The Ethics Blog

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

Year: 2025 (Page 2 of 2)

Can consumers contribute to more responsible antibiotic use?

29 April, 2025 / / 1 Comment

Most people are probably aware that antimicrobial resistance is one of the major threats to global health. When microorganisms develop resistance to antibiotics, more people become seriously ill from common infections and more people will die from them. It is like an arms race. By using antibiotics to defend ourselves against infections, we speed up the development of resistance. Since we need to be able to defend ourselves against infections, antibiotics must be used more responsibly so that the development of resistance is slowed down.

However, few of us are equally aware that food production also contributes significantly to the development of antimicrobial resistance. In animal husbandry around the world, large amounts of antibiotics are used to defend animals against infections. The development of resistance is accelerated to a large extent here, when the microorganisms that survive the antibiotics multiply and spread. In addition, antibiotics from animal husbandry can leek out and further accelerate the development of antimicrobial resistance in an antibiotic-contaminated environment. Greater responsibility is therefore required, not least in the food sector, for better animal husbandry with reduced antibiotic use.

Unfortunately, the actors involved do not seem to feel accountable for the accelerated development of antimicrobial resistance. There are so many actors in the food chain: policymakers in different areas, producers, retailers and consumers. When so many different actors have a common responsibility, it is easy for each actor to hold someone else responsible. A new article (with Mirko Ancillotti at CRB as one of the co-authors) discusses a possibility for how this standstill where no one feels accountable can be broken: by empowering consumers to exercise the power they actually have. They are not as passive as we think. On the contrary, through their purchasing decisions, and by communicating their choices in various ways, consumers can put pressure on other consumers as well as other actors in the food chain. They may demand more transparency and better animal husbandry that is not as dependent on antibiotics.

However, antimicrobial resistance is often discussed from a medical perspective, which makes it difficult for consumers to see how their choices in the store could affect the development of resistance. By changing this and empowering consumers to make more aware choices, they could exercise their power as consumers and influence all actors to take joint responsibility for the contribution of food production to antimicrobial resistance, the authors argue. The tendency to shift responsibility to someone else can be broken if consumers demand transparency and responsibility through their purchasing decisions. Policymakers, food producers, retailers and consumers are incentivized to work together to slow the development of antimicrobial resistance.

The article discusses the issue of accountability from a theoretical perspective that can motivate interventions and empirical studies. Read the article here: Antimicrobial resistance and the non-accountability effect on consumers’ behaviour.

Pär Segerdahl

Written by…

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

Nordvall, A-C., Ancillotti, M., Oljans, E., Nilsson, E. (2025). Antimicrobial resistance and the non-accountability effect on consumers’ behaviour. Social Responsibility Journal. DOI: 10.1108/SRJ-12-2023-0721

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Approaching future issues

Is this really true?

snowball fight
15 April, 2025 / / 3 Comments

Why is the question of truth so marvelous? A common attitude is that the question can make us check that our opinions really are correct before we express them. By being as well-informed as possible, by examining our opinions so that they form as large and coherent a system as possible of well-considered opinions, we can in good conscience do what we all have a tendency to do: give vent to our opinions.

Letting the question of truth raise the demands on how we form our opinions is, of course, important. But the stricter requirements also risk reinforcing our stance towards the opinions that we believe meet the requirements. We are no longer just right, so to speak, but right in the right way, according to the most rigorous requirements. If someone expresses opinions formed without such rigor, we immediately feel compelled to respond to their delusions by expressing our more rigorous views on the matter.

Responding to misconceptions is, of course, important. One risk, however, is that those who are often declared insufficiently rigorous soon learn how to present a rigorous facade. Or even ignore the more demanding requirements because they are right anyway, and therefore also have the right to ignore those who are wrong anyway!

Our noble attitude to the question of truth may not always end marvelously, but may lead to a harsher climate of opinion. So how can the question of truth be marvelous?

Most of us have a tendency to think that our views of the world are motivated by everything disturbing that happens in it. We may even think that it is our goodness that makes us have the opinions, that it is our sense of justice that makes us express them. These tendencies reinforce our opinions, tighten them like the springs of a mechanism. Just as we have a knee-jerk reflex that makes our leg kick, we seem to have a knowledge reflex that makes us run our mouths, if I may express myself drastically. As soon as an opinion has taken shape, we think we know it is so. We live in our heads and the world seems to be inundated by everything we think about it.

“Is this really true?” Suppose we asked that question a little more often, just when we feel compelled to express our opinion about the state of the world. What would happen? We would probably pause for a moment … and might unexpectedly realize that the only thing that makes us feel compelled to express the opinion is the opinion itself. If someone questions our opinion, we immediately feel the compulsion to express more opinions, which in our view prove the first opinion.

“Is this really true?” For a brief moment, the question of truth can take our breath away. The compulsion to express our opinions about the state of the world is released and we can ask ourselves: Why do I constantly feel the urge to express my opinions? The opinions are honest, I really think this way, I don’t just make up opinions. But the thinking of my opinions has a deceptive form, because when I think my opinions, I obviously think that it is so. The opinions take the form of being the reality to which I react. – Or as a Stoic thinker said:

“People are disturbed not by things themselves, but by the views they take of them.” (Epictetus)

“Is this really true?” Being silenced by that question can make a whole cloud of opinions to condense into a drop of clarity. Because when we become silent, we can suddenly see how the knowledge reflex sets not only our mouths in motion, but the whole world. So, who takes truth seriously? Perhaps the one who does not take their opinions seriously.

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 challenge habits of thought

New insights into borderline personality disorder

Man in dark clothes walking alone on a hill beside the ocean. Photo: Polina Kuzovkova, from Unsplash.
1 April, 2025 / / 1 Comment

Individuals with borderline personality disorder (BPD) often suffer from strong emotions that change rapidly, from one extreme to another. They may fear abandonment and experience an inner emptiness. They may also behave impulsively and have suicidal thoughts or behaviors. BPD is often mis- or underdiagnosed and there is a tendency among clinicians to avoid the diagnosis.

Given the diagnostic complexity of BPD, it is important to establish a diagnosis. Recent therapeutic advances show that the disorder responds to treatment and that significant recovery is possible. Because mental health services prioritize major psychiatric disorders, such as psychotic disorders and mood disorders, individuals with BPD have significant unmet needs. The suicide rate for BPD is as high as 10%, mirroring that of schizophrenia, and the enduring impairments from the disorder are comparable to those of chronic mental illnesses.

Clinical decision-making regarding diagnosis can be challenging for healthcare professionals for several reasons and is surrounded by ethical challenges. Several studies have shown that stigmatization and negative attitudes regarding the diagnosis of BPD are still common. Healthcare professionals, including emergency room staff and multidisciplinary teams, have been surveyed. Results suggest that even specialized mental health professionals have more negative attitudes toward BPD patients than toward those with other diagnoses, such as depression. This is likely due to factors associated with the diagnosis itself, but it is also probably related to clinicians’ perceptions of BPD symptoms and their previous treatment experiences.

Stigmatization is also reinforced by research. Derogatory terms and attitudes regarding BPD are pervasive in academic work on the disorder. A particularly common example is the attribution of negative intentions to individuals with BPD, such as wearing provocative clothing to attract attention or seeking attention by choosing, for example, artistic careers. Yet, we are not aware of any empirical documentation suggesting that BPD is associated with clothing or with specific intentions regarding career choices.

Additionally, many healthcare professionals do not consider BPD to be a genuine diagnosis and believe it to be self-induced or self-diagnosed. Consequently, individuals with BPD are often not informed about their disorder or are told that they have another diagnosis, such as bipolar disorder, compromising the principle of transparent diagnosis and patient empowerment for informed and consensual care.

The diagnosis of personality disorder is sometimes used as a label for disliked individuals. This is hardly surprising, given that interpersonal relationship problems are the primary characteristic of these disorders. However, we cannot ignore the fact that personality issues are extremely common, and rejection based on perceived undesirability is not acceptable. We now have evidence from around the world that personality disorders occur in 6 to 12% of the population, with a much higher prevalence among psychiatric patients. Of course, these figures may prompt accusations of inappropriate medicalization of normal human variations, but this criticism must be questioned. Recent findings have shown that even relatively mild personality disorders are associated with greater psychopathology, higher use of health services, and higher costs compared to individuals without personality pathology, and this is an increasing trend.

In a new article, I challenge existing perspectives and discourses about the clinical reality of the disorder. I compared impulsivity, anxiety, hopelessness, suicidal tendencies and depression in BPD patients and the general population during the COVID-19 isolation in France. While all groups exhibited elevated levels of impulsivity and anxiety, statistically significant differences were found in the severity of hopelessness, suicidal ideation, anxiety, and depression. Specifically, individuals with BPD showed markedly higher levels of these symptoms compared to the general population sample. This suggests that BPD exhibits a distinct profile of chronic distress, exceeding the levels seen in general stress reactions or other disorders like depression or anxiety that are more recognized and accepted in society.

My own and similar studies suggest that there is a need for a critical reevaluation of the diagnostic methods for personality disorders such as BPD. There is growing concern that some healthcare professionals may underdiagnose personality disorders, possibly because such disorders are not perceived to be severe. This reluctance to diagnose, combined with inadequate training in diagnostic procedures, may contribute to a systemic failure to recognize and address the prevalence and impact of personality disorders. The healthcare system then risks perpetuating the misconception that diagnostic and communication challenges related to personality disorders are not significant.

Better diagnostic practices, coupled with more accurate case descriptions and better treatment planning, can ensure faster and more effective treatment. This would provide individuals with the opportunity for personal and clinical recovery. Furthermore, the process of communicating the diagnosis of BPD is fundamental to how people understand and interpret their diagnosis, which in turn can affect their hope for recovery and motivation to use healthcare services. In conclusion, there is room for significant improvement in how we approach personality disorders such as borderline personality disorder.

This post is written by…

Sylvia Martin

Sylvia Martin, Clinical Psychologist and Senior Researcher at the Centre for Research Ethics & Bioethics (CRB).

Sylvia Martin, Instability of the unstable, an observation of borderline personality disorder traits and impulsivity declaration during the pandemic, L’Encéphale, 2025, https://doi.org/10.1016/j.encep.2024.10.007

We challenge habits of thought

Existential conversations in palliative care

Sick man in bed. Photo by Kampus Production on Pexels.
25 March, 2025 / / 2 Comments

In palliative care of seriously ill and dying patients, healthcare professionals deal not only with medical needs, but also with the existential needs of patients and their families. Although the palliative healthcare teams can receive support from professions that focus on existential conversations, it is the physicians and not least the nurses, care assistants, physiotherapists and occupational therapists who more continuously talk with patients about life, dying and death. Sometimes the conversations are planned in advance, but often they arise spontaneously in connection with the care interventions.

A Swedish interview study investigated experiences of spontaneous existential conversations with patients and their families within the healthcare professions that meet them daily: nurses, care assistants, physiotherapists and occupational therapists. They were asked questions about when existential conversations could arise and what influenced the quality of the conversations. They were also asked about how they talked to patients about their thoughts about death, how they reacted to patients’ existential questions, and how they reacted when relatives had difficulty accepting the situation.

The aim of the study was to create a structured overview of the experiences of the healthcare professionals, a model of what was considered important for existential conversations to arise and function well. Strategies used by the palliative teams were identified, as well as obstacles to meaningful existential conversations.

The main concern for the healthcare professionals was to establish a trusting relationship with patients and next of kin. Without such a relationship, no meaningful conversations about life, dying and death could arise. A core category that emerged from the interview material was to maintain presence: to be like a stable rock under all circumstances. In the meeting with patients and relatives, they stayed physically close and were calmly present during quiet moments. This low-key presence could spark conversations about the end of life, about memories, about support for quality of life, even in situations where patients and relatives were afraid or upset. By maintaining a calm presence, it was perceived that one became receptive to existential conversations.

The palliative teams tried to initiate conversations about death early. As soon as patients entered the ward, open-ended questions were asked about how they were feeling. The patients’ thoughts about the future, their hopes and fears were carefully probed. Here, the main thing is to listen attentively. Another strategy was to capture wishes and needs by talking about memories or informing about the diagnosis and how symptoms can be alleviated. The healthcare professionals must also guide relatives, who may be anxious, angry and frustrated. Here, it is important not to take any criticism and threats personally, to calmly acknowledge their concerns and inform about possible future scenarios. Relatives may also need information on how they can help care for the patient, as well as support to say goodbye peacefully when the patient has died. Something that also emerged in the interviews was the importance of maintaining one’s professional role in the team. For example, a physiotherapist must maintain focus on the task of getting patients, who may lack motivation, to get up and exercise. A strategy for dealing with similar difficulties was to seek support from others in the care team, to talk about challenges that one otherwise felt alone with.

Something that could hinder existential conversations was the fear of making mistakes: then one dares neither to ask nor to listen. Another obstacle could be anxious relatives: if relatives are frustrated and disagreeing, this can hinder existential conversations that help them say goodbye and let the patient die peacefully. A third obstacle was lack of time and feeling strained: sometimes the health care professionals have other work tasks and do not have time to stop and talk. And if relatives do not accept that the patient is dying, but demand that the patient be moved to receive effective hospital care, the tension can hinder existential conversations. Finally, lack of continuous training and education in conducting existential conversations was perceived as an obstacle, as was lack of support from colleagues and from the healthcare organization.

Hopefully, the article can motivate educational efforts within palliative care for those professions that manage the existential needs of patients and relatives on a daily basis. You can find the article here: Interdisciplinary strategies for establishing a trusting relation as a pre-requisite for existential conversations in palliative care: a grounded theory study.

Pär Segerdahl

Written by…

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

Lagerin, A., Melin-Johansson, C., Holmberg, B. et al. Interdisciplinary strategies for establishing a trusting relation as a pre-requisite for existential conversations in palliative care: a grounded theory study. BMC Palliative Care 24, 47 (2025). https://doi.org/10.1186/s12904-025-01681-x

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Nurses’ experiences of dehumanization

Female nurse resting on a sofa with her face towards the ceiling, and her eyes shut. Photo: Cedric Fauntleroy, from Pexels.
11 March, 2025 / / 1 Comment

Many healthcare professionals who work in nursing report that they experience a sense of dehumanization in their work. Although this is an increasingly recognized problem, it is still unclear how it manifests itself in practice and should be addressed. Previous studies indicate that the experience of dehumanization is often linked to excessive workload, lack of institutional support, and growing bureaucratization of medical care. As healthcare becomes more standardized and protocol-driven, nurses find themselves constrained by rigid structures that limit their ability to provide personalized and compassionate care. Over time, these conditions contribute to professional exhaustion, a loss of meaning in work, and in some cases, institutional mistreatment that is not intentional but arises as a byproduct of a dysfunctional organization of work.

The ethical implications of this phenomenon are significant. Respecting the dignity of both healthcare professionals and patients is fundamental to medical ethics, but this principle is increasingly challenged by current working conditions. The erosion of humanity in nurse-patient interactions not only affects the emotional well-being of nurses but also impacts the quality of care itself. Studies have shown that depersonalization in healthcare settings is associated with higher rates of medical errors. Furthermore, institutions bear a collective responsibility to ensure ethical working conditions, providing nurses with the necessary resources and support to maintain both their professional integrity and personal well-being.

Dehumanization of care is one of the topics of Marie-Charlotte Mollet’s soon-to-be completed dissertation at Paris Nanterre University. In one of her most recent studies, 263 French nurses, working in a variety of healthcare settings (public, private, nursing homes), were surveyed regarding factors related to their working conditions. They answered questionnaires about their workload, emotional demands, and organizational dehumanization. They also answered questions about their mental states, psychological flexibility, psychological distress, stress, and burnout. They moreover provided sociodemographic data on age, seniority, and gender.

In the analysis of the data, gender was found to be a relevant factor, raising new questions about dehumanization. For example, a significant difference between men and women was observed regarding dehumanization of patients: male nurses dehumanize patients more than female nurses do. This difference was measured by having study participants answer questions about “depersonalization” in a psychological assessment instrument for burnout (Maslach Burnout Inventory). Marie-Charlotte Mollet’s work thus suggests that dehumanization in healthcare needs to be examined through a gendered lens. For example, several studies have demonstrated that female nurses often face different expectations than their male counterparts, especially when it comes to emotional labor. Female nurses are more often expected to show empathy and provide emotional support, which places an additional burden on them and increases their vulnerability to burnout.

Addressing challenges related to dehumanization requires serious rethinking of the ethical and institutional frameworks of healthcare. Systemic reforms are necessary to uphold humanistic values and ethical standards in medical practice and to ensure that nurses are not merely treated as functional units within an overburdened system. Empirically informed reflection on equity, recognition, and gender in nursing is crucial to fostering a more sustainable and just profession; one where both patients and nurses are treated with the dignity they deserve. It is in the context of this need for well-founded reflection on the working conditions of nursing that this study and similar research efforts should be understood and considered: for the nurses’ own sake but also for the well-being of the patients and the quality of the care they receive.

This post is written by…

Sylvia Martin

Sylvia Martin, Clinical Psychologist and Senior Researcher at the Centre for Research Ethics & Bioethics (CRB).

Marie-Charlotte Mollet, PhD student at Paris Nanterre University.

Ethics needs empirical input

Why does science ask the question of artificial consciousness?

Two little girls facing each other. One of them is smiling and dancing, the other one has an old TV screen on her head. Photo: Ryunosuke Kikuno, from Unsplash.
4 March, 2025 / / 1 Comment

The possibility of conscious AI is increasingly perceived as a legitimate and important scientific question. This interest has arisen after a long history of scientific doubts about the possibility of consciousness not only in other animals, but sometimes even in humans. The very concept of consciousness was for a period considered scientifically suspect. But now the question of conscious AI is being raised within science.

For anyone interested in how such a mind-boggling question can be answered philosophically and scientifically, I would like to recommend an interesting AI-philosophical exchange of views in the French journal Intellectica. The exchange (which is in English) revolves around an article by two philosophers, Jonathan Birch and Kristin Andrews, who for several years have discussed consciousness not only among mammals, but also among birds, fish, cephalopods, crustaceans, reptiles, amphibians and insects. The two philosophers carefully distinguish between psychological questions about what might make us emotionally attracted to believe that an AI system is conscious, and logical questions about what philosophically and scientifically can count as evidence for conscious AI. It is to this logical perspective that they want to contribute. How can we determine whether an artificial system is truly conscious; not just be seduced into believing it because the system emotionally convincingly mirrors the behavior of subjectively experiencing humans? Their basic idea is that we should first study consciousness in a wide range of animal species beyond mammals. Partly because the human brain is too different from (today’s) artificial systems to serve as a suitable reference point, but above all because such a broad comparison can help us identify the essential features of consciousness: features that could be used as markers for consciousness in artificial systems. The two philosophers’ proposal is thus that by starting from different forms of animal consciousness, we can better understand how we should philosophically and scientifically seek evidence for or against conscious AI.

One of my colleagues at CRB, Kathinka Evers, also a philosopher, comments on the article. She appreciates Birch and Andrews’ discussion as philosophically clarifying and sees the proposal to approach the question of conscious AI by studying forms of consciousness in a wide range of animal species as well argued. However, she believes that a number of issues require more attention. Among other things, she asks whether the transition from carbon- to silicon-based substrates does not require more attention than Birch and Andrews give it.

Birch and Andrews propose a thought experiment in which a robot rat behaves exactly like a real rat. It passes the same cognitive and behavioral tests. They further assume that the rat brain is accurately depicted in the robot, neuron for neuron. In such a case, they argue, it would be inconsistent not to accept the same pain markers that apply to the rat for the robot as well. The cases are similar, they argue, the transition from carbon to silicon does not provide sufficient reason to doubt that the robot rat can feel pain when it exhibits the same features that mark pain in the real rat. But the cases are not similar, Kathinka Evers points out, because the real rat, unlike the robot, is alive. If life is essential for consciousness, then it is not inconsistent to doubt that the robot can feel pain even in this thought experiment. Someone could of course associate life with consciousness and argue that a robot rat that exhibits the essential features of consciousness must also be considered alive. But if the purpose is to identify what can logically serve as evidence for conscious AI, the problem remains, says Kathinka Evers, because we then need to clarify how the relationship between life and consciousness should be investigated and how the concepts should be defined.

Kathinka Evers thus suggests several questions of relevance to what can logically be considered evidence for conscious AI. But she also asks a more fundamental question, which can be sensed throughout her commentary. She asks why the question of artificial consciousness is even being raised in science today. As mentioned, one of Birch and Andrews’ aims was to avoid the answer being influenced by psychological tendencies to interpret an AI that convincingly reflects human emotions as if it were conscious. But Kathinka Evers asks, as I read her, whether this logical purpose may not come too late. Is not the question already a temptation? AI is trained on human-generated data to reflect human behavior, she points out. Are we perhaps seeking philosophical and scientific evidence regarding a question that seems significant simply because we have a psychological tendency to identify with our digital mirror images? For a question to be considered scientific and worth funding, some kind of initial empirical support is usually required, but there is no evidence whatsoever for the possibility of consciousness in non-living entities such as AI systems. The question of whether an AI can be conscious has no more empirical support than the question of whether volcanoes can experience their eruptions, Kathinka Evers points out. There is a great risk that we will scientifically try to answer a question that lacks scientific basis. No matter how carefully we seek the longed-for answer, the question itself seems imprudent.

I am reminded of the myth of Narcissus. After a long history of rejecting the love of others (the consciousness of others), he finally fell in love with his own (digital) reflection, tried hopelessly to hug it, and was then tormented by an eternal longing for the image. Are you there? Will the reflection respond? An AI will certainly generate a response that speaks to our human emotions.

Pär Segerdahl

Written by…

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

Birch Jonathan, Andrews Kristin (2024/2). To Understand AI Sentience, First Understand it in Animals. In Gefen Alexandre & Huneman Philippe (Eds), Philosophies of AI: thinking and writing with LLMs, Intellectica, 81, pp. 213-226.

Evers Kathinka (2024/2). To understand sentience in AI first understand it in animals. Commentary to Jonathan Birch and Kristin Andrews. In Gefen Alexandre & Huneman Philippe (Eds), Philosophies of AI: thinking and writing with LLMs, Intellectica, 81, pp. 229-232.

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We challenge habits of thought

Ethics as an integral part of standard care

Four people sitting at a table, and a women in a black shirt sitting in front of a laptop. Photo: Cottonbro, from Pexels.
25 February, 2025 / / 1 Comment

Healthcare professionals experience ethical dilemmas and ethically challenging situations on a daily basis. A child receiving important treatment may have difficulty sitting still. How should one think about physically restraining children in such situations? In order to provide good care, healthcare professionals may regularly need time and support to reflect on ethical dilemmas that may arise in their work.

Experiences from an attempt to introduce regular reflection on ethics cases are reported in an article with Pernilla Pergert as the main author. Staff in pediatric cancer care received training in conducting so-called ethics rounds, where healthcare professionals meet to discuss relevant ethics cases. The course participants were assigned to arrange ethics rounds at their respective workplaces both during and after the training. They were then interviewed about their experiences. Hopefully, the results can help others who are planning to introduce ethics rounds.

The experiences revolved around the challenge of positioning ethics in the workplace. How do you find time and space for regular ethical reflection in healthcare? Positioning ethics was not least about the status of ethics in a healthcare organization that prioritizes direct patient care. From such a perspective, ethics rounds may be seen as a luxury that does not really belong to the care work itself, even though ethical reflection is necessary for good care.

The interviewees also spoke about different strategies for positioning ethics. For example, it was considered important that several interested parties form alliances where they collaborate and share responsibility for introducing ethics rounds. This also helps ensure that several different professional groups can be included in the ethics rounds, such as physicians, nurses, social workers and psychologists. It was also considered important to talk about the ethics rounds and their benefits at staff meetings, as well as to identify relevant patient cases with ethical dilemmas that may create concern, uncertainty and conflicts in the care work. These ethical dilemmas do not have to be big and difficult, also more frequently occurring everyday ethical challenges need to be discussed. Finally, the importance of scheduling the ethics rounds at fixed times was emphasized.

The authors conclude that their study highlights the need to position ethics in healthcare so that staff can practice ethics as part of their care work. The study also exemplifies strategies for achieving this. A major challenge, the authors emphasize, is the polarization between care and ethics, as if ethics were somehow outside the actual care work. But if ethical dilemmas are part of everyday healthcare, then ethics should be seen as an integral part of standard care, the authors argue.

Read the article here: Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care.

Pär Segerdahl

Written by…

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

Pergert, P., Molewijk, B. & Bartholdson, C. Positioning Ethics When Direct Patient Care is Prioritized: Experiences from Implementing Ethics Case Reflection Rounds in Childhood Cancer Care. HEC Forum (2024). https://doi.org/10.1007/s10730-024-09541-6

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Conceivability and feasibility of artificial consciousness

A robot hand pointing towards a blue wall.
11 February, 2025 / / 0 Comments

Can artificial consciousness be engineered, is the endeavor even conceivable?  In a number of previous posts, I have explored the possibility of developing AI consciousness from different perspectives, including ethical analysis, a comparative analysis of artificial and biological consciousness, and a reflection about the fundamental motivation behind the development of AI consciousness.

Together with Kathinka Evers from CRB, and with other colleagues from the CAVAA project, I recently published a new paper which aims to clarify the first preparatory steps that would need to be taken on the path to AI consciousness: Preliminaries to artificial consciousness: A multidimensional heuristic approach. These first requirements are above all logical and conceptual. We must understand and clarify the concepts that motivate the endeavor. In fact, the growing discussion about AI consciousness often lacks consistency and clarity, which risks creating confusion about what is logically possible, conceptually plausible, and technically feasible.

As a possible remedy to these risks, we propose an examination of the different meanings attributed to the term “consciousness,” as the concept has many meanings and is potentially ambiguous. For instance, we propose a basic distinction between the cognitive and the experiential dimensions of consciousness: awareness can be understood as the ability to process information, store it in memory, and possibly retrieve it if relevant to the execution of specific tasks, while phenomenal consciousness can be understood as subjective experience (“what it is like to be” in a particular state, such as being in pain).

This distinction between cognitive and experiential dimensions is just one illustration of how the multidimensional nature of consciousness is clarified in our model, and how the model can support a more balanced and realistic discussion of the replication of consciousness in AI systems. In our multidisciplinary article, we try to elaborate a model that serves both as a theoretical tool for clarifying key concepts and as an empirical guide for developing testable hypotheses. Developing concepts and models that can be tested empirically is crucial for bridging philosophy and science, eventually making philosophy more informed by empirical data and improving the conceptual architecture of science.

In the article we also illustrate how our multidimensional model of consciousness can be tested empirically. We focus on awareness as a case study. As we see it, awareness has two fundamental capacities: the capacity to select relevant information from the environment, and the capacity to intentionally use this information to achieve specific goals. Basically, in order to be considered aware, the information processing should be more sophisticated than a simple input-output processing. For example, the processing needs to evaluate the relevance of information on the basis of subjective priors, such as needs and expectations. Furthermore, in order to be considered aware, information processing should be combined with a capacity to model or virtualize the world, in order to predict more distant future states. To truly be markers of awareness, these capacities for modelling and virtualization should be combined with an ability to intentionally use them for goal-directed behavior.

There are already some technical applications that exhibit capacities like these. For instance, researchers from the CAVAA project have developed a robot system which is able to adapt and correct its functioning and to learn “on the fly.” These capacities make the system able to dynamically and autonomously adapt its behavior to external circumstances to achieve its goals. This illustrates how awareness as a dimension of consciousness can already be engineered and reproduced.

Is this sufficient to conclude that AI consciousness is a fact? Yes and no. The full spectrum of consciousness has not yet been engineered and perhaps its complete reproduction is not conceivable or feasible. In fact, the phenomenal dimension of consciousness appears as a stumbling block against “full” AI consciousness. Among other things, because subjective experience arises from the capacity of biological subjects to evaluate the world, that is, to assign specific values to it on the basis of subjective needs. These needs are not just cognitive needs, as in the case of awareness, but emotionally charged and with a more comprehensive impact on the subjective state. Nevertheless, we cannot rule out this possibility a priori, and the fundamental question whether there can be a “ghost in the machine” remains open for further investigation.

Written by…

Michele Farisco, Postdoc Researcher at Centre for Research Ethics & Bioethics, working in the EU Flagship Human Brain Project.

K. Evers, M. Farisco, R. Chatila, B.D. Earp, I.T. Freire, F. Hamker, E. Nemeth, P.F.M.J. Verschure, M. Khamassi, Preliminaries to artificial consciousness: A multidimensional heuristic approach, Physics of Life Reviews, Volume 52, 2025, Pages 180-193, ISSN 1571-0645, https://doi.org/10.1016/j.plrev.2025.01.002

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The need for self-critical expertise in public policy making

Tired nurse. Photo by Cedric Fauntleroy on Pexels
28 January, 2025 / / 1 Comment

Academics are often recruited as experts in committees tasked with developing guidelines for public services, such as healthcare. It is of course important that policy documents for public services are based on knowledge and understanding of the problems. At the same time, the role of an expert is far from self-evident, because the problems that need to be addressed are not purely academic and cannot be defined in the same way that researchers define their research questions. A competent academic who accepts the assignment as an expert therefore has reason to feel both confident and uncertain. It would be unfortunate otherwise. This also affects the expectations of those around them, not least the authority that commissions the experts to develop the guidelines. The expert should be given the opportunity to point out any ambiguities in the committee’s assignment and also to be uncertain about his or her role as an expert. Again, it would be unfortunate otherwise. But if the expert role is contradictory, if it contains both certainty and uncertainty, both knowledge and self-criticism, how are we to understand it?

A realistic starting point for discussing this question is an article in Politics & Policy, written by Erica Falkenström and Rebecca Selberg. They conducted an empirical case study of ethical problems related to the development of Swedish guidelines for intensive care during the COVID-19 pandemic: “National principles for prioritization in intensive care under extraordinary circumstances.” The expert group consisted of 11 men, all physicians or philosophers. The lack of diversity is obviously problematic. The professional group that most directly comes into contact with the organizational challenges in healthcare, nurses, mostly women, was not represented in the expert group. Nor did the expert group include any social scientists, who could have contributed knowledge about structural problems in Swedish healthcare even before the pandemic broke out, such as problems related to the fact that elderly care in Sweden is administered separately by the municipalities. Patients in municipal nursing homes were among the most severely affected groups during the pandemic. They were presented in the policy document as a frail group that should preferably be kept away from hospitals (where the most advanced medical care is provided), and instead be cared for on site in the nursing homes. A problematic aspect of this was that the group of elderly patients in municipal care did not have access to competent medical assessment of their individual ability to cope with intensive care, which could possibly be seen as discriminatory. This reduction in the number of patients requiring intensive care may in turn have given the regional authorities responsible for intensive care reason to claim that they had sufficient resources. Moreover, if one of the purposes of the guidelines was to reduce stress among healthcare staff, one might wonder what impact the guidelines had on the stress level of municipal employees in nursing homes.

The authors identify ethical issues concerning three aspects of the work to develop the national guidelines: regarding the starting points, regarding the content of the document, and regarding the implementation of the guidelines. They also discuss an alternative political-philosophical way of approaching the role of being an expert, which could counteract the problems described in the case study. This alternative philosophical approach, “engaged political philosophy,” is contrasted with a more conventional philosophical expert role, which according to the alternative view overemphasizes the role of philosophy. Among other things, by letting philosophical theory define the problem without paying sufficient attention to the context. Instead, more open questions should be asked. Why did the problem become a public issue right now? What are the positions and what drives people apart? By starting from such open-ended questions about the context, the politically engaged philosopher can identify values ​​at stake, the facts of the current situation and its historical background, and possible contemporary alternatives. As well as including several different forms of relevant expertise. A broader understanding of the circumstances that created the problem can also help authorities and experts to understand when it would be better not to propose a new policy, the authors point out.

I personally think that the risk of experts overemphasizing the importance of their own forms of knowledge is possibly widespread and not unique to philosophy. An alternative approach to the role of being an expert probably requires openness to its basic contradiction: the expert both knows and does not know. No academic discipline can make exclusive claim to such self-critical awareness, although self-examination can be described as philosophical in a broad sense that takes us beyond academic boundaries.

I recommend the article in Politics & Policy as a fruitful case study for further research and reflection on challenges in the role of being an expert: Ethical Problems and the Role of Expertise in Health Policy: A Case Study of Public Policy Making in Sweden During COVID-19.

Pär Segerdahl

Written by…

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

Falkenström, E. and Selberg, R. (2025), Ethical Problems and the Role of Expertise in Health Policy: A Case Study of Public Policy Making in Sweden During COVID-19. Politics & Policy, 53: e12646. https://doi.org/10.1111/polp.12646

This post in Swedish

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Do the goals of care reflect the elderly patient’s personal preferences?

Elderly person with a golden ring on their finger.
14 January, 2025 / / 1 Comment

Person-centered care is not only an ethical approach that values ​​the patient’s personal preferences and decision-making. It is also a concrete way to improve care and the patient’s quality of life. This is especially important when caring for elderly patients, who may have multiple chronic conditions and various functional limitations. This requires sensitivity to the patient’s description of their situation and joint planning to adapt care to the patient’s individual needs and wishes. The care plan should be documented in the patient’s medical record in the form of evaluable goals.

A new Swedish study investigated the presence of person-centered, evaluable goals in the care plans for patients at a geriatric psychiatric outpatient clinic. It was found that the goals documented in the patients’ medical records had a biomedical focus on the disease: on recovery or on reduced symptoms. Although the analysis of the medical records revealed that the patients themselves also expressed other needs, such as existential needs and the need for support in carrying out everyday activities they perceived were important for a better quality of life, these personal wishes were not reflected in the care plans in the form of evaluable goals.

A biomedical focus on disease treatment could also manifest itself in the form of decisions to reduce the prescription of addictive drugs, without the care plan indicating alternative measures or mentioning the effects that this medical goal could have on the patient.

The authors point out that the fact that the medical records nevertheless documented the patients’ personal wishes indicates that there was a certain degree of person-centered interaction with the patients. However, since the conversations did not result in documented goals of care, the person-centered process seems to have stopped halfway, the authors argue in their discussion of the results. The patients’ stories were included, but were not incorporated into the medical decision-making process and the planning of care.

An aim of the study was also to examine psychiatric care plans at the end of life. Although the proximity to death and the possibility of palliative care could be mentioned in the medical records, the goals were rarely changed from curative to palliative care. Moreover, neither the healthcare professionals nor the patients seemed to view psychiatric care as part of palliative care. On the contrary, they seemed to view palliative care as a reason to end psychiatric care. None of the few decisions to change the focus of care led in practice to any straightforward palliative approach.

The absence of the concept of palliative care, despite the fact that the patients were close to death when the studied goals of care were established, is surprising, according to the authors. Conversations about goals and hopes at the end of life should be self-evident in geriatric psychiatry, and in their discussion, the authors suggest concrete tools that are already available to support such conversations. Given the complex combination of conditions and the proximity to death, there are strong reasons to formulate care plans with an increased focus on improved quality of life and not just on restored mental health, the authors argue.

In their conclusion, the authors point out the need for more research on how person-centered care interacts with the planning of evaluable goals. They also point out the importance of a palliative approach in geriatric psychiatric care, where patients may suffer from multiple concurrent conditions as well as more or less severe and long-term mental disorders.

Read the article here: Psychiatric Goals of Care at the End of Life: A Qualitative Analysis of Medical Records at a Geriatric Psychiatric Outpatient Clinic.

Pär Segerdahl

Written by…

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

Kullenberg, Helena, Helgesson, Gert, Juth, Niklas, Lindblad, Anna, Psychiatric Goals of Care at the End of Life: A Qualitative Analysis of Medical Records at a Geriatric Psychiatric Outpatient Clinic, Journal of Aging Research, 2024, 2104985, 10 pages, 2024. https://doi.org/10.1155/jare/2104985

This post in Swedish

Ethics needs empirical input

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