The dangers of nonviolent coercion can be seen in the largely nonviolent attempts at civil subversion by supporters of Donald Trump during Trump's attempts to overturn the results of the U.S. presidential election in 2020, while the effectiveness of noncoercive, nonviolent power is illustrated by the resistance of U.S. democratic institutions to resist them.
The principle of nonmaleficence states a prohibition on causing harm to others in the absence of justifying circumstances. After surveying some prominent accounts of the nature of harm, we defend a counterfactual account: you harm someone if and only if you make them worse off than they would have been in the absence of your intervention. Using this account we specify nonmaleficence into several general moral rules corresponding to ways in which individuals can be harmed. These foundational reflections are followed by discussions of three areas of ethical concern in which rules concerning harm are prominent: (1) the ethics of torture, including health professionals’ involvement in torture; (2) the limits of permissible risk in pediatric research; and (3) the ethics of medical assistance-in-dying. We argue for a prohibition of torture, a specific risk ceiling for pediatric research, and a liberal approach, with various safeguards, to medical assistance-in-dying.
This volume offers a carefully argued, compelling theory of bioethics while eliciting practical implications for a wide array of issues including medical assistance-in-dying, the right to health care, abortion, animal research, and the definition of death. The authors' dual-value theory features mid-level principles, a distinctive model of moral status, a subjective account of well-being, and a cosmopolitan view of global justice. In addition to ethical theory, the book investigates the nature of harm and autonomous action, personal identity theory, and the 'non-identity problem' associated with many procreative decisions. Readers new to particular topics will benefit from helpful introductions, specialists will appreciate in-depth theoretical explorations and a novel take on various practical issues, and all readers will benefit from the book's original synoptic vision of bioethics. This title is also available as Open Access on Cambridge Core.
In this chapter, we consider how youth make sense of their own retaliatory goals and actions in the aftermath of being harmed, and we elaborate on the implications of their meaning-making for processes of moral development and behavior. We begin by describing how youths’ experiences of revenge are distinct from other forms of harmdoing, and how these unique features of revenge may inform the meanings that they construct from their retaliatory desires and actions. Next, we describe age-related changes in these constructive processes, and discuss how youths’ histories of interactions in their social milieu may undergird their constructions of meaning about revenge. We conclude by articulating implications of our analyses for intervening with children and adolescents surrounding issues of revenge.
There is increasing interest in potential harmful effects of mindfulness-based interventions. In relation to psychosis, inconsistency and shortcomings in how harm is monitored and reported are holding back our understanding. We offer eight recommendations to help build a firmer evidence base on potential harm in mindfulness for psychosis.
Failure in health research regulation is nothing new. Indeed, the regulation of clinical trials was developed in response to the Thalidomide scandal, which occurred some 50 years ago. Yet, health research regulation is at the centre of recent failures. In this chapter, I use health research regulation for medical devices to look at the regulatory framing of harm through the language of technological risk, i.e. relating to safety. My overall argument is that reliance on this narrow discourse of technological risk in the regulatory framing of harm may marginalise stakeholder knowledges of harm to produce a limited knowledge base. The latter may underlie harm, and in turn lead to the construction of failure.
Recent work by Ingmar Persson and Jason Hanna has posed an interesting new challenge for deontologists: How can they account for so-called cases of letting oneself do harm? In this article, I argue that cases of letting oneself do harm are structurally similar to real-world cases such as climate change, and that deontologists need an account of the moral status of these cases to provide moral guidance in real-world cases. I then explore different ways in which deontologists can solve this challenge and argue that the most promising way to conceive of cases of letting oneself do harm is as nonstandard cases of allowing harm, supplemented with an additional argument for the moral relevance of one's own agency. The upshot is that cases of letting oneself do harm are both more theoretically challenging and practically important than has been acknowledged.
Early in the history of liberalism, its most important proponents were concerned with freedom of religion. As polities and individuals now accept a dizzying array of religions, this has receded to the background for most theorists. It nonetheless remains a concern. Freedom of speech is a similar concern and very much in the foreground for theorists looking at the current state of academia. In this essay, I argue that inappropriate limits to freedom of religion and inappropriate limits to freedom of speech—especially in the form of de-platforming on college campuses—both have, as one of their effects, what I call harms of silence. This means we ought not have those limits, so should seek to change them where they exist.
The single most important of the conditions for the availability of the exception is that the quotation be ‘compatible with fair practice’. As noted in Chapter 2, it was the introduction of the concept of fair practice that enabled the parties to agree on a quotation exception. Previous attempts to reach an international consensus, which had sought to limit quotation by reference to type of work, extent of taking or purpose had failed to provide a sufficiently flexible criterion. The concept of ‘fair practice’ (or ‘bons usages’) proved the magic solution.
The discussion of democratic journalism focused on what I called the pro-active norms of journalism – norms that call on journalists to promote certain ideals and social goals.
However, I also said that media ethics contains “restraining” norms that call on journalists to act responsibly when they use their freedom to publish. The power of news media can be abused. Abuse leads to misinformation, erroneous judgments, and harmful consequences for individuals, groups, and countries. Therefore, we can ask: What are the main restraining principles of democratically engaged journalism? One set of principles has to do with avoiding or minimizing media harm, that is, the harm that is caused by publication.
Mindfulness-based therapies are increasingly available for a range of mental disorders, such as depression and anxiety. However, there remain concerns that mindfulness has the potential to exacerbate psychosis, despite a growing body of literature demonstrating effectiveness. These concerns may relate to long-standing perceptions about the suitability of offering psychological therapies to people with psychosis.
Many U.S. states have proposed policies that restrict bathroom access to an individual’s birth sex. These policies have had widespread effects on safety for transgender and gender-nonconforming people, as well as on state economies. In this registered report, we assessed the role of disgust in support for policies that restrict transgender bathroom access. We found that sensitivity to pathogen disgust was positively associated with support for bathroom restrictions; sexual and injury disgust were unrelated. We also examined the role of disgust-driven moral concerns, known as purity concerns, as well as harm-related moral concerns in support for bathroom restrictions. While concerns about harm to cisgender and transgender people predicted support for bathroom restrictions, purity was a much stronger predictor. Also, purity partially mediated the link between pathogen disgust and support for bathroom restrictions, even after accounting for harm concerns. Findings and implications are discussed.
High-profile controversies have created an impression that expressive freedom is imperilled on university campuses in North America. Analyses of this alleged campus crisis typically focus either on the negative psychosocial characteristics of those who oppose potentially harmful expression or on the cynical ways that expressive freedom can be invoked to normalize harmful expression. Conversely, I argue that theories of harm are key to understanding the contemporary discourse and politics of expressive freedom on campus. To shift the frame of analysis, I critically analyze three interrelated theoretical concepts that feature elastic conceptualizations of harm and are consequential for expressive limits in an academic environment: epistemic injustice, argumentational injustice and epistemic exploitation. I argue that all three concepts require a distinction between testimony and argumentation in order to better balance protection from harm, on the one hand, and expressive freedom and open inquiry, on the other.