Background Social workers (SWs) who support older people encounter ethical dilemmas and experience value conflicts when working with other professionals while fulfilling their responsibilities. We explored these experien...Background Social workers (SWs) who support older people encounter ethical dilemmas and experience value conflicts when working with other professionals while fulfilling their responsibilities. We explored these experiences by interviewing SWs engaged in care for older people in Japan. Methods We conducted a qualitative interview survey with a targeted sample, employing a narrative analysis method. The participants included twenty-one SWs (four male, seventeen female) employed across acute-care hospitals, convalescent rehabilitation hospitals, home healthcare, and nursing homes. Results SWs described experiences of ethical dilemmas in supporting older people due to conflicting obligations and value priorities. They highly prioritize understanding the life backgrounds and values of patients to be able to discharge their duty to advocate patient autonomy and promote the best interest of the patients. However, SWs faced ethical dilemmas due to their responsibility to the organization, conflicting obligations toward the patient's family versus the patient's wishes, and differing prioritized values compared with medical professionals who prioritize the patient's physical function. Additionally, the relationship between SWs and medical professionals poses challenges in addressing these ethical dilemmas. Conclusion It is crucial to appreciate the significance of individuals from diverse professions by comprehending their respective roles and specialties, fostering equitable relationships, and capitalizing on their distinct expertise through collaboration.
Felman E, Kerridge I, Vered M
… +1 more, Komesaroff P
J Bioeth Inq
· 2025 Sep · PMID 40493332
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A key maxim guiding the introduction of new technologies, including those utilizing artificial intelligence, is that such technologies should carry rewards of "convenience": indeed, the more "convenient" a new technology...A key maxim guiding the introduction of new technologies, including those utilizing artificial intelligence, is that such technologies should carry rewards of "convenience": indeed, the more "convenient" a new technology is considered to be, the more likely it is to be welcomed and adopted. Rudimentary examples from last century include the microwave, washing machine, and dishwasher; more recent innovations from the present century include portable navigation systems, online shopping applications, internet search engines, smart phones, telehealth, automated workplace systems and processes, email and messaging technologies, and-most recently-large language models that are able to undertake multiple complex tasks. Each of these technologies offers a variety of benefits. However, a unifying feature is that all have been considered to enhance convenience, understood as saving time and/or effort. In this paper we explore the provenance and meaning of the-usually unexamined-concept of convenience, identifying an unexpected link with erosion of values and depletion of the diversity and richness of personal experiences. We conclude that the prioritization of convenience as a driver of innovation carries with it risks, which may go unnoticed or be difficult to discern.
J Bioeth Inq
· 2025 Dec · PMID 40459827
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The use of suicide risk assessments in individual psychiatric treatment is widespread and, in many countries, mandatory. However, these assessments exhibit poor predictive accuracy and offer limited clinical value. This...The use of suicide risk assessments in individual psychiatric treatment is widespread and, in many countries, mandatory. However, these assessments exhibit poor predictive accuracy and offer limited clinical value. This raises the question of whether non-medical reasons underpin their continued use. In this paper, suicide risk assessments are interpreted as medical rituals-formalized, repetitive behaviours imbued with symbolic significance that fulfil social functions. Several such functions are proposed, including uniting care providers around shared values in suicide prevention, fostering a sense of safety and control over suicidal behaviour, projecting accountability, and signalling to the public that action is being taken. However, this practice may inadvertently lead to an increase in non-beneficial compulsory admissions, flawed prioritization of patients, and the proliferation of defensive medicine. While the ritualistic use of suicide risk assessments may serve important societal purposes, their potential to harm individual patients renders them indefensible from a medico-ethical standpoint.Instead, evidence-based suicide preventive interventions are recommended. These include implementing general safety measures, equipping psychiatric patients with safety plans, and providing effective mental health treatment according to medical needs.
J Bioeth Inq
· 2025 Sep · PMID 40459826
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Over the last decade, bioethics has begun to address the ethical issues emerging as artificial intelligence (AI) and associated technological processes such as automated decision-making (ADM) become part of healthcare an...Over the last decade, bioethics has begun to address the ethical issues emerging as artificial intelligence (AI) and associated technological processes such as automated decision-making (ADM) become part of healthcare and research. Recent work on justice in AI demonstrates that supposedly neutral AI systems can perpetuate the marginalization of various communities. But so far, there has been little exploration of the interaction of AI and disability. In this empirically based project, we have explored the implications of ADM in the lives of people with disability in Australia. This paper focuses on a point that was consistently raised in discussion by disabled participants but is rarely encountered in the AI ethics literature, especially in relation to disability: the problem of automated systems' failures of recognition.
J Bioeth Inq
· 2025 Dec · PMID 40459825
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Rodger and Venter have proposed a monopsony system in which the National Health Service (NHS) in England, as the single buyer, allows living kidney donors to opt-in to receive £35,000 tax-free financial compensation whil...Rodger and Venter have proposed a monopsony system in which the National Health Service (NHS) in England, as the single buyer, allows living kidney donors to opt-in to receive £35,000 tax-free financial compensation while preserving the right to donate without such compensation. This approach aims to alleviate the severe and growing shortage of kidneys available for transplant in England and is projected to generate substantial economic savings for the NHS. This paper sets out to strengthen their proposal by: (1) presenting updated figures on the increasing kidney transplant wait list in England to highlight the urgency for intervention; (2) detailing the rigor of the existing donor evaluation process to mitigate concerns about exploitation and coercion in compensated living donation; (3) outlining the various kinds of living kidney donation and the U.K. Living Kidney Sharing Scheme, to demonstrate that the proposal's projected economic benefits are likely to be underestimations; (4) suggesting five modifications to the proposal that do not significantly alter its underlying structure; and (5) providing additional arguments against the major objections to such proposals-that financial compensation is exploitative, coercive, and likely to "crowd out" altruistic donors-and showing how the five suggested modifications could strengthen the proposal by bolstering it against those objections. The paper strengthens existing arguments for a pilot project of financial compensation for living kidney donors in England.
J Bioeth Inq
· 2025 Sep · PMID 40392473
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As AI systems increasingly operate with autonomy and adaptability, the traditional boundaries of moral responsibility in techno-social systems are being challenged. This paper explores the evolving discourse on the deleg...As AI systems increasingly operate with autonomy and adaptability, the traditional boundaries of moral responsibility in techno-social systems are being challenged. This paper explores the evolving discourse on the delegation of responsibilities to intelligent autonomous agents and the ethical implications of such practices. Synthesizing recent developments in AI ethics, including concepts of distributed responsibility and ethical AI by design, the paper proposes a functionalist perspective as a framework. This perspective views moral responsibility not as an individual trait but as a role within a socio-technical system, distributed among human and artificial agents. As an example of "AI ethical by design," we present Basti and Vitiello's implementation. They suggest that AI can act as artificial moral agents by learning ethical guidelines and using Deontic Higher-Order Logic to assess decisions ethically. Motivated by the possible speed and scale beyond human supervision and ethical implications, the paper argues for "AI ethical by design," while acknowledging the distributed, shared, and dynamic nature of responsibility. This functionalist approach offers a practical framework for navigating the complexities of AI ethics in a rapidly evolving technological landscape.
J Bioeth Inq
· 2025 Sep · PMID 40392472
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The triad of clinical signs, (extensive bilateral retinal haemorrhages, subdural haematoma, and encephalopathy) is regarded by some expert witnesses as pathognomonic proof that an infant was deliberately shaken and head...The triad of clinical signs, (extensive bilateral retinal haemorrhages, subdural haematoma, and encephalopathy) is regarded by some expert witnesses as pathognomonic proof that an infant was deliberately shaken and head injured (shaken baby syndrome / abusive head injury). However, that view is controversial since scientific evidence does not support the diagnostic accuracy of the triad. In contrast to previous cases, a Victorian Supreme Court jury found an accused not guilty of homicide of a one-month-old infant afflicted with the triad. Prosecution witnesses were heavily criticized for failing to provide impartial testimony and to abide by Supreme Court expert evidence rules. We argue that there is a need to reassess the manner in which expert witness testimony is considered by the courts in shaken baby cases where injury has caused the death of the infant.
This theoretical essay offers a critical exploration of the ethics involved in interacting with and talking about large language models (LLMs) of artificial intelligence (AI). The discussion is framed within philosophica...This theoretical essay offers a critical exploration of the ethics involved in interacting with and talking about large language models (LLMs) of artificial intelligence (AI). The discussion is framed within philosophical post-humanist conceptualizations of the ethical agent, which is understood as a sociocognitive assemblage of human-machine interactions at various scales. The central argument asserts that the morality of texts generated by AI cannot be determined by extracting moral properties from the natural language used in the training corpus. There are inherent limits to how much analysing moral language can contribute to establishing a moral theory or a "language of mores" among humans. The essay also examines the ethical implications of current public discourse surrounding the capabilities of LLMs, as well as the ways in which LLM outputs personify the AI model itself. It is proposed that the ethics of LLMs should be approached as an ethics of translating informational patterns of linguistic symbols into multi-layered cultural meanings and vice versa. This includes addressing the opacity of the inner workings of these translations in the model, as well as the public relations practices of the creators. Ultimately, the discussion encourages rethinking the ethical agent as a human-machine sociocognitive hybrid, suggesting the need for a reassessment of what it means to be human and ethical in current AI ethics debates.
J Bioeth Inq
· 2025 Jun · PMID 40279031
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Andalusian medicine, characterized by its holistic approach to healthcare, placed a unique emphasis on the interconnectedness of physical health, emotional well-being, and spiritual harmony. Eminent scholars, including p...Andalusian medicine, characterized by its holistic approach to healthcare, placed a unique emphasis on the interconnectedness of physical health, emotional well-being, and spiritual harmony. Eminent scholars, including physicians like Ibn Sina, Ibn al-Nafis, and Ibn Wafid, pioneered advancements in understanding mental disorders, the complexities of the human psyche, and the intricate relationship between the body and mind. One of the most enduring legacies of Andalusian contributions to mental health was the establishment of mental health hospitals, known as "maristanes." These institutions, distinguished by their compassionate and patient-centred care, profoundly influenced the development of Western medicine, and laid the groundwork for the emergence of psychology as a scientific discipline. This paper goes through the intellectual tapestry of Andalusia during the historical era of Islamic governance, commonly known as the Andalusian Renaissance. Situated in the heart of the Iberian Peninsula, this period of remarkable intellectual convergence and cultural exchange is celebrated for its profound contributions to the field of mental health.
J Bioeth Inq
· 2025 Jun · PMID 40227536
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Recent reports from 2023 and 2024 have brought to light alarming instances of healthcare professionals in China being involved in commercial surrogacy arrangements. These cases reveal the dual roles these professionals p...Recent reports from 2023 and 2024 have brought to light alarming instances of healthcare professionals in China being involved in commercial surrogacy arrangements. These cases reveal the dual roles these professionals play: active facilitation, which includes actions such as selling fraudulent birth certificates that contribute to baby trafficking, and passive involvement, where routine medical care is provided to surrogate mothers without full awareness of the surrogacy context. Current regulations in China broadly prohibit surrogacy-related medical activities but fail to differentiate between healthcare professionals who actively facilitate surrogacy arrangements and those who fulfil their professional obligations to patients. Drawing on professional ethics outlined in the revised 2021 Medical Practitioners Law of the People's Republic of China and recent developments in modern slavery scholarship that emphasize the critical role of healthcare professionals in identifying and preventing exploitation, this paper argues that China has an opportunity to clarify and broaden the role of healthcare professionals in the context of surrogacy. Healthcare professionals should not be prohibited from providing medical care to surrogate mothers, provided they are not actively facilitating surrogacy arrangements. Simultaneously, they should be empowered to act as gatekeepers against exploitation. This would be an important step toward enhancing the current regulatory framework, ensuring better protections for children and women involved in surrogacy.
J Bioeth Inq
· 2025 Jun · PMID 40202575
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Older people are often cared for by family caregivers who may experience a variety of challenges. Robots may be helpful. Understanding the attitudes of family caregivers in this context is essential as they are a major f...Older people are often cared for by family caregivers who may experience a variety of challenges. Robots may be helpful. Understanding the attitudes of family caregivers in this context is essential as they are a major factor in robot use. To date, most studies on family caregivers ' attitudes toward robot assistance in elder care have been conducted in East Asian or Western societies, but as such perceptions are affected by culture, in the present study, we investigated the attitudes of Arab family caregivers in Israel. Semi-structured interviews were conducted with twenty Arab family caregivers who provide care to ADL (activities of daily living)-dependent older people. All participants were Muslim and adult children of a person requiring care. The majority (75 per cent) were women, and the average age was fifty-one. Analysis of the interviews revealed two main themes: (1) Attitudes: Most participants strongly objected to the assistance of a robot in caring for older people, and perceived it as a violation of family values; and (2) Reasons for attitudes: Participants preferred human care over robot care due to concerns previously documented among other populations regarding system malfunctions, the risk of loneliness, and lack of technological literacy. We also identified a unique factor: the family 's moral obligation to care for older people. The absolute opposition of family members to the use of a robot in the care of older people requires the development of intervention programmes to increase technological literacy among family caregivers and reduce negative attitudes. These programmes need to address the opportunities and risks associated with the use of robots, and how these risks can be avoided.
Bio-convergent enhancements for soldiers are becoming increasingly inevitable. Medical professionals, bioethicists, lawyers, and neuroscientists are increasingly aware of the potential for these enhancements to raise sig...Bio-convergent enhancements for soldiers are becoming increasingly inevitable. Medical professionals, bioethicists, lawyers, and neuroscientists are increasingly aware of the potential for these enhancements to raise significant ethical issues, especially around issues of consent and responsibility for long-term care. This has, in the last few years, led to an increase in research on the ethics of soldier enhancements. The literature on this issue has rightly leveraged decades of bioethics, medical ethics, and research ethics literature. What is missing however from the literature is the perspective of the potential subjects of such enhancements, namely members of special operations forces. This paper seeks to fill this gap, by first arguing that subjective views of special operations members matter for ethical questions and then by reporting results of our interview-based qualitative study on United States Special Operations Forces' perspectives on consent and long-term care.