The Ethics Blog

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

Category: In the research debate (Page 4 of 33)

Empirical ethics nuances ethical issues

crowd
17 October, 2023 / / 1 Comment

A few years ago, my colleague Pär Segerdahl published a blog post on why bioethicists do empirical studies. He pointed out that surveys and interview studies on what people think hardly provide evidence that can decide controversial ethical issues, for example whether euthanasia should be allowed. Empirical studies rather give us a better grasp of the problem itself. They help us see what is actually at stake for people. I agree with him that ethical issues are not decided by surveys and interview studies and that such studies rather help us to see more clearly the meaning of the issues.

In this post, I want to further exemplify how empirical methods can nuance ethical questions and help us see what is at stake for people: help us see what we need to consider in the ethical discussion. I have in mind how, through a well-considered choice of empirical method, one can better describe the relative importance of ethical difficulties, values and preferences among stakeholders, as well as conflicts between ethical views. How? I am thinking of methods where respondents do not just answer what they think on certain individual issues, but are faced with complex scenarios where several factors are simultaneously at stake. Even if you have the firm opinion that drugs should not have side effects, are you perhaps still prepared to choose such a drug if it is more effective against your symptoms than other drugs, or is cheaper, or easier to use? In such studies, we create a multidimensional world with nuances for respondents to make complex decisions in.

Here is my example: Soon, therapies based on human embryonic stem cells may become a reality for patients with Parkinson’s disease. But is it morally acceptable to use human embryonic stem cells (hESC) for drug therapy? This has long been a controversial issue, partly because the embryo is destroyed when the stem cells are harvested. Perhaps the question is about to become even more topical now, when countries are changing legislation in a direction that gives the embryo a higher status and more legal protection. It is therefore particularly important that research provides a nuanced picture of the issues. In light of the political landscape and the new possibilities for treating patients with Parkinson’s, a more complex empirical method can support a better contemporary discussion about what types of research and therapies are within the scope of what can be allowed to be done with an embryo. The discussion concerns both ethics and law and must also include scientific challenges to ensure that stem cell research and therapies are carried out in ethically acceptable ways.

A common way to empirically examine the ethical issue is to look at the ethical arguments for and against the destruction of human embryos: to examine how different actors think and feel about this. Undoubtedly, such studies help us see what is at stake. But they can also easily steer respondents towards a yes-or-no answer, a pro-or-against attitude. Therefore, it is important to choose an empirical method that elicits perceived benefits and risks and explores multiple dimensions of the problem. How do patients feel about taking a medicine based on leftover embryos that not only relieves their symptoms but also repairs the damage, while the level of knowledge is low? It is not easy to answer such a question, but reality often has this complexity.

One method that can stage such complex considerations is a choice-based survey called Discrete Choice Experiments (DCE). With that method, we can investigate ethically sensitive issues and use the results to describe more fully the relative importance of ethical difficulties, values and preferences among stakeholders, as well as conflicts between ethical views. DCE provides an understanding of the balance between factors involved in different situations. In a new article in BMC Medical Ethics, my colleagues and I have investigated which factors are associated with the preferences of patients with Parkinson’s disease regarding embryonic stem cell-based treatments for the disease in the future. We invited patients to participate in a web-based choice-based experiment to assess the importance of the following factors: (1) type of treatment, (2) purpose of the treatment, (3) available knowledge about different types of treatment, (4) effect on symptoms and (5) the risk of serious side effects. The results showed that the fourth factor, “effect on symptoms,” was the most important factor in the choice of treatment option. Patients’ previous experience with treatment, side effects and advanced treatment therapy, as well as religious beliefs were associated with what they thought was most important, but not their view of what an embryo is. If you want to read more, you can find the article here: Patients accept therapy using embryonic stem cells for Parkinson’s disease: a discrete choice experiment.

These kinds of results from DCE studies can, in my opinion, help us to understand and frame ethical questions in ways that reflect how people think when multiple factors are at stake simultaneously. I believe that the more realistic complexity of such studies can contribute to more informed ethical considerations. I believe that they could also strengthen democratic processes by giving public conversation a background of more nuanced empirical findings.

Written by…

Jennifer Viberg Johansson, Associate Professor in Medical Ethics at Uppsala University’s Centre for Research Ethics & Bioethics.

Bywall, K.S., Drevin, J., Groothuis-Oudshoorn, C. et al. Patients accept therapy using embryonic stem cells for Parkinson’s disease: a discrete choice experiment. BMC Med Ethics 24, 83 (2023). https://doi.org/10.1186/s12910-023-00966-1

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Ethics needs empirical input

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How clearly are ethical approval and informed consent reported in published articles?

Looking through a looking glass
3 October, 2023 / / 1 Comment

In a scientific article, it is of course essential that the authors describe the aim, methods and results of the study. But all researchers also have a research ethical responsibility to reflect on ethical aspects of the work and to plan and carry out their studies in accordance with relevant laws and guidelines. The ethical approach in the study should also be described in the article. This description is not as extensive as the method description, but certain information about ethical approval and informed consent should be given with sufficient detail. If the study also entailed specific ethical challenges, perhaps because it involved vulnerable participants such as seriously ill or dying patients, then the article should report how the challenges were handled regarding, for example, obtaining informed consent.

Although scientific journals have the standard that information on ethical approval and informed consent must be declared, it is unclear how well this requirement is complied with in practice, by both authors and journal editors. A group of ethics researchers, including Tove Godskesen, William Bülow and Stefan Eriksson linked to CRB, recently investigated this question within a relevant field, namely research on palliative and end-of-life care. Patients who participate in such research can be considered vulnerable and research in this area involves particular ethical challenges. How well do scientific publications in the field meet the requirements for reporting ethical approval and informed consent?

The ethicists’ survey was conducted on 169 empirical studies in 101 journals, published after January 1, 2019. It was limited to studies conducted in Norway and Sweden, as the author group was well acquainted with the regulations and practices of ethical review in these countries and could therefore assess whether the articles contained information about relevant laws and authorities. To rate how well the articles reported ethical approval and consent, a scoring scale was created from 0 to 3. Articles with no reporting at all received a score of 0 and articles with minimal reporting (e.g., “Ethical approval was granted”) received a score of 1. If the article contained clear and concise statements about ethical approval and informed consent, and in addition included one piece of detailed information (such as the name of the committee or authority that gave the approval), then the article received a score of 2.

An original feature of the examination is the detailed requirements for obtaining the highest score. The requirements for scoring 3 are intended to also serve as a suggestion for best practice. They are proposed as a possible basis for clearer guidelines in the future for authors, journal editors and peer reviewers. What details must be reported to get the score 3? No irrelevant details, but perfectly reasonable information if you think about it. For example, the identity of the review board should be disclosed as well as the identification number of their decision. Why? To be able to contact the board for verification or questions, for readers to be able to see that the research complies with relevant laws and ethical guidelines, and for the public to be able to access the information. One should also mention the Act under to which the decision on ethical approval was made. Why? It shows that the researchers are ethically proficient and it helps editors and reviewers to compare the statements with legal requirements in doubtful cases. Regarding informed consent, one should state, among other things, what type of consent was obtained and from whom the consent was obtained. Why? So that one can assess whether the procedures meet ethical requirements in the current case. In palliative care research, for example, both the patients and their families can be involved in the consent process. Also for the informed consent, relevant legislation should be indicated to demonstrate awareness of legal requirements and to enable critical review.

The requirements are therefore about completely reasonable information that should be easy to provide. But what were the results of the survey? I content myself with reproducing the percentage of articles that received the lowest and the highest scores. A non-negligible proportion of the articles contained no reported information at all and got 0 points: 5% for ethical approval and 13% for informed consent. A larger but still small proportion of the articles reported sufficiently detailed information to receive the highest score: 27% for ethical approval and 19% for informed consent.

Considering that the requirements for the highest score can be considered reasonable and not particularly onerous, the results are disappointing. The substandard reporting creates uncertainty about the ethical rigor of studies, the authors write in their conclusion, which is particularly troubling for studies with vulnerable participants, such as patients in palliative and end-of-life care, who require special ethical considerations.

What can we do about the problem? A common measure is training in research ethics, which is of course important. But the authors suggest that a more effective way to quickly bring about change is for scientific journals to start making clearer demands on how ethical approval and informed consent must be reported in articles to be considered for publication. So why not use the requirements to get the highest score on this survey as a template? They are proposed as a reasonable description of best practice. Read the survey here: How do journals publishing palliative and end-of-life care research report ethical approval and informed consent?

In a box in the article, the authors cite an exemplary description of ethical approval and informed consent that includes the details for score level 3. It strikes me how clarifying it is to see a good example, so look for the box in the article.

Pär Segerdahl

Written by…

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

Godskesen, T., Vie, K.J., Bülow, W., Holmberg, B., Helgesson, G. and Eriksson, S. (2023), How do journals publishing palliative and end-of-life care research report ethical approval and informed consent? Learned Publishing. https://doi.org/10.1002/leap.1580

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Thinking about authorship

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Data for gender equality in European research organizations

Woman scientist
26 September, 2023 / / 1 Comment

Inequality is not just a bad feeling that some may have, but a bad reality that we share. Especially in countries where gender equality work is not well established, it is important that inequality is not handled as a contested issue, but as a fact about which more knowledge should be sought. Who has the power over the criteria for what a successful researcher is and who has a better chance of succeeding? Which structures undermine or support gender equality? What does childcare look like? Are the research teams homogeneous and how does that affect the work? Where do women end up in the author order in scientific publications and where do they end up in the competition for research funds? Are there mechanisms and values in science that systematically make inequality invisible and prevent equality?

There is a will in the EU to improve gender equality in research organizations, especially in some of the Member States where gender equality work is particularly neglected. How can the necessary changes be brought about? In Sweden, all state universities are commissioned to collect data on (in)equality. Under the slogan “No data: No policies!” an EU project presents its approach to gender equality plans. The project, MINDtheGEPs, develops and implements gender equality plans in a collaboration between 7 European research organizations in 5 countries: Spain, Poland, Ireland, Italy and Serbia. The focus is on changing the organizations structurally and culturally and increasing women’s participation in research and innovation. The project is coordinated from the Center for Women’s and Gender Studies at the University of Turin. The work is supported by a further 4 organizations: the publishing house Elsevier in the Netherlands, the research organization Knowledge & Innovation in Italy, the National Research Council of Italy, and by the Centre for Research & Bioethics (CRB) at Uppsala University, which leads the communication work.

In the participating countries, there is a lack of sufficient data on factors behind equality and inequality, which means that those who suffer from inequality also suffer from not being seen. Therefore, it is important to carry out studies that map the problems. If the studies are also carried out in one’s own organization and one contributes to producing the data, this can further contribute to making the problems visible and motivating change. Therefore, the organizations in MINDtheGEPs collect data together to develop, adapt and support interventions at the local level. Behind the approach is a reasonable idea: if you cannot provide evidence of inequality, you will not get support to remedy the problems either. The project thus collects data on existing legislation and policy in the 5 countries, as well as data on the proportion of women in governing bodies at different levels, on the proportion of women who apply for and receive research support in competition, as well as data on the existence of gender equality measures. Surveys and interview studies are also carried out with researchers, administrative staff, rectors and vice rectors, department directors and other relevant actors. This large data collection and analysis is the basis for the 7 gender equality plans that are developed and implemented in MINDtheGEPs. Here you will find a presentation of the data collection.

If you want a summary of the work with evidence-based equality plans, you can read this policy brief from the project: No data: No policies! The MINDtheGEP’s approach to evidence-based policies for Gender Equality Plans. The document gives a brief account of structural and cultural measures that are recommended on the basis of the studies in various areas. It is about balance in recruitment and career progression and about balance between work and private life. It is about making gender equality issues visible in research and teaching, for example through courses that highlight gender as an important dimension in these activities. Finally, it is about changing the work in decision making bodies so that more women can reach higher positions within research organizations in the countries in the project collaboration.

The approach in MINDtheGEPs can probably inspire other organizations in addition to those included in the project, even organizations that do not work with research. This is also a thought behind the project. The hope is that the work of developing and implementing gender equality plans in a number of research organizations will influence the rest of society. Without data, gender inequality risks being made invisible as a bad feeling.

Pär Segerdahl

Written by…

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

Solera, Cristina, Balzano, Angela, Turco, Federica, Pisacane, Lucio, & Fernow, Josepine. (2023). No data: No policies! The MINDtheGEPs approach to evidence-based policies for Gender Equality Plans. Zenodo. https://doi.org/10.5281/zenodo.7785413

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We want solid foundations

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Participation in biomedical research with dynamic consent

19 September, 2023 / / 1 Comment

Imagine that you are asked to participate in a biomedical research project and to provide biological samples and health data to the project. Imagine also that this research project is meant to be long-term and that you will be invited, occasionally, to provide more data and samples. If you decide to participate, you will be asked to sign an informed consent, which is a sort of social contract between you and the research study. Through this document, you consent to the use of your data and samples in scientific research, and your rights as a participant are defined. In this situation, which kind of informed consent would make you feel at ease? What would be the most appropriate consent, balancing the researchers’ need to maximize the use of data and samples against the respect for your values and rights to make autonomous decisions? Would it be an acceptable option to sign the consent form and never be contacted again? Or would you expect researchers to communicate with you and keep you updated on what is happening with the data and samples you provided? If so, you might want to feel engaged and reasonably aware of what is happening in the research, but not overwhelmed by continuous communication with the project. But how much would the “right amount” of communication be? And which ways of communicating with you would you find the easiest and most appropriate?

Ethicists, philosophers, and law experts have debated the most suitable informed consent model for biobanking research. Among the different types of consent, such as specific, broad, and meta-consent, dynamic consent has been proposed as an apt solution in the context of biomedical research, especially in long-term research endeavors such as biobanking and longitudinal studies, where research participation is foreseen to be long-lasting and require repeated participant engagement over the years.

What characteristics of dynamic consent make it particularly relevant in such a context? Participants are regularly informed about the research being conducted with their data and samples and can change their choices on participation over time. Information technology plays a central role in dynamic consent: through an online interface, participants can access and review their informed consent and obtain information about the research in which they participate. In dynamic consent, communication between researchers and participants is thus an integral part of the informed consent process. Communication ensures that participants can make autonomous decisions about their participation throughout the time they are involved in the research. Dynamic consent thus acknowledges that participants’ values and life circumstances may change over the years and that their decision on research participation may differ at a later point in life, or depending on the further development of the research. Dynamic consent makes it possible to combine broad research aims with specificity of information in long-term projects, and ongoing communication is key to this.

What might dynamic consent look like in practice? An example of a study that uses dynamic consent is Cooperative Health Research in South Tyrol (CHRIS), a longitudinally designed study conducted in Italy. Our ELSI research team is led by Deborah Mascalzoni and is located at Eurac Research. In an article, we describe crucial aspects of dynamic consent as developed in the CHRIS study. We discuss the ten years of experience of dynamic consent in the study and what we have learned so far through observations and empirical evidence. I would like to point out two elements that that we found particularly important and what the participants in our studies thought about them. One concerns the possibility of changing choices over time and the other is about the communication.

First, CHRIS participants can change their choices about the level of participation and the amount of information they want. For example, they can change their choice regarding the return of research results, decide whether they wish to be re-contacted for research and communication purposes, or want their data and samples to be shared with other research institutions. Although the overall rate of change was low, CHRIS participants appreciated being able to change choices and having detailed options, because these options were important for them and made them feel comfortable.

Second, CHRIS communication uses multiple tools and media, adapting to the socio-cultural context and aiming for accessibility. For example, the study uses both traditional and online strategies, it engages the local press, and it uses both German and Italian. The introduction of a film about the study during the consent process shortened the enrollment time because the film was perceived to provide answers to the questions participants had previously asked CHRIS study assistants. CHRIS participants appreciated the multimedia strategy, which enhanced their understanding of the study, and they valued the communication from the study.

Our studies of CHRIS participants’ experience with dynamic consent thus gave us relevant insights into the issues discussed in this blog post. If you want to read more, you can find the above-mentioned article here: Ten years of dynamic consent in the CHRIS study: informed consent as a dynamic process. A general lesson from our work is that researchers can learn from the experiences of research participants to refine the informed consent process and adapt it to the needs of participants and researchers while meeting ethical and legal requirements.

Roberta Biasiotto

Written by…

Roberta Biasiotto is a research fellow at the Department of Biomedical, Metabolic and Neural Sciences of the University of Modena and Reggio Emilia and a researcher at the Institute for Biomedicine at Eurac Research, Italy.

Mascalzoni D, Melotti R, Pattaro C, Pramstaller PP, Gögele M, De Grandi A, Biasiotto R. Ten years of dynamic consent in the CHRIS study: informed consent as a dynamic process. Eur J Hum Genet (2022). https://doi.org/10.1038/s41431-022-01160-4

Approaching future issues

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Precision medicine algorithms and personal encounters

12 September, 2023 / / 1 Comment

The characters in Franz Kafka’s novels go astray in the corridors of bureaucracy. Impersonal officials handle never-defined cases as if they were robots controlled by algorithms as obscure as they are relentless. Judgments are passed without the convicted receiving any comprehensible information about possible charges.

Please excuse this dramatic introduction, which, in a perhaps slightly extreme way, is only intended to highlight a point in an article about precision medicine. Namely, the importance of placing the methods of precision medicine within the framework of the meeting between patient and physician: the importance of “personalizing” precision medicine.

Precision medicine is the name for methods to optimize disease management on the basis of the patient’s individual genetic profile. A bit like in a dating app that is meant to identify the best potential partner for you. Algorithms are used to calculate how patients with different genetic variants are likely to respond to drug treatments for some disease. There are advantages to this. The most effective and safe treatment for the patient in question can be identified. It also means that you can avoid treatments from which a patient with a certain genetic profile has very serious side effects. Or from which the patient is unlikely to get any positive effect, but would only suffer the side effects.

Together with several co-authors, Åsa Grauman at CRB recently published an interview study on precision medicine. Patients with a form of blood cancer (AML) in Finland, Italy and Germany were interviewed about how they viewed precision medicine, and about their preferences for being involved in this new way of making treatment decisions. Something I found interesting was that several (not all) participants wanted and valued information, but not for the purpose of making decisions. They wanted information to prepare themselves mentally, to know what to expect and to understand why different measures were being taken. They wanted information to be able to make the transition to being patients, I would like to say.

Almost all participants were unfamiliar with precision medicine. When the interviewer described the concept to them, most of them felt that precision medicine made sense and they were hopeful that the methods could be useful in the future. For example, to avoid unnecessary treatments with severe side effects in patients with a certain genetic profile. But even if the participants had faith in the algorithms that may be used in precision medicine, they emphasized that the algorithms are only a tool for the physician. They said that the physician can see the human side of the patient and the disease, and that the physician should be able to go against the algorithm depending on factors in the patient other than those included in the algorithm. The algorithm must not replace the physician or run over the patient. Many participants thus seemed to hold the view that difficult treatment decisions can be left to the physician, if the physician has listened to both the algorithm and the patient. Participants also highlighted the problem of not fitting into the algorithm: being denied treatment because the algorithm does not consider one to be the right patient for the available treatment options.

In their discussion, the authors highlighted a particularly interesting aspect of the situation of making treatment decisions. Namely, that the patient can weigh benefits and risks differently than both the physician and the algorithm. Incorporating the patient’s own trade-offs is therefore fundamental, they write, for precision medicine to be considered personalized care. Read the thought-provoking interview study here: Personalizing precision medicine: Patients with AML perceptions about treatment decisions.

To summarize, one could say that patients need to meet not only their algorithmically optimized treatment. In order to understand and influence their situation as patients, they above all need to meet their physician. Even if the patients feel that the decisions are too difficult and are positive to the possibilities of precision medicine, they want to talk to the physician and they want their meeting to influence the decisions. Perhaps treatment in an important sense begins even before the treatment decision is made, when the patient first meets the physician and they begin to find their way together through the hospital corridors. Corresponding meaningful encounters were never experienced by the characters in Kafka’s novels.

Pär Segerdahl

Written by…

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

Åsa Grauman, Mika Kontro, Karl Haller, et al. Personalizing precision medicine: Patients with AML perceptions about treatment decisions. Patient Education and Counseling 115, 2023, https://doi.org/10.1016/j.pec.2023.107883

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In dialogue with patients

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The importance of ethical review in research with severely ill children

5 September, 2023 / / 1 Comment

Research ethics committees play an important role in safeguarding human beings in research. Respect for human dignity in research has not always been self-evident. The emergence of research ethics has taken place in the wake of ethical scandals and abuses in which society’s most vulnerable have been used and exploited in the name of science. I am thinking, for example, of the Nazis’ cruel medical experiments on children and other vulnerable people.

At a time when the role of ethical review is being vigorously debated in the media and the research community, it is important to do research on the significance of ethical review. In particular, we should explore the question how ethical review serves to protect those most vulnerable from being exploited in research.

In a recent study conducted by myself together with Anna T. Höglund, Sara Frygner-Holm and Tove Godskesen, we focus on ethical issues in research with ill children, who are often considered a particularly vulnerable group in research. We have interviewed members of the Swedish Ethical Review Authority about their perceptions of ethical issues in research applications involving ill children, for example children with cancer.

One thing that members really emphasized was how crucial it is that the researcher provides good, age-appropriate information to children when they invite them to research. Without good information, children are excluded from being involved in a meaningful way in decisions about research participation. Many of the members we interviewed were concerned that good information for children was often missing from research applications. This suggests that we as researchers may need to increase our efforts to really take children’s legal right to information and participation seriously and not leave the decisions about research participation to the parents alone. There might be a need for more practical guidance on how we can inform and ask children about research in an ethically sound and sustainable way.

Children’s active participation in decisions about research participation is ethically important, but so is of course also children’s right to be protected from various risks associated to research. Some populations of severely ill children are “heavily researched,” among them children with cancer. This is of course very good because it enables groundbreaking medical advances in childhood cancer care and treatment. But at the same time, we know that children and their parents can be particularly vulnerable when recruited to research, due to their challenging life situation. They are also very dependent on the healthcare system. For such reasons, the committee members in the study considered it essential that the children’s physical as well as mental health and integrity are sufficiently protected. This means that as a researcher, you should not only focus on medical risks, but also consider how the whole child is affected, both short and long term, by being part of your research project.

The members we interviewed felt they had an ethical responsibility to protect children from “bad research” – when severely ill children give of their precious time and energy, it is especially important that the research is of high scientific quality and answers research questions that are truly important, new and urgent. It has been controversial whether or not research ethics committees should assess the design and quality of research. However, as shortcomings in design and quality can significantly reduce the potential benefits of a project, such aspects should be assessed as part of the ethical review, so that ill children can be spared participation in research that is not likely to lead to new knowledge or medical advances.

Ethical review is governed by laws and regulations. Some members were concerned that the ethical review system risks becoming too one-sidedly focused on legal compliance and formalities, giving ethical reflection to little space. Ethical review of research involving severely ill children undoubtedly places high demands not only on legal competence, but also on clinical and ethical competence, good teamwork and personal qualities such as accuracy and responsibility. Moreover, the emergence of new advanced technologies in research and healthcare constantly presents research ethics committees with new complex ethical issues to ponder and address. Thankfully, philosophy and its ethical principles offer invaluable tools!

So, what is the role and significance of ethical review in research with ill children? As our study suggests, ethical review and research ethics committees have, among other things, a crucial role in monitoring and promoting children’s right to information, participation and protection from harm and risks in research. These are urgent tasks, both from a children’s rights perspective and a research ethics perspective. If you want to know more about our results and read our discussion of the findings, you can find the study here: Research ethics committee members’ perspectives on paediatric research: a qualitative interview study.

Children’s perspectives have not been represented in research ethics to any great extent and more knowledge is therefore needed regarding children’s own experiences of research participation. Therefore, in an upcoming study, we will now interview children with cancer and their parents about how they experienced being asked to participate in research. 

Kajsa Norberg Wieslander

Written by…

Kajsa Norberg Wieslander, PhD student at the Centre for Research Ethics & Bioethics, is exploring ethical and clinical aspects of recruiting children with cancer to research studies.

Norberg Wieslander, K., Höglund, A. T., Frygner-Holm, S., & Godskesen, T. (2023). Research ethics committee members’ perspectives on paediatric research: a qualitative interview study. Research Ethics, 0(0). https://doi.org/10.1177/17470161231179663

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Ethics needs empirical input

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Philosophically anchored psychotherapy

Socrates image by fszalai on Pixabay
20 June, 2023 / / 3 Comments

Philosophy is often regarded as impractical and useless. At the same time, philosophy has a therapeutic aspect. Socrates practiced philosophy with people he met in Athens. He tried to persuade them to care not only about their bodies, their money and the affairs of the state, but to also examine themselves and take care of their soul. The same can be said of the Stoics, who emphasized that philosophy must be put into practice and actually change our ways of life. They gave public inspirational speeches about the importance of bringing order to our chaotic souls and they talked to people about how we can live completely fulfilling lives. How impractical and useless is that?

Both Socrates’ art of conversation and the life advice of the Stoics have inspired the emergence of cognitive behavioral therapies. In recent times, Asian philosophy and meditation have also inspired psychotherapy in the form of so-called mindfulness, used as a method to manage stress, anxiety and pain. However, there is a tendency to gloss over the philosophical influence behind these methods, as if philosophy were something impractical and useless! There is a risk that, in an effort to present a clinically effective facade, one covers up the philosophical depth, while the problems one tries to treat are often connected with superficial hopes for quick and effective solutions.

Can today’s psychotherapies more openly and directly draw inspiration from philosophy? Are there already such bridges to philosophy that can be strengthened? If so, what distinguishes them? These questions are investigated by Sylvia Martin, researcher at CRB and a practicing psychotherapist herself. In a review article, she focuses on work with values in various forms of cognitive behavioral therapy as a bridge to philosophy that could be strengthened. I will give an example from the article of such work, which suggests how patients can be supported to find a more stable and fulfilling attitude to life.

Many people seek meaning in life through various objectives and projects, which they then try to realize. They believe that happiness will only come if they get to travel to Beijing, find a new job, buy a house or get a dog. Objectives do not provide stable meaning and fulfillment. On the contrary. The satisfaction when objectives are realized is short-lived and soon turns into a feeling of emptiness that must be filled by new exciting projects. There is of course nothing wrong with travel, jobs, houses or dogs, but when chasing new objectives becomes a pattern it can be unfortunate. Soon a whole life is filled with objectives that do not give the stable fulfillment that one is really longing for. The pattern of seeking new objectives and projects that will give meaning and satisfaction becomes a self-destructive lifestyle, which it eventually becomes difficult to get out of. But through therapy, people can be helped to see the unfortunate pattern. For example, they can be given the task of imagining the objective of “traveling to Beijing”: how they save money for the trip, learn Chinese and plan the trip. They can imagine all the fun they have in Beijing. But how does it feel to come home again? To come home is to return to meaninglessness and immediately the same old emptiness must be filled by a new project. Values such as compassion and truth differ from objectives by being more like a road that never ends. Values can be cultivated and deepened without end. The path becomes the destination, fulfillment lies in walking it, and the elusive notion of “finally finding fulfillment” dissolves. But all of this of course assumes that the therapy is not perceived as a “trip to Beijing” that will finally bring fulfillment. There are no easy solutions to the problem of a meaningless life, such as new trips, new jobs, new houses… or new therapies.

Philosophically anchored psychotherapy can contribute to the deepening required, so that the work with values does not become another project that reinforces superficial attitudes to life. Perhaps the impression that philosophy is impractical and useless is even related to the restless attitude that a meaningful life requires objectives to be effectively realized? Philosophy is not a project, but more like a lifelong path. Read Sylvia Martin’s review article here: Using values in cognitive and behavioral therapy: a bridge back to philosophy.

Pär Segerdahl

Written by…

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

Martin, S. Using values in cognitive and behavioral therapy: a bridge back to philosophy. Journal of Evaluation in Clinical Practice. 2023; 1- 7. doi:10.1111/jep.13872

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We challenge habits of thought

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Using artificial intelligence with academic integrity

Phone with ChatGPT open
6 June, 2023 / / 1 Comment

AI tools can both transform and produce content such as texts, images and music. The tools are also increasingly available as online services. One example is the ChatGPT tool, which you can ask questions and get well-informed, logically reasoned answers from. Answers that the tool can correct if you point out errors and ambiguities. You can interact with the tool almost as if you were conversing with a human.

Such a tool can of course be very useful. It can help you solve problems and find relevant information. I venture to guess that the response from the tool can also stimulate creativity and open the mind to unexpected possibilities, just as conversations with people tend to do. However, like all technology, these tools can also be abused and students have already used ChatGPT to complete their assignments.

The challenge in education and research is thus to learn to use these AI tools with academic integrity. Using AI tools is not automatically cheating. Seven participants in a European network for academic integrity (ENAI), including Sonja Bjelobaba at CRB, write about the challenge in an editorial in International Journal for Educational Integrity. Above all, the authors summarize tentative recommendations from ENAI on the ethical use of AI in academia.

An overarching aim in the recommendations is to integrate recommendations on AI with other related recommendations on academic integrity. Thus, all persons, sources and tools that influenced ideas or generated content must be clearly acknowledged – including the use of AI tools. Appropriate use of tools that affect the form of the text (such as proofreading tools, spelling checkers and thesaurus) are generally acceptable. Furthermore, an AI tool cannot be listed as a co-author in a publication, as the tool cannot take responsibility for the content.

The recommendations also emphasize the importance of educational efforts on the ethical use of AI tools. Read the recommendations in their entirety here: ENAI Recommendations on the ethical use of Artificial Intelligence in Education.

Pär Segerdahl

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

Foltynek, T., Bjelobaba, S., Glendinning, I. et al. ENAI Recommendations on the ethical use of Artificial Intelligence in Education. International Journal for Educational Integrity 19, 12 (2023). https://doi.org/10.1007/s40979-023-00133-4

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We care about education

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Encourage children to take responsibility for others?

30 May, 2023 / / 1 Comment

It happens that academics write visionary texts that highlight great human challenges. I blogged about such a philosophically visionary article a few years ago; an article in which Kathinka Evers discussed the interaction between society and the brain. In the article, she developed the idea that we have a “proactive” responsibility to adapt our societies to what we know about the brain’s strengths and weaknesses. Above all, she emphasized that the knowledge we have today about the changeability of the brain gives us a proactive responsibility for our own human nature, as this nature is shaped and reshaped in interaction with the societies we build.

Today I want to recommend a visionary philosophical article by Jessica Nihlén Fahlquist, an article that I think has points of contact with Kathinka Evers’ paper. Here, too, the article highlights our responsibility for major human challenges, such as climate and, above all, public health. Here, too, human changeability is emphasized, not least during childhood. Here, too, it is argued that we have a responsibility to be proactive (although the term is not used). But where Kathinka Evers starts from neuroscience, Jessica Nihlén Fahlquist starts from virtue ethics and from social sciences that see children as social actors.

Jessica Nihlén Fahlquist points out that we live in more complex societies and face greater global challenges than ever before in human history. But humans are also complex and can under favorable circumstances develop great capacities for taking responsibility. Virtue ethics has this focus on the human being and on personal character traits that can be cultivated and developed to varying degrees. Virtue ethics is sometimes criticized for not being sufficiently action-guiding. But it is hard to imagine that we can deal with major human challenges through action-guiding rules and regulations alone. Rules are never as complex as human beings. Action-guiding rules assume that the challenges are already under some sort of control and thus are not as uncertain anymore. Faced with complex challenges with great uncertainties, we may have to learn to trust the human being. Do we dare to trust ourselves when we often created the problems?

Jessica Nihlén Fahlquist reasons in a way that brings to mind Kathinka Evers’ idea of a proactive responsibility for our societies and our human nature. Nihlén Fahlquist suggests, if I understand her correctly, that we already have a responsibility to create environments that support the development of human character traits that in the future can help us meet the challenges. We already have a responsibility to support greater abilities to take responsibility in the future, one could say.

Nihlén Fahlquist focuses on public health challenges and her reasoning is based on the pandemic and the issue of vaccination of children. Parents have a right and a duty to protect their children from risks. But reasonably, parents can also be considered obliged not to be overprotective, but also to consider the child’s development of agency and values. The virus that spread during the pandemic did not cause severe symptoms in children. Vaccination therefore does not significantly protect the child’s own health, but would be done with others in mind. Studies show that children may be capable of reasoning in terms of such responsibility for others. Children who participate in medical research can, for example, answer that they participate partly to help others. Do we dare to encourage capable children to take responsibility for public health by letting them reason about their own vaccination? Is it even the case that we should support children to cultivate such responsibility as a virtue?

Nihlén Fahlquist does not claim that children themselves have this responsibility to get vaccinated out of solidarity with others. But if some children prove to be able to reason in such a morally complex way about their own vaccination, one could say that these children’s sense of responsibility is something unexpected and admirable, something that we cannot demand from a child. By encouraging and supporting the unexpected and admirable in children, it can eventually become an expected responsibility in adults, suggests Jessica Nihlén Fahlquist. Virtue ethics makes it meaningful to think in terms of such possibilities, where humans can change and their virtues can grow. Do we dare to believe in such possibilities in ourselves? If you do not expect the unexpected you will not discover it, said a visionary Greek philosopher named Heraclitus.

Jessica Nihlén Fahlquist’s article is multifaceted and innovative. In this post, I have only emphasized one of her lines of thought, which I hope has made you curious about an urgent academic text: Taking risks to protect others – pediatric vaccination and moral responsibility.

In summary, Jessica Nihlén Fahlquist argues that vaccination should be regarded as an opportunity for children to develop their sense of responsibility and that parents, schools, healthcare professionals and public health authorities should include children in debates about ethical public health issues.

Pär Segerdahl

Written by…

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

Jessica Nihlén Fahlquist, Taking Risks to Protect Others – Pediatric Vaccination and Moral Responsibility, Public Health Ethics, 2023;, phad005, https://doi.org/10.1093/phe/phad005

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Approaching future issues

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When ordinary words get scientific uses

Neuron
16 May, 2023 / / 1 Comment

A few weeks ago, Josepine Fernow wrote an urgent blog post about science and language. She linked to a research debate about conceptual challenges for neuroscience, challenges that arise when ordinary words get specialized uses in science as technically defined terms.

In the case under debate, the word “sentience” had been imported into the scientific study of the brain. A research group reported that they were able to determine that in vitro neurons from humans and mice have learning abilities and that they exhibit “sentience” in a simulated game world. Of course, it caused quite a stir that some neurons grown in a laboratory could exhibit sentience! But the research team did not mean what attracted attention. They meant something very technical that only a specialist in the field can understand. The surprising thing about the finding was therefore the choice of words.

When the startling choice of words was questioned by other researchers, the research team defended themselves by saying that they defined the term “sentience” strictly scientifically, so that everyone should have understood what they meant, at least the colleagues in the field. Well, not all people are specialists in the relevant field. Thus the discovery – whatever it was that was discovered – raised a stir among people as if it were a discovery of sentience in neurons grown in a laboratory.

The research group’s attitude towards their own technical language is similar to an attitude I encountered long ago in a famous theorist of language, Noam Chomsky. This is what Chomsky said about the scientific study of the nature of language: “every serious approach to the study of language departs from the common-sense usage, replacing it by some technical concept.” Chomsky is of course right that linguistics defines its own technical concepts of language. But one can sense a certain hubris in the statement, because it sounds as if only a linguistic theorist could understand “language” in a way that is worthy of serious attention. This is untenable, because it raises the question what a technical concept of language is. In what sense is a technical concept a concept of language? Is it a technical concept of language in the common sense? Or is it a technical concept of language in the same inaccessible sense? In the latter case, the serious study of language seems to degenerate into a navel-gazing that does not access language.

For a technical concept of language to be a concept of language, our ordinary notions must be taken into account. Otherwise, the technical concept ceases to be a concept of language.

This is perhaps something to consider in neuroscience as well. Namely to the extent that one wants to shed light on phenomena such as consciousness and sentience. Of course, neuroscience will define its own technical concepts of these phenomena, as in the debated case. But if the technical concepts are to function as concepts of consciousness and sentience, then one cannot neglect our ordinary uses of words.

Science is very serious and important. But if the special significance of science goes to our heads, then our attitude risks undermining the great importance of science for humanity. Here you can read the views of three neuroethicists on these important linguistic issues: Conceptual conundrums for neuroscience.

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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Minding our language

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