A blog from the Centre for Research Ethics & Bioethics (CRB)

Tag: communication

Resolving conflicts where they arise

I believe that many of us feel that the climate of human conversation is getting colder, that it is becoming harder for us to talk and get along with each other. Humanity feels colder than in a long time. At the same time, the global challenges are escalating. The meteorological signs speak for a warmer planet, while people speak a colder language. It should be the other way around. To cool the planet down, humanity should first get warmer.

How can humanity get warmer? How can we deal with the conflicts that make our human climate resemble a cold war on several fronts: between nations, between rich and poor, between women and men, and so on?

Observe what happens within ourselves when the question is asked and demands its answer. We immediately turn our attention to the world and to the actions we think could solve the problem there. A world government? Globally binding legislation? A common human language in a worldwide classless society that does not distinguish between woman and man, between skin colors, between friend and stranger?

Notice again what happens within ourselves when we analyze the question, either in this universalist way or in some other way. We create new conflicts between ourselves as analysts and the world where the problems are assumed to arise. The question itself is a conflict. It incriminates a world that must necessarily change. This creates new areas of conflict between people who argue for conflicting analyses and measures. One peace movement will fight another peace movement, and those who do not take the necessary stand on these enormous issues… well, how should we handle them?

Observe for the third time what happens within ourselves when we have now twice in a row directed our attention towards ourselves. First, we noted our inner tendency to react outwardly. Then we noted how this extroverted tendency created new conflicts not only between ourselves and an incriminated world that must change, but also between ourselves and other people with other analyses of an incriminated world that must change. What do we see, then, when we observe ourselves for the third time?

We see how we look for the source of all conflict everywhere but within ourselves. Even when we incriminate ourselves, we speak as if we were someone other than the one analyzing the problem and demanding action (“I should learn to shut up”). Do you see the extroverted pattern within you? It is like a mental elbow that pushes away a problematic world. Do you see how the conflicts arise within ourselves, through this constant outward reactivity? We think we take responsibility for the world around us, but we are only projecting our mental reflexes.

There was once a philosopher named Socrates. He was likened to an electric ray as he seemed to numb those he was talking to with his unexpected questions, so that they could no longer react with worldly analyses and sharp-witted arguments. He was careful to point out that he himself was equally numbed. He saw the extroverted tendency within himself. Every time he saw it, he became silent and motionless. Sometimes he could stand for hours on a street corner. He saw the source of all conflict in the human mind that always thinks it knows, that always thinks it has the analysis and all the arguments. He called this inner numbness his wisdom and he described it like this: “what I do not know, I do not think I know either.”

Naturally, a philosopher thus numbed could not harbor any conflict, because the moment it began to take shape, he would note the tendency within himself and be numbed. He mastered the art of resolving conflicts where they arise: within ourselves. Free from the will to change an incriminated world, he would thereby have revolutionized everything.

Socrates’ wisdom may seem too simple for the complex problems of our time. But given our three observations of how all conflict arises in the human mind, you see how we ourselves are the origin of all complexity. This simple wisdom can warm a humanity that has forgotten to examine itself.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

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We care about communication

Dynamic consent: broad and specific at the same time

The challenge of finding an appropriate way to handle informed consent to biobank research is big and has often been discussed here on the Ethics Blog. Personal data and biological samples are collected and saved for a long time to be used in future research, for example, on how genes and the environment interact in various diseases. The informed consent to research is for natural reasons broad, because when collecting data and samples it is not yet possible to specify which future research studies the material will be used in.

An unusually clear and concise article on biobank research presents a committed approach to the possible ethical challenges regarding broad consent. The initial broad consent to research is combined with clearly specified strong governance and oversight mechanisms. The approach is characterized also by continuous communication with the research participants, through which they receive updated information that could not be given at the time of the original consent. This enables participants to stay specifically informed and make autonomous choices about their research participation through time.

The model is called dynamic consent. This form of consent can be viewed as broad and specific at the same time. The article describes experiences from a long-term biobank study in South Tyrol in Italy, the CHRIS study, where dynamic consent is implemented since 2011. The model is now used to initiate the first follow-up phase, where participants are contacted for further sampling and data collection in new studies.

The article on dynamic consent in the CHRIS study is written by Roberta Biasiotto, Peter P. Pramstaller and Deborah Mascalzoni. In addition to describing their experiences of dynamic consent, they also respond to common objections to the model, for example, that participants would be burdened by constant requests for consent or that participants would have an unreasonable influence over research.

I would like to emphasize once again the clarity of the article, which shows great integrity and courage. The authors do not hide behind a facade of technical terminology and jargon, so that one must belong to a certain academic discipline to understand. They write broadly and specifically at the same time, I am inclined to say! This inspires confidence and indicates how sincerely one has approached the ethical challenges of involving and communicating with research participants in the CHRIS study.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Biasiotto, Roberta; Pramstaller, Peter P.; Mascalzoni, Deborah. 2021. The dynamic consent of the Cooperative Health Research in South Tyrol (CHRIS) study: broad aim within specific oversight and communication. Part of BIOLAW JOURNAL-RIVISTA DI BIODIRITTO, pp. 277-287. http://dx.doi.org/10.15168/2284-4503-786

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We care about communication

People care about antibiotic resistance

The rise of antibiotic-resistant bacteria is a global threat to public health. In Europe alone, antibiotic resistance (AR) causes around 33,000 deaths each year and burdens healthcare costs by around € 1.5 billion. What then causes AR? Mainly our misuse and overuse of antibiotics. Therefore, in order to reduce AR, we must reduce the use of antibiotics.

Several factors drive the prescribing of antibiotics. Patients can contribute to increased prescriptions by expecting antibiotics when they visit the physician. Physicians, in turn, can contribute by assuming that their patients expect antibiotics.

In an article in the International Journal of Antimicrobial Agents, Mirko Ancillotti from CRB presents what might be the first study of its kind on the public’s attitude to AR when choosing between antibiotic treatments. In a so-called Discrete Choice Experiment, participants from the Swedish public were asked to choose between two treatments. The choice situation was repeated several times while five attributes of the treatments varied: (1) the treatment’s contribution to AR, (2) cost, (3) risk of side effects, (4) risk of failed treatment effect, and (5) treatment duration. In this way, one got an idea of ​​which attributes drive the use of antibiotics. One also got an idea of ​​how much people care about AR when choosing antibiotics, relative to other attributes of the treatments.

It turned out that all five attributes influenced the participants’ choice of treatment. It also turned out that for the majority, AR was the most important attribute. People thus care about AR and are willing to pay more to get a treatment that causes less antibiotic resistance. (Note that participants were informed that antibiotic resistance is a collective threat rather than a problem for the individual.)

Because people care about antibiotic resistance when given the opportunity to consider it, Mirko Ancillotti suggests that a path to reducing antibiotic use may be better information in healthcare and other contexts, emphasizing our individual responsibility for the collective threat. People who understand their responsibility for AR may be less pushy when they see a physician. This can also influence physicians to change their assumptions about patients’ expectations regarding antibiotics.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

M. Ancillotti, S. Eriksson, D.I. Andersson, T. Godskesen, J. Nihlén Fahlquist, J. Veldwijk, Preferences regarding antibiotic treatment and the role of antibiotic resistance: A discrete choice experiment, International Journal of Antimicrobial Agents, Volume 56, Issue 6, 2020. doi.org/10.1016/j.ijantimicag.2020.106198

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Exploring preferences

The Ebola epidemic also created an epidemic of rumors

Pär SegerdahlThe outbreak of Ebola virus disease in West Africa in 2014 was fought with scientific, medical knowledge about the virus. But for that knowledge to be translated into practice, good communication with the people in the affected areas was needed.

Joachim Allgaier and Anna Lydia Svalastog describe how communication was hampered by the fact that the epidemic also created an epidemic of rumors about the disease, which internet and mobile communication quickly spread in the affected areas and other parts of the world. The Ebola epidemic was at least two epidemics:

Unscientific ideas about the causes of the disease or about remedies (like eating raw onions, drinking salt water) spread online. But also conspiracy theories about the international efforts spread, which sometimes led to locals hiding their sick or preventing the work of humanitarian organizations.

The article also includes examples of successful treatments of the communicational epidemic. Local anthropologists found, for example, that the name “isolation centers” was interpreted by the locals as “death chambers,” and suggested that one should instead speak of “treatment centers.” Anthropologists could also, by contacting respected members of local communities, help changing burial rituals and other customs that contributed to the spread of the Ebola virus.

The article furthermore gives examples of how online social networks and YouTube, which contributed to the spread of rumors, also were used by the local populations to inform each other about how to wash  hands and behave to actually reduce the spread of the disease.

The conclusion of the article is that even if scientific and medical tools are absolutely central to combating virus epidemics, we must in order to succeed also treat the secondary, virtual epidemics that quickly spread through click-friendly news links and social networks online. All this requires sensitivity to local contexts.

Both kinds of epidemics must be treated simultaneously.

Pär Segerdahl

This post in Swedish

We care about communication - the Ethics Blog