The Ethics Blog

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

Author: Pär Segerdahl (Page 1 of 42)

What do MS patients consider to be the most important features of treatment?

Nervous Tissue: Spinal Cord Motor Neuron. Photo by Bioscience Image Library by Fayette Reynolds.
17 June, 2025 / / 0 Comments

Multiple sclerosis (MS) is a chronic inflammatory disease that affects the nerves of the brain and spinal cord. Symptoms can vary between individuals and the progression of the disease is difficult to predict. Medications can slow the progression of the disease and relieve symptoms, but they do not cure the disease. Symptoms tend to come and go and need to be monitored so that the patient always receives appropriate treatment.

Because MS is a lifelong disease with symptoms that come and go, and that change throughout life, it is important to know which features of treatment are perceived by patients as particularly important. Such knowledge can help healthcare professionals, in consultation with patients, to better tailor treatment to the individual’s wishes and needs. Patient-centred care is probably particularly important for lifelong diseases such as MS, with unpredictable progression and changing symptoms.

So how can we know which features of treatment are considered most important by patients? Preference studies can be conducted. The approaches in such studies vary. Patients can be interviewed or they can complete surveys. Surveys can ask questions in different ways, for example, the task may be to rank alternatives. Sometimes preference studies resemble experiments in which participants are presented with a series of choice situations that are systematically varied.

A Swedish-Italian collaboration investigated what patients perceive as important features of the treatment by giving them a ranking task. MS patients at an Italian university hospital were asked to rank alternatives for five different features of the treatment, including treatment effect and intervention method. The treatment effect that was ranked highest was preserved cognitive function, and the intervention method that was valued highest was disease-modifying drugs. The patients were also asked to justify their answers.

The research team then evaluated the results of the ranking task. The options that the patients ranked highest were now identified as important features of the treatment. Here is the final list of important features of the treatment:

Physical activity

Cognitive training

Disease-modifying drugs

Emotional support

Treatment effects

Each feature has 3–4 alternatives: different types of physical activity, different types of cognitive training, and so on. This ranking study is a preliminary study for a future, more experimental-like preference study that will be based on the features in the list. The advantage of such a step-by-step work process is that you can ensure that you ask the right questions and include the relevant features when designing the experimental study.

The final results therefore remain to be seen, but the above features can be considered an important step along the way. You can read the article here: What matters to patients with multiple sclerosis? Identifying patient-relevant attributes using a ranking exercise with open-ended answers from an online survey in Italy.

Pär Segerdahl

Written by…

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

Bywall KS, Kihlbom U, Johansson JV, et al. What matters to patients with multiple sclerosis? Identifying patient-relevant attributes using a ranking exercise with open-ended answers from an online survey in Italy. BMJ Open 2025;15:e095552. doi: 10.1136/bmjopen-2024-095552

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Exploring preferences

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Are you a blissfully unaware author of an article you never wrote?

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3 June, 2025 / / 3 Comments

Every day, researchers receive a motley of offers from dubious journals to publish in them – for a fee. The fact that researchers do not accept these offers does not prevent them from one day discovering that they have become authors of an article that they never wrote.

This recently happened to four surprised colleagues of mine. Suddenly, they began to receive inquiries from other colleagues about a new article that they were supposed to have written. When they investigated the matter, they discovered that an article actually existed in published form, in their names, even though they had neither written it nor even dreamed of the study described in it. Since they had never submitted a manuscript, they were of course not in communication with the journal’s editorial staff: they received neither peer reviews nor proofs to read. Although the article they read with increasing astonishment seemed to report a study on children with cancer, a vulnerable group, the study lacked both ethical approval and funding, and the location of the study was not disclosed. When my puzzled and concerned colleagues contacted the journal about these oddities, they naturally received no response.

One may wonder how such publicist virgin births can occur. If we rule out the possibility that a deity has begun to communicate with humanity via new electronic forms of publishing, in the name of established researchers, perhaps we should focus on the question of who can profit from the miracles. Could it be a cheating researcher trying to improve their credentials by publishing a fraudulent study? Hardly, the cheater’s name is not included in the list of authors, so the publication would not be of any use in the CV. Or could it be the owners of the journal who are trying to make the journal look more legitimate by borrowing the names of established and credible researchers, so that more researchers will be tempted to accept the offers to publish in the journal – for a fee? With the help of AI, an article can easily be generated that reports research that no real researcher would even dream of. Such as a study on children with cancer without ethics approval and funding, conducted in an unknown location and published without the slightest contact with the journal.

To alert scientific journals to this new challenge, one of my colleagues chose to publish a description of the group’s experience of becoming authors of an article they never wrote. You will find the description here – the author’s name is authentic and not just a generated “probable name”: Fraudulent Research Falsely Attributed to Credible Researchers—An Emerging Challenge for Journals?

Pär Segerdahl

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

Godskesen, T. (2025), Fraudulent Research Falsely Attributed to Credible Researchers—An Emerging Challenge for Journals? Learned Publishing, 38: e2009. https://doi.org/10.1002/leap.2009

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What influences pregnant women’s decisions about prenatal diagnosis?

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20 May, 2025 / / 1 Comment

A large proportion of pregnant women in Sweden undergo prenatal diagnosis to assess the likelihood of chromosomal anomalies in the fetus. This initially involves a so-called CUB test, which combines ultrasound with a biochemical test. If the CUB test indicates a high probability of a chromosomal anomaly, further tests are offered. This can be a non-invasive NIPT test, which examines small parts of the fetus’s DNA that are found in a blood sample from the woman, or an invasive test which involves a slightly increased risk of miscarriage.

What influences pregnant women’s decisions about whether or not to undergo prenatal diagnosis? A study investigated the question by interviewing 24 pregnant women in an early stage of pregnancy. Most had not yet been informed by the midwife about prenatal diagnosis and their perceptions in the interviews were therefore probably not influenced by information from healthcare professionals. The study should be highly relevant to prenatal care and genetic counseling as it provides insights into what influences decision-making for pregnant women and deepens the understanding of what they perceive is at stake.

It is instructive to take part in the results and how the interviewees think about prenatal diagnosis. The pregnant women’s reasoning is based on their own experiences, perceptions and values. When they wonder about chromosomal anomalies, they do not wonder about genetics, but about what the anomalies can mean for the child and for themselves. What kind of life can the child have? And how are the conditions for one’s own professional and social life affected? Women who did not consider terminating the pregnancy in the event of a chromosomal anomaly still saw value in prenatal diagnosis, as the knowledge could make it possible to prepare for the birth of the child. Some saw the test as an opportunity to confirm the pregnancy and the health of the fetus, while some were concerned that the CUB test only indicates the probability of a chromosomal anomaly. If a woman can give birth to a completely healthy child despite the test indicating a high risk of anomaly, is it worth the anxiety that the risk assessment would create during pregnancy? Self-perceived risk also influenced the decision-making. Some stated that they would probably choose prenatal diagnosis if they were older, or if there had been a history of chromosomal anomalies in the family.

Furthermore, certain external factors influenced the women’s reasoning about prenatal diagnosis, such as the characteristics of the test. It was very clear that they preferred risk-free tests. Even women who were positive about prenatal diagnosis became hesitant if the testing procedure in question could increase the risk of miscarriage. The accuracy of the test was also important, as was the time between testing and receiving results. For women who could consider terminating their pregnancy in the event of a chromosomal anomaly, early prenatal diagnosis was important. Other people’s perceptions of prenatal diagnosis were another external factor that could influence the decision-making. Although some of the interviewees emphasized that decisions about their bodies were their own, the majority wanted the opportunity to discuss the decision about prenatal diagnosis with their partner. The interviews also revealed that the attitudes of the healthcare professionals influenced the decisions, for example whether the midwife presents prenatal diagnosis as something urgent or not. Finally, the way healthcare services are organized could also influence the decisions. The very fact that prenatal diagnosis is offered was perceived by some women as a recommendation. The fact that the CUB test is subsidized for pregnant women over a certain age meant that older women perceived it as more compelling to choose it, while younger pregnant women might not choose it even if they wanted to.

In addition to the fact that the interview study provides insights into how pregnant women think about prenatal diagnosis, the analysis of the interview material contributes to an overview of how multidimensional the decision-making is. So much is at stake, so many types of factors interact and influence the decisions. When pregnant women are informed about prenatal diagnosis, all of these factors should be taken into account in order to support the women’s decision-making. Healthcare professionals should also be aware that their attitudes and demeanor influence women’s decisions, and that decisions are influenced not only by what they say to the women but also by what they do not say, the authors conclude their article.

To see more results and read the authors’ discussion, you can find the article here: Factors influencing pregnant women’s decision to accept or decline prenatal screening and diagnosis – a qualitative study.

Pär Segerdahl

Written by…

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

Ternby, E., Axelsson, O., Ingvoldstad Malmgren, C. et al. Factors influencing pregnant women’s decision to accept or decline prenatal screening and diagnosis – a qualitative study. J Community Genet 15, 711–721 (2024). https://doi.org/10.1007/s12687-024-00746-3

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“Consentless measures” in somatic care: how do healthcare staff reason about them?

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6 May, 2025 / / 2 Comments

How do you handle a reluctant patient who may not want to take their medication or who protests against measures that are deemed to be beneficial to the patient, such as inserting a urinary catheter? Do you just give up because the patient does not consent?

Except in acute emergency situations, coercive somatic treatment is not permitted in Sweden. How do healthcare professionals ethically reflect on situations where the patient does not consent to an action that can be considered to benefit the patient and which is therefore attempted anyway? A new interview study with healthcare staff on medical wards at two Swedish hospitals examines the issue in terms of “consentless measures”: ways of getting a reluctant patient to comply with treatment, for example by persuading, coaxing, deceiving or using some form of physical power.

In the interviews, the participants had difficulty finding appropriate words to describe the measures that occurred daily on the wards. They distanced themselves from the word “coercion” and preferred to talk about persuading, coaxing and deceiving. They generally accepted the use of consentless measures. In many cases, the measures were seen as such an obvious part of daily work situations that the measures did not need to be justified, or were justified by being what was best for the patient. Staff who gave up too quickly were seen as uncommitted and unreliable. While trying to avoid coercion, one still did not want to give up measures that the patient was judged to need. More coercive-like measures were in some cases considered acceptable if milder and less coercive measures had first been tried.

Consentless measures were further described as an integral part of the work on the wards, as part of a ward culture where the overall goal is to carry out one’s tasks. Some participants appreciated the culture while others were critical, but all agreed that the ward culture tacitly condones consentless measures. Participants also said that there was a tendency to use such measures more often with older patients, who were perceived as easier to persuade than younger ones. Several participants saw this as ethically problematic. Finally, participants considered it unacceptable to use excessive physical power or to insist on treatments that are of no benefit to the patient.

In their discussion of the interview results, the authors, Joar Björk, Niklas Juth and Tove Godskesen, point out a number of possible ethical problems to be aware of. One of these has to do with the division of labor where physicians make decisions about measures that nurses must then carry out. This can create a conflict of loyalty for nurses. They work closely with patients, but at the same time they are loyal to the system and want to complete the tasks they are given, which can contribute to the acceptance of consentless measures. The ideal of “not giving up” probably needs to be further examined, as does the question of whether good nursing can sometimes hide ethical challenges under the nurse’s warmth, flexibility and communicative ability. Another issue to further examine is the tendency to use consentless measures on older patients to a greater extent than on younger patients. The authors suggest in their conclusion that a strong sense of duty to carry out care interventions and to “get the job done” may lead to healthcare staff taking patients’ autonomy and consent too lightly. Participants generally took non-consent more lightly than might be expected given established norms in medical ethics, they conclude.

You can read the article here: Ethical reflections of healthcare staff on ‘consentless measures’ in somatic care: A qualitative study.

Pär Segerdahl

Written by…

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

Björk J, Juth N, Godskesen T. Ethical reflections of healthcare staff on ‘consentless measures’ in somatic care: A qualitative study. Nursing Ethics. 2025;0(0). doi:10.1177/09697330251328649

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Ethics needs empirical input

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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

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Is this really true?

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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

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

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Existential conversations in palliative care

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25 March, 2025 / / 1 Comment

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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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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Ethics as an integral part of standard care

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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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The need for self-critical expertise in public policy making

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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

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