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

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Genetic risk: Should researchers let people know?

September 24, 2018

Should researchers inform research participants if they happen to discover individual genetic risks of disease? Yes, many would say, if the information is helpful to the participants. However, the value of complex genetic risk information for individuals is uncertain. Jennifer Viberg Johansson suggests that this uncertainty needs to be acknowledged by both geneticists and ethicists.

One reason people want to participate in large genetic studies is the comprehensive health checks researchers often offer to collect data. In the future, people could also be offered information about genetic risks. According to Jennifer Viberg Johansson, there are some factors researchers should consider before offering these kinds of results.

Providing genetic risk information may not be as helpful to individuals as one may think. Knowing your genetic make-up is not the same as knowing your own probability for disease. In addition, the genetic risk information from research is not based on symptoms or personal concerns, as it would be in the healthcare system. It is thus less “personalised” and not connected to any symptoms.

Genetic risk information is complex and can be difficult to understand. To the research participants interviewed by Jennifer Viberg Johansson, risk information is something that offers them an explanation of who they are, where they are from, and where they may be heading. To them, learning about their genetic risk is an opportunity to plan their lives and take precautions to prevent disease.

Whether research participants want genetic risk information or not is more complex. Research participants themselves may change their answer depending on the way the question is asked. Risk research shows that we interpret probabilities differently, depending on the outcome and consequences. Jennifer Viberg Johansson’s work points in the same direction: probability is not an essential component of people’s decision-making when there are ways to prevent disease.

People have difficulties making sense of genetic risk when it is presented in the traditional numeric sense. It is hard to interpret what it means to have a 10 per cent or 50 per cent risk of disease. Instead, we interpret genetic risk as a binary concept: you either have risk, or you don’t. Based on her results, Jennifer Viberg Johansson suggests we keep this in mind for genetic counselling. We need to tailor counselling to people’s often binary perceptions of risk.

Communicating risk is difficult, and requires genetic counsellors to understand how different people understand the same figures in different ways.

Jennifer Viberg Johansson defended her dissertation September 21, 2018.

Anna Holm

Viberg Johansson J., (2018), INDIVIDUAL GENETIC RESEARCH RESULTS – Uncertainties, Conceptions, and Preferences, Uppsala: Acta Universitatis Upsaliensis

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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.)

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Intellectual asceticism

August 7, 2018

Pär SegerdahlWe dismiss the magician’s claim to be in touch with the spirit world. We dismiss the priest’s claim to be in touch with the divine. We do not believe in supernatural contact with a purer world beyond this one!

Nevertheless, similar claims permeate our enlightened rationalist tradition. Even philosophers promised contact with a purer sphere. The difference is that they described the pure sphere in intellectual terms. The promised control of “concepts,” “categories,” “principles” and so on. They lived, like monks and magicians, as ascetics. They sought power over life itself, but they did it through intellectual self-discipline.

If you want to think about asceticism as a trait of our philosophical tradition, you may want to take a look at an article I wrote: Intellectual asceticism and hatred of the human, the animal, and the material.

In the article, I try to show that philosophy’s infamous anthropocentrism is illusory. Philosophers never idealized the human. They idealized something much more exclusive. They idealized the ascetically purified intellect.

Pär Segerdahl

Segerdahl, P. 2018. Intellectual asceticism and hatred of the human, the animal, and the material. Nordic Wittgenstein Review 7 (1): 43-58. DOI 10.15845/nwr.v7i1.3494

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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

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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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Can a robot learn to speak?

May 29, 2018

Pär SegerdahlThere are self-modifying computer programs that “learn” from success and failure. Chess-playing computers, for example, become better through repeated games against humans.

Could a similar robot also learn to speak? If the robot gets the same input as a child gets when it learns to speak, should it not be possible in principle?

Notice how the question zigzags between child and machine. We say that the robot learns. We say that the child gets input. We speak of the robot as if it were a child. We speak of the child as if it were a robot. Finally, we take this linguistic zigzagging seriously as a fascinating question, perhaps even a great research task.

An AI expert and prospective father who dreamed of this great research task took the following ambitious measures. He equipped his whole house with cameras and microphones, to document all parent-child interactions during the child’s first years. Why? He wanted to know exactly what kind of linguistic input a child gets when it learns to speak. At a later stage, he might be able to give a self-modifying robot the same input and test if it also learns to speak.

How did the project turn out? The personal experience of raising the child led the AI ​​expert to question the whole project of teaching a robot to speak. How could a personal experience lead to the questioning of a seemingly serious scientific project?

Here, I could start babbling about how amiably social children are compared to cold machines. How they learn in close relationships with their parents. How they curiously and joyfully take the initiative, rather than calculatingly await input.

The problem is that such babbling on my part would make it seem as if the AI ​​expert simply was wrong about robots and children. That he did not know the facts, but now is more well-informed. It is not that simple. For the idea behind ​​the project presupposed unnoticed linguistic zigzagging. Already in asking the question, the boundaries between robots and children are blurred. Already in the question, we have half answered it!

We cannot be content with responding to the question in the headline with a simple, “No, it cannot.” We must reject the question as nonsense. Deceitful zigzagging creates the illusion that we are dealing with a serious question, worthy of scientific study.

This does not exclude, however, that computational linguistics increasingly uses self-modifying programs, and with great success. But that is another question.

Pär Segerdahl

Beard, Alex. How babies learn – and why robots can’t compete. The Guardian, 3 April 2018

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