Supporting clinicians to trust themselves

October 3, 2018

Pär SegerdahlSuppose that you want to learn to speak a language, but the course is overloaded by grammatical terminology. During the lessons, you hardly hear any of the words that belong to the language you want to learn. They drown in technical, grammatical terms. It is as if you had come to a course on general linguistic theory, not German.

When clinicians encounter healthcare ethics as a subject of education, they may have similar experiences. As adult humans they already can feel when everything is alright in a situation. Or when there is a problem; when attention is needed and action must be taken. (We do it every day.) However, to handle the specific challenges that may arise in healthcare, clinicians may need support to further develop this already existing human ability.

Unfortunately, healthcare ethics is typically not presented as development of abilities we already have as human beings. Instead, it is presented as a new subject. Being ethical is presented as having the specific knowledge of this subject. Ethics then seems to be about reasoning in terms of abstract ethical concepts and principles. It is as if you had come to a course on general moral theory, not healthcare ethics. And since most of us do not know a thing about moral theory, we feel ethically stupid and powerless, and lose our self-confidence.

However, just as you don’t need linguistic theory to speak a language, you don’t need moral theory to function ethically. Rather, it is the other way around. It is because we already speak and function ethically that there can be such intellectual activities as grammar and moral theory. Can healthcare ethics be taught without putting the cart before the horse?

A new (free to download) book discusses the issue: Rethinking Health Care Ethics. The book is a lucid critique of healthcare ethics as a specific subject; a critique that naturally leads into constructive suggestions for an alternative pedagogy. The book should be of high interest to teachers in healthcare ethics, to ethicists, and to anyone who finds that ethics often is presented in ways that make us estranged from ourselves.

What most impresses me in this book is its trust in the human. The foundation of ethics is in the human self, not in moral theory. Any adult human already carries ethics in the self, without verbalizing it as specific ethical concepts and principles.

Certainly, clinicians need education in healthcare ethics. But what is specific in the teaching is the unique ethical challenges that may arise in healthcare. Ethics itself is already in place, in the living humans who are entering healthcare as a profession.

Ethics should not be imposed, then, as if it were a new subject. It rather needs support to grow in humans, and to mature for the specific challenges that arise in healthcare.

This trust in the human is unusual. Distrust, feeding the demand for control, is so much more common.

Pär Segerdahl

Scher, S. & Kozlowska, K. 2018. Rethinking Health Care Ethics. Palgrave

This post in Swedish

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Sharing a blog post on consciousness

August 29, 2018

Michele Farisco at CRB has written an interesting post for the BMC blog on medicine. He says that “whereas ethical analyses of disorders of consciousness traditionally focus on residual awareness, there may be a case to be made for the ethical relevance of the retained unawareness.”

Interested to read more? Here is a link to the post: On consciousness and the unconscious.

Pär Segerdahl

We recommend readings - the Ethics Blog


Philosophy in responsible research and innovation

August 22, 2018

Pär SegerdahlThe honorable discipline philosophy is hardly anything we associate with groundbreaking research and innovation. Perhaps it is time we began to see a connection.

To begin with, we can let go of the image of philosophy as an honorable discipline. Instead, let us talk about the spirit of philosophy. People who think for themselves, as philosophers do, rarely find themselves at home within the narrow bounds of disciplines and fields. Not even if they are called philosophical. On the contrary, if such a person encounters boundaries that restrict her thought, she investigates the boundaries. And removes them, if necessary.

Forget the reverent representation of philosophy as an honorable discipline.

The spirit of philosophy is to avoid discipline, submission, tradition and all forms of dependence. Someone who functions as a loyal representative of a philosophical school is hardly a genuine thinker. A philosopher is someone who, in a spirit of absolute independence, questions everything that makes a pretense of being true, right and correct. Therefore, it has been said that one cannot learn philosophy, only to philosophize. As soon as a philosophy crystallizes, the philosophical spirit awakens and investigates the boundaries of what usually turns out to be a fad that attracts insecure intellects who shun independent thinking. No system of thought restricts a freely investigating thinker. Especially not the philosophy that is in fashion.

How does this spirit of philosophy connect to research and innovation? The connection I see is different than you probably guess. It is not about boosting the development by removing all boundaries, but about taking responsibility for the development. Philosophical thinking does not resemble an overheated research field’s fast flow of ideas, or an entrepreneur’s grandiose visions for the future. On the contrary, a philosopher takes a step back to calmly investigate the flow of ideas and visions.

Philosophy’s freedom is basically a responsibility.

Responsible Research and Innovation has become an important political theme for the European Commission. This responsibility is understood as an interactive process that engages social actors, researchers and innovators. Together, they are supposed to work towards ethically permissible research activities and products. This presupposes addressing also underlying societal visions, norms and priorities.

For this to work, however, separate actors cannot propagate separate interests. You need to take a step back and make yourself independent of your own special interests. You need to make yourself independent of yourself! Reflect more open-mindedly than you were disciplined to function, and see beyond the bounds of your fragmentary little field (and self). This spacious spirit of philosophy needs to be awakened: the freedom of thought that is basically the responsibility of thought.

Concrete examples of what this means are given in the journal, Neuroethics. In an article, Arleen Salles, Kathinka Evers and Michele Farisco describe the role that philosophical reflection currently plays in the European Flagship, the Human Brain Project. Here, philosophy and neuroethics are no mere appendages of neuroscientific research. On the contrary, by reflecting on central concepts in the project, philosophers contribute to the overall self-understanding in the project. Not by imposing philosophy as a special interest, or as a competing discipline with its own concepts, but by open-mindedly reflecting on neuroscientific concepts, clarifying the questions they give rise to.

The authors describe three areas where philosophy contributes within the Human Brain Project, precisely through awakening the spirit of philosophy. First, conceptual questions about connections between the brain and human identity. Secondly, conceptual questions about connections between the brain and consciousness; and between consciousness and unconsciousness. Thirdly, conceptual questions about links between neuroscientific research and political initiatives, such as poverty reduction.

Let us drop the image of philosophy as a discipline. For we need the spirit of philosophy.

Pär Segerdahl

Salles, A., Evers, K. & Farisco, M. Neuroethics (2018). https://doi.org/10.1007/s12152-018-9372-9

(By the way, anyone can philosophize. If you have the spirit, you are a philosopher. A demanding education in philosophy as a separate discipline can actually be an obstacle that you have to overcome.)

This post in Swedish

We transgress disciplinary borders - the Ethics Blog


Driverless car ethics

June 20, 2018

Pär SegerdahlSelf-driving robot cars are controlled by computer programs with huge amounts of traffic rules. But in traffic, not everything happens smoothly according to the rules. Suddenly a child runs out on the road. Two people try to help a cyclist who collapsed on the road. A motorist tries to make a U-turn on a too narrow road and is stuck, blocking the traffic.

Assuming that the robots’ programs are able to categorize traffic situations through image information from the cars’ cameras, the programs must select the appropriate driving behavior for the robot cars. Should the cars override important traffic rules by, for example, steering onto the sidewalk?

It is more complicated than that. Suppose that an adult is standing on the sidewalk. Should the adult’s life be compromised to save the child? Or to save the cyclist and the two helpful persons?

The designers of self-driving cars have a difficult task. They must program the cars’ choice of driving behavior in ethically complex situations that we call unexpected, but the engineers have to anticipate far in advance. They must already at the factory determine how the car model will behave in future “unexpected” traffic situations. Maybe ten years later. (I assume the software is not updated, but also updated software anticipates what we normally see as unexpected events.)

On a societal level, one now tries to agree on ethical guidelines for how future robot cars should behave in tragic traffic situations where it may not be possible to completely avoid injuries or fatal casualties. A commission initiated by the German Ministry for Transportation, for example, suggests that passengers of robot cars should never be sacrificed to save a larger number of lives in the traffic situation.

Who, by the way, would buy a robot car that is programmed to sacrifice one’s life? Who would choose such a driverless taxi? Yet, as drivers we may be prepared to sacrifice ourselves in unexpected traffic situations. Some researchers decided to investigate the matter. You can read about their study in ScienceDaily, or read the research article in Frontiers in Behavioral Neuroscience.

The researchers used Virtual Reality (VR) technology to expose subjects to ethically difficult traffic situations. Thereafter, they studied the subjects’ choice of traffic behavior. The researchers found that the subjects were surprisingly willing to sacrifice themselves to save others. But they also took into consideration the age of potential victims and were prepared to steer onto the sidewalk to minimize the number of traffic victims. This is contrary to norms that we hold important in society, such as the idea that age discrimination should not occur and that the lives of innocent people should be protected.

In short, humans are inclined to drive their cars politically incorrectly!

Why was the study done? As far as I understand, because the current discussion about ethical guidelines does not take into account empirical data on how living drivers are inclined to drive their cars in ethically difficult traffic situations. The robot cars will make ethical decisions that can make the owners of the cars dissatisfied with their cars; morally dissatisfied!

The researchers do not advocate that driverless cars should respond to ethically complex traffic situations as living people do. However, the discussion about driverless car ethics should take into account data on how living people are inclined to drive their cars in traffic situations where it may not be possible to avoid accidents.

Let me complement the empirical study with some philosophical reflections. What strikes me when I read about driverless car ethics is that “the unexpected” disappears as a living reality. A living driver who tries to handle a sudden traffic situation manages what very obviously is happening right now. The driverless car, on the other hand, takes decisions that tick automatically, as predetermined as any other decision, like stopping at a red light. Driverless car ethics is just additional software that the robot car is equipped with at the factory (or when updating the software).

What are the consequences?

A living driver who suddenly ends up in a difficult traffic situation is confronted – as I said – with what is happening right now. The driver may have to bear responsibility for his actions in this intense moment during the rest of his life. Even if the driver rationally sacrifices one life to save ten, the driver will bear the burden of this one death; dream about it, think about it. And if the driver makes a stupid decision that takes more lives than it saves, it may still be possible to reconcile with it, because the situation was so unexpected.

This does not apply, however, to the robot car that was programmed at the factory according to guidelines from the National Road Administration. We might want to say that the robot car was preprogrammed to sacrifice our sister’s life, when she stood innocently on the sidewalk. Had the car been driven by a living person, we would have been angry with the driver. But after some time, we might be able to start reconciling with the driver’s behavior. Because it was such an unexpected situation. And the driver is suffering from his actions.

However, if it had been a driverless car that worked perfectly according to the manufacturer’s programs and the authorities’ recommendations, then we might see it as a scandal that the car was preprogrammed to steer onto the sidewalk, where our sister stood.

One argument for driverless cars is that, by minimizing the human factor, they can reduce the number of traffic accidents. Perhaps they can. But maybe we are less accepting as to how they are programmed to save lives in ethically difficult situations. Not only are they preprogrammed so that “the unexpected” disappears as a reality. They do not bear the responsibility that living people are forced to bear, even for their rational decisions.

Well, we will probably find ways to implement and accept the use of driverless cars. But another question still concerns me. If the present moment disappears as a living reality in the ethics software of driverless cars, has it not already disappeared in the ethics that prescribes right and wrong for us living people?

Pär Segerdahl

This post in Swedish

We like real-life ethics : www.ethicsblog.crb.uu.se


Can neuroscience and moral education be united?

June 4, 2018

Daniel Pallarés DomínguezPeople have started to talk about neuroeducation, but what is it? Is it just another example of the fashion of adding the prefix neuro- to the social sciences, like neuroethics, neuropolitics, neuromarketing and neurolaw?

Those who remain sceptical consider it a mistake to link neuroscience with education. However, for some authors, neuroscience can provide useful knowledge about the brain, and they see neuroeducation as a young field of study with many possibilities.

From its birth in the decade of the brain (1990), neuroeducation has been understood as an interdisciplinary field that studies developmental learning processes in the human brain. It is one of the last social neurosciences to be born. It has the progressive aim of improving learning-teaching methodologies by applying the results of neuroscientific research.

Neuroscientific research already plays an important role in education. Taking into account the neural bases of human learning, neuroeducation looks not only for theoretical knowledge but also for practical implications, such as new teaching methodologies, and it reviews classical assumptions about learning and studies disorders of learning. Neuroeducation studies offer possibilities such as early detection of special learning needs or even monitoring and comparing different teaching methodologies implemented in school.

Although neuroeducation primarily focuses on disorders of learning, especially in mathematics and language (dyscalculia and dyslexia), can it be extended to other areas? If neuroscience can shed light on the development of ethics in the brain, can such explorations form the basis of a new form of neuroeducation, moral neuroeducation, which studies the learning or development of ethics?

Before introducing a new term (moral neuroeducation), prudence and critical discussion are needed. First, what would the goal of moral neuroeducation be? Should it consider moral disorders in the brain or just immoral behaviours? Second, neuroscientific knowledge is used in neuroeducation to help design practices that allow more efficient teaching to better develop students’ intellectual potentials throughout their training process. Should this be the goal also of moral neuroeducation? Should we strive for greater efficiency in teaching ethics? If so, what is the ethical competence we should try to develop in students?

It seems that we still need a critical and philosophical approach to the promising union of neuroscience and moral education. In my postdoctoral project, Neuroethical Bases for Moral Neuroeducation, I will contribute to developing such an approach.

Daniel Pallarés Domínguez

My postdoctoral research at the Centre for Research Ethics and Bioethics (CRB) is linked to a research project funded by the Ministry of Economy and Competitiveness in Spain. That project is entitled, Moral Neuroeducation for Applied Ethics [FFI2016-76753-C2-2-P], and is led by Domingo García-Marzá.

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Bioethics dissolving misdirected worldliness

May 16, 2018

Pär SegerdahlWhen we feel low, we often make the mistake of scanning the external environment to find the cause of our state of mind out there. One could speak of the depressed person’s misdirected worldliness. We are convinced that something in the world makes us depressed. We exclude that we ourselves play a role in the drama: “I am depressed because he/she/they/society is so damned…”

The depressed person naturally believes that the way to happiness lies in eliminating the external cause of the depression: “If I just could be spared from dealing with him/her/them/society, I would feel a lot better.” That is what the depressed person’s worldliness looks like. We are unable to turn around and see (and treat) the emergence of the problem within ourselves.

Xenophobia might be a manifestation of the depressed person’s misunderstanding of life. We could speak of the insecure person’s misdirected worldliness. One scans the external environment to find the cause of one’s insecurity in the world. When one “finds” it, one apparently “proves” it beyond doubt. The moment one thinks about immigration, one is attacked by strong feelings of insecurity: no doubt, that’s the cause! The alternative possibility that one carries the insecurity within oneself is excluded: “I’m suffering because society is becoming increasingly insecure.”

Finally, one makes politics of the difficulty of scrutinizing oneself. One wants to eliminate the external cause of the insecurity one feels: “If we stop immigration, society will become safer and I will feel more secure!” That is what the insecure person’s misdirected worldliness looks like.

You might be surprised that even anti-xenophobia can exhibit the depressed person’s misunderstanding of life. If we lack a deep understanding of how xenophobia can arise within a human being, we will believe that there are evil people who in their stupidity spread fake statistics about increasing social insecurity. These groups must be eliminated, we think: “If there were no xenophobic groups in society, then I would feel much better.” That is what the good activist’s worldliness can look like.

Like that we go on and on, in our misdirected worldliness, because we fail to see our own role in the drama. We make politics of our inner states, which flood the world as if they were facts that should appear in the statistics. (Therefore, we see them in the statistics.)

Now you may be surprised again, because even bioethics can exhibit the depressed person’s misunderstanding of life. I am thinking of the tendency to make ethics an institution that maintains moral order in society. Certainly, biomedical research needs regulation, but sometimes regulation runs the errands of a misdirected worldliness.

A person who feels moral unease towards certain forms of research may think, “If researchers did not kill human embryos, I would feel a lot better.” Should we make policy of this internal state by banning embryonic stem cell research? Or would that be misdirected projection of an inner state on the world?

I cannot answer the question in this post; it requires more attention. All I dare to say is that we, more often than we think, are like depressed people who seek the cause of our inner states in the world. Just being able to ask if we manifest the depressed person’s misunderstanding of life is radical enough.

I imagine a bioethics that can ask the self-searching question and seek practical ways to handle it within ourselves. So that our inner states do not flood the world.

Pär Segerdahl

This post in Swedish

We think about bioethics : www.ethicsblog.crb.uu.se


Where to publish and not to publish in bioethics – the 2018 list

May 2, 2018

Stefan Eriksson, Associate Professor of Research Ethics, Uppsala University

Allegedly, there are over 12.000 so called predatory journals out there. Instead of supporting readers and science, these journals serve their own economic interests first and at best offer dubious merits for scholars. We believe that scholars working in any academic discipline have a professional interest and a responsibility to keep track of these journals. It is our job to warn the young or inexperienced of journals where a publication or editorship could be detrimental to their career and science is not served. We have seen “predatory” publishing take off in a big way and noticed how colleagues start to turn up in the pages of some of these journals. While many have assumed that this phenomenon mainly is a problem for low status universities, there are strong indications that predatory publishing is a part of a major trend towards the industrialization of misconduct and that it affects many top-flight research institutions (see Priyanka Pulla: “In India, elite institutes in shady journals”, Science 354(6319): 1511-1512). This trend, referred to by some as the dark side of publishing, needs to be reversed.

Gert Helgesson, Professor of Medical Ethics, Karolinska InstitutetThus we published this blog post in 2016. This is our second  annual update (the first version can be found here). At first, we relied heavily on the work of Jeffrey Beall, a librarian at the University of Colorado, who run blacklists of “potential, possible, or probable” predatory publishers and journals. His lists have since been removed although they live on in new form (anonymous) at the Stop predatory journals site (SPJ) and they can also be found archived. These lists were not, however, the final say on the matter, as it is impossible for one person to judge reliably actors in every academic discipline. Moreover, since only questionable journals are listed, the good journals must be found elsewhere.

A response of gatekeeping needs to be anchored in each discipline and the scholars who make up that discipline. As a suitable response in bioethics, we have chosen to, first, collect a few authoritative lists of recommended bioethics journals that can be consulted by anyone in bioethics to find good journals to publish with. For our first post, we recommended a list of journals ourselves, which brought on some well-deserved questions and criticism about criteria for inclusion. Unfortunately then, our list ultimately drew attention from other parts of the message that we were more concerned to get across. Besides, there are many other parties making such lists. We therefore have dropped this feature. Instead we have enlarged the collection of good journal lists to the service of our readers. They are all of great use when further exploring the reputable journals available:

It is of prime importance to list the journals that are potentially or possibly predatory or of such a low quality that it might be dishonoring to engage with them. We have listed all 39 of them (up with three from last year, although some are presently not responsive) alphabetically and provided both the homepage URL and links to any professional discussion of these journals that we have found (which most often alerted us to their existence in the first place).

Each of these journals asks scholars for manuscripts from, or claims to publish papers in bioethics or related areas (such as practical philosophy). They have been reviewed by the authors of this blog post as well as by a group of reference scholars that we have asked for advice on the list. Those journals listed have unanimously been agreed are journals that – in light of the criticism put forth and the quality we see – we would not deem acceptable for us to publish in. Typical signs as to why a journal could fall in this category, such as extensive spamming, publishing in almost any subject, or fake data being included on the website etc., are listed here:

We have started to more systematically evaluate the journals against the 25 defining characteristics we outlined in the article linked to above (with the help of science and technology PhD students). The results will be added when they exist.

We would love to hear about your views on this blog post, and be especially grateful for pointers to journals engaging in sloppy or bad publishing practices. The list is not meant as a check-list but as a starting point for any bioethics scholar to ponder for him- or herself where to publish.

Also, anyone thinking that a journal in our list should be given due reconsideration might post their reasons for this as a comment to the blog post or send an email to us. Journals might start out with some sloppy practices but shape up over time and we will be happy to hear about it. You can make an appeal against the inclusion of a journal and we will deal with it promptly and publicly.

Please spread the content of this blog as much as you can and check back for updates (we will do a major update annually and continually add any further information found).

WHERE NOT TO PUBLISH IN BIOETHICS – THE 2018 LIST

UPDATE I:

Journal of International Ethical Theory and Practice (MedCrave)
Criticism 1 │ Criticism 2 │ Criticism 3 │ Criticism 4 │ Criticism 5 │ Criticism 6 │ Criticism 7
Critical remark (May 2018): New journal with no articles or issues yet – but still is in need of so many editors that spam emails are sent. They kindly allow for scientific articles: “The research articles can include the findings and the methodology you used.” MedCrave uses many alternative indexing services. They are listed by SPJ. They also spam the Internet with claims for all criticism to be a hoax or fake news.

UPDATE II:

The following journals are all included in Cabells’ blacklist of “predatory journals”:

  • American Open Ethics Journal (Research and Knowledge Publication)
  • Ethics Today Journal (Franklin Publishing)
  • Universal Open Ethics Journal (Adyan Academic Press)

UPDATE III:

Journal of Research in Philosophy and History (Scholink)
Criticism 1 │
Critical remark (June 2018): Listed on several lists of predatory publishers. They only do “peer review” through their own editorial board, a flowchart states. They claim to check for plagiarism but the first 2018 article abstract run by us through a checker turned out to be self-plagiarized from a book and it looks to have been published many times over. Unfortunately, the next paper checked in the same issue was also published the previous year by another journal listed above…

UPDATE IV:

International Journal of Current Research and Academic Review (Excellent Publishers)
Critical remark (June 2018): Listed by SPJ and Cabells because of misleading claims about credentials, metrics, and too quick review; alternative indexing; publishes in almost any field imaginable; the editor -in-chief is head of the “Excellent Education and Researh Institute” (sic) which does not seem to exist even when spelled right?

UPDATE V:

Annals of Bioethics & Clinical Applications (Medwin Publishers)
Criticism 1 │ Criticism 2
Critical remark: Publisher was on Beall’s list and is on many other lists of these journals. They say that they are “accepting all type of original works that is related to the disciplines of the journal” and indeed the flow chart of manuscript handling does not have a reject route. Indexed by alternative indexes.

End remark:

In light of recent legal action taken against people trying to warn others about dubious publishers and journals – see here and here – we want to stress that this blog post is about where we would like our articles to show up, it is about quality, and as such it is an expression of a professional judgement intended to help authors find good journals with which to publish. Indirectly, this may also help readers to be more discerning about the articles they read. As such it is no different from other rankings that can be found for various products and services everywhere. Our list of where not to publish implies no accusation of deception or fraud but claims to identify journals that experienced bioethicists would usually not find to be of high quality. Those criticisms linked to might be more upfront or confrontational; us linking to them does not imply an endorsement of any objectionable statement made therein. We would also like to point out that individual papers published in these journals might of course nevertheless be perfectly acceptable contributions to the scholarly literature of bioethics.

Stefan Eriksson & Gert Helgesson

Read more about Stefan’s work at CRB here

Essential resources on so-called predatory publishing and open access:

We like ethics : www.ethicsblog.crb.uu.se


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