David M. Shaw

Evidence shows that people doing biomedical research with non-human animals suffer psychological consequences. A culture of care in animal research demands ensuring the well-being of personnel and research animals, and proposals for ethical oversight, social support, and external interventions to address the psychological burden on personnel are growing. With biomedical research being a public good, and the people involved doing so to advance scientific knowledge for societal health benefits, society bears some responsibility for animal research and could be involved in ways that promote the well-being of research personnel. Society, through citizen involvement initiatives, is increasingly involved in shaping biomedical research more generally, while the animal research community is also committed to greater openness and transparency regarding animal use. These initiatives, in addition to the “citizen responsibility” approach used in criminal justice, can be explored to pursue societal involvement in promoting the culture of care in animal research.

This study explores animal research professionals’ attitudes toward the 3R principles (i.e., 3R: replacement, reduction, and refinement of the use of animals in research) using an experimental ethics approach. A thought experiment involving a superior extraterrestrial alien species conducting research on humans according to 3R was presented to 13 Swiss-based animal research professionals (i.e., researchers using animals, veterinarians, animal welfare officers, 3R coordinators, animal science trainers, and members of animal experimentation commissions) during qualitative semi-structured interviews. Participants were asked to reflect on whether the aliens’ research is justified, as well as on the extent to which 3R is the right framework for it. Thematic analysis was used to analyze the data. Participants revealed a spectrum of attitudes, ranging from ambivalent acceptance to outright rejection of “3R for humans”. Key themes included concerns about legitimacy, consent, and power asymmetry, as well as anthropocentric and speciesist attitudes. These findings support previously identified concerns about the limitations of 3R and show that professionals also recognize these challenges when reflecting on the issue using a role-reversal thought experiment. This underscores the ongoing need to advance ethical frameworks in animal research, expanding beyond 3R to incorporate broader moral considerations. Ultimately, our findings suggest that empirical animal ethics, and in particular thought experiments of this kind, offers a promising route to fostering ethical reflection and reform.

Plato decided that the poets, that is, all creative writers, should be banned from his ideal state. He objected to the claim that they imparted knowledge to their audiences. The poets gave no explanation of the basis for the stories that they told or the conclusions to which those stories led. Plato denied the validity of any claim to knowledge that was not accompanied by an account that justified the claim. Management scholars make comparable objections to management consultants. They argue that consultants use rhetoric and story-telling to persuade clients of their knowledge, when their services often have no foundation in real knowledge. Consultancy knowledge is to a large extent socially constructed, dependent for its status as knowledge on clients’ acceptance of it as such. Consultants often sell their services and persuade clients of their value by appealing to their relevance to passing management fashions and fads. The poets necessarily are susceptible to Plato’s objections, because they are creative artists whose proper business is primarily to entertain rather than to impart knowledge. By contrast, consultants have a clear role in imparting and applying management knowledge. They should respond to management scholars’ objections by shifting their focus ever more sharply towards the technoeconomic contributions that consultants can make to their clients, and away from the use of rhetoric and story-telling to promote their services.

Plato’s programme for establishing his ideal state involved propagating two foundation myths for it, described by Socrates as a “noble lie”, which were designed to persuade its citizens to embrace the classes of society to which they had been assigned, and their roles within them, contentedly and in harmony with their fellow citizens. Because most citizens were judged incapable of understanding the truth about the most important matters, the rulers of the ideal state were authorised to tell them whatever stories, true or false, would induce them to behave well. Advocates of the management of corporate culture similarly emphasise the potency of story-telling and myth-making in inducing employees to adopt the beliefs, values and assumptions that corporate leaders consider desirable for both corporate performance and employee wellbeing. There are similarities between Plato’s programme for his ideal state and the programmes recommended by advocates of the management of corporate culture. There are also similarities between them in the ethical questions that they raise. Do corporate leaders have the moral authority to shape people’s beliefs, values and assumptions in the ways that these programmes entail? Are the outcomes to which those programmes lead really beneficial for all those who are affected by them? Even assuming that those outcomes are beneficial, how likely are the strategies proposed for realising them to be successful? Literature that explores these ethical issues is sparse, and this paper argues that it is doubtful whether any of these questions can be answered decidedly in the affirmative.

Business ethicists draw extensively on Aristotle’s work in defining the purpose of the business corporation. Insights from ancient authors can be valuable in illuminating contemporary issues, but we should be wary of enlisting their authority for our views without paying careful attention to what they might have intended by what they said in their own social and economic context. Business ethicists have argued that the business corporation should be a community within which its members can live a good life; that its purpose should not be to maximise profits; and that it should integrate itself into a range of wider communities beyond its own boundaries and serve their interests. Aristotle would have agreed that the business corporation should not seek to make as much profit as possible, although he might have accepted that – in the light of modern developments in economic management - it should make enough profit to fund projects that would be beneficial to society. Aristotle’s view that the polis provided the setting in which people could best live a good life does not justify the claim that the business corporation can or should serve a similar purpose. Aristotle believed that people should strive for enough and not too much in several contexts, not only in acquiring wealth, but also in defining the size and scope of the community of which they should be members. Some expansive, contemporary views on the communities into which the business corporation should integrate itself are alien to Aristotle’s thinking.

The academic literature on management consulting raises many questions about the ethics of management consulting. The uncertain, emergent, and often socially constructed nature of management consultancy knowledge limits the scope both for regulating the industry in the manner of the established professions, and for evaluating management consultants’ work objectively. The character of management consultants is therefore a central issue in how far clients and other stakeholders can trust them. This paper considers three questions, using Aristotle’sNicomachean Ethicsas a guide. These are, first, ‘What is the function of a management consultant?’, second, ‘How should a management consultant act in order to be a good management consultant?’, and third, ‘Where does the boundary lie between the ethical responsibilities of the management consultant and those of the client and other stakeholders?’ Aristotelian virtue ethics are valuable in answering these questions. Their focus on character is well suited to the distinct ethical problems of management consulting. Aristotle’s overarching concern with human flourishing, and an ethically balanced approach towards benefiting from the good things to which a virtuous person may aspire, has more promise as an influence on consultants’ behaviour than the lists of prohibitions that typify codes of ethical practice in the industry. Aristotle’s call for leaders to habituate their people to ethical behaviour should be heard by the leaders of management consultancy firms. In accordance with Aristotle’s philosophy, this paper proposes a positive target at which management consultants can aim in shooting for ethical practice.

Writers on organisational change often refer to the cosmology of Heraclitus in their work. Some use these references to support arguments for the constancy and universality of organisational change and the consignment to history of organisational continuity and stability. These writers misunderstand the scope of what Heraclitus said. Other writers focus exclusively on the idea that originated with Heraclitus that the universe is composed of processes and not of things. This idea, which has been particularly associated with Heraclitus’s thought from the time of Plato, does indeed provide a rich source of insights into organisational analysis, not least the current trends towards giving proper attention to processual studies of organisational change. Yet there is some uncertainty as to whether Heraclitus actually said that the universe was composed exclusively of processes rather than things, and even if that was what he thought, he intended his ideas on flux to be understood not in isolation but in the context of other aspects of his cosmology. Writers on organisational change seldom make reference to this wider context. Heraclitus was a rational but also a religious thinker. A central element in his thought was the notion of divine Justice, which to a Greek of his era meant the order of the universe. Remote as his Olympian theology may seem today, it sets a crucial and entirely rational context for understanding his ideas about flux. It means that ideas about continuity and stability were quite as important in Heraclitus’s cosmology as his more commonly quoted ideas about change. This paper sets out an overview of Heraclitus’s philosophy, insofar as it appears to have potential relevance to organisational analysis, and discusses how far it supports or contradicts the ideas that organisational change scholars have drawn from it.

In The Prince, Machiavelli presents a set of generalisations about leadership that he has derived from his experience and scholarship. His concept of leadership is aligned with that of formal organisational leadership, and is therefore more narrowly focused than much modern leadership literature, which also brings the concepts of informal and egalitarian leadership under its aegis. Having been written long before many of the assumptions that have accumulated around modern leadership publications, Machiavelli provides a fresh and realistic view of formal organisational leadership whose insights have value for modern business leaders. He identifies what he refers to as the virtue of a good leader but, by contrast with modern usage, his idea of virtue concerns leaders’ energy and will to do whatever is needed to accomplish their goals. He makes the case that most leaders have a particular cast of mind, which causes them to lead in fixed, unvarying ways, and makes it difficult for them to adapt to changing circumstances. Thus, leaders are likely to be successful only when they encounter circumstances that suit their particular kind of virtue. And even then, unforeseeable ill fortune that they cannot guard against may frustrate their endeavours. Much leader-centric organisational research presumes too much for the salience of leadership in explaining organisational outcomes, and pays too little attention to the contexts in which leadership is exercised, the processes over time whereby leaders carry out their work, and the unforeseeable events that can overturn the best leaders’ plans.

Research on emerging technologies such as AI-driven health interventions, extended reality (XR) systems, biobanks, and genome editing poses novel ethical challenges that traditional ethics governance models struggle to address. This article explores various models of research ethics governance within the European Union (EU) context, starting from traditional one-time research ethics committee (REC) reviews, REC review with post-approval monitoring, as well as alternative models such as ethics self-assessment, and ethics-by-design approaches. Based on literature analysis and a survey of European research ethics experts, the study identifies prevalent models of research ethics oversight, research ethics expert perceptions of their sufficiency, and challenges such as insufficient technical and ethics expertise, lack of specific guidelines, and unclear boundaries of REC responsibilities. Findings also indicate that traditional REC reviews remain dominant but have limitations in effectively managing rapidly evolving technologies. Research ethics experts highlighted the feasibility of continuous oversight mechanisms to better integrate ethical reflection throughout the research lifecycle. The article concludes by recommending a shift towards proportional, risk-based oversight, development of clearer, technology-specific guidelines, enhanced REC training, and improved harmonization across EU ethics governance systems to address current gaps.

Artificial intelligence (AI) based clinical decision support systems (CDSS) are becoming ever more widespread in healthcare and could play an important role in diagnostic and treatment processes. For this reason, AI‐based CDSS has an impact on the doctor‐patient relationship, shaping their decisions with its suggestions. We may be on the verge of a paradigm shift, where the doctor‐patient relationship is no longer a dual relationship, but a triad. This paper analyses the role of AI‐based CDSS for shared decision‐making (SDM) to better comprehend its promise and associated ethical issues. Moreover, it investigates how certain AI implementations may instead foster the inappropriate paradigm of paternalism. Understanding how AI relates to doctors and influences doctor‐patient communication is essential to promote more ethical medical practice. Both doctors’ and patients’ autonomy need to be considered in the light of AI.This article is protected by copyright. All rights reserved.

Animals can only be used in research when there is a convincing scientific justification, when the expected benefits of the research outweigh the potential risks in terms of animal suffering and when the scientific objectives cannot be achieved using non-animal alternative methods. Researchers must also apply the 3R principles—replace, reduce and refine—to ensure that animals are used ethically in research. All research involving animals must have been reviewed and approved by an ethics committee prior to commencing the study; the harm–benefit analysis (HBA) is the cornerstone of ethical evaluation, as it will determine if the use of animals is justified. In this paper, we apply the 3R principles (refine, reduce, replace) and HBA used in regulation of animal research to veterinary studies of homeopathy and provide an ethical analysis of such studies. It emerges that proper application of the 3Rs and HBA effectively rules out any homeopathy research in animals.

Background Scientific research projects involving animals are required to undergo ethical evaluation, generally known as harm-benefit analysis (HBA), to ensure that they address important ethical concerns related to animal welfare and the scientific quality of the research to maximize the likelihood of their potential benefits. Research continuously shows the challenges encountered by decision-makers, prompting researchers to review how HBA is conducted and to propose tools to aid decision-making. However, the extent to which such resources are currently available, their jurisdictions of applicability, and how they guide decision-making are not entirely clear. Method Through a Scoping Review methodology, a systematic literature search was conducted in PubMed, Scopus and Web of Science for publications in Europe and North America (USA and Canada) from 1985 to 2023. Title and abstract, full-text, and reference screenings, followed by data charting, respectively, were carried out for retrieved publications using pre-developed and registered review protocol. Results 17 resources that can guide HBA and decision-making were identified. They discussed what should constitute harm to animals and benefits of research, and how these two interests can be balanced to make a decision. Some adopt mathematical calculations, some propose guidelines for committee discussions, while others propose the combination of different approaches to decision-making. Conclusions Decision-making based on deliberation among committee members should be supported over the use of scoring approaches. Additionally, making ethical decisions on a case-by-case basis is preferable to accuracy, which may not be realistically practicable.

Doing scientific research with animals is a subject of intense societal debate, often involving polarized and public discussions with stakeholders and groups interested in animal research. Patients, given their medical conditions, have a high stake in biomedical research, including research involving animals. However, their perspectives are rarely heard in policy-related discussions on animal experiments. This essay discusses the positions and stakes of groups involved in public discourse and policy-relevant engagements. It further explores the legitimate interest of patients and the need for an all-inclusive approach to animal research policy. This subject is complex and democratic societies must address societal issues with an all-inclusive approach to reach policy decisions reflecting the interests of all stakeholders. The positions of groups—pro-animal research stakeholders and anti-animal-research advocates—with vested interests involved in animal research discourse considerably shape research policies. Animal research policies arguably affect patients. Through democratic ideals, inclusive approaches that are suitable for resolving science-driven societal issues, and initiatives currently guiding animal research policies, patients need to actively be involved in public discourses and policy-relevant decision-making processes in deciding the place of animal research in biomedical advancement as a society.

Changing relationships with nonhuman animals have led to important modifications in animal welfare legislations, including the protection of animal life. However, animal research regulations are largely based on welfarist assumptions, neglecting the idea that death can constitute a harm to animals. In this article, four different cases of killing animals in research contexts are identified and discussed against the background of philosophical, societal, and scientific-practical discourses: 1. Animals killed during experimentation, 2. Animals killed before research, 3. “Surplus” animals and 4. “Leftover” animals. The scientific community and, accordingly, animal research regulations such as the internationally acknowledged framework 3R (“Replace”, “Reduce”, “Refine”) tend to aim at the reduction of “surplus” and, to some extent, “leftover” animals, whereas the first two classes are rather neglected. However, the perspective that animal death matters morally is supported by both societal moral intuitions and certain theoretical accounts in animal ethics. Therefore, we suggest the implementation of the 3Rs in regulations, so that they: 1. Make their underlying philosophical position transparent; 2. Are based on a weighing account of animal death; 3. Are applicable to procedures on living and dead animals; 4. Apply the “reduction” principle to procedures on dead animals; 5. Entail that methods using (parts of) dead animals need to be replaced by animal free methods, if possible; 6. Do not suggest replacing research on living animals by research on killed animals; 7. Include all kinds of animals, depending on the respective harm of death; 8. Are applied to the broader context of experimentation, including breeding and the fate of the animals after the experiment.

In this chapter I consider the narrow and wider benefits of permitting assisted dying in the specific context of organ donation and transplantation. In addition to the commonly used arguments, there are two other neglected reasons for permitting assisted suicide and/or euthanasia: assisted dying enables those who do not wish to remain alive to prolong the lives of those who do, and also allows many more people to fulfill their wish to donate organs after death. In the first part of this chapter I explore the possibility of allowing those who die with assistance to donate their organs and the potential benefits of doing so in countries where some form of assisted dying is legal; in the second part I consider the added force that organ donation considerations bring to the argument in favour of legalizing assisted dying in countries where such practices remain forbidden.

This chapter explores what we actually mean by data donation after death, and what different types of data donation metadata are involved in the process. It then provides an analysis of the ethical ramifications of each of these different types of data, outlines the concepts of data advance directives and data donation guardians as one way of dealing with these issues, and considers alternative governance mechanisms. The degree of control given to the first data donors may need to be high in order to maintain trust, but over time attitudes may evolve towards everyone giving “big consent” to data donation.

The rise of self-driving cars raises numerous ethical conundrums, none has attracted so much public attention as the question of how to programme AVs in crash scenarios. How does a car respond when difficult, life-and-death choices are to be made? The most popular approach to answering this question is to employ trolley problems (trolleyology). Trolleyology, employed within the context of AVs, pits one human life against another on the basis of their distinctive characteristics: old vs young, single vs group membership, innocent vs guilty, etc. Doing so attempts to create value hierarchies for human particularity. This article argues for the failure of this approach by considering the distinctive manner in which trolley problems are employed within crash scenarios involving AVs. The article argues for the evaluative error of establishing human value on human particularity through a process of abstract individualisation. Properly speaking, individual humans are valued not on the basis of their particularities, but on the basis of their innate unsubstitutability.

Many business graduates regard management consultancy firms as a desirable, even utopian, career destination. Hythloday's description of the island of Utopia identifies several characteristics that resonate with aspects of the management consulting industry. They include its separation from the rest of humanity, the Utopians' attitude to acquiring knowledge, their commitment to their way of life, their attitude to work, the governance structure of their state, and their attitude to wealth. These characteristics may be compared and contrasted with management consultancy firms' elite identities, their knowledge intensity, their use of standardized methods, their cultural commitment to intensive work, the autonomy that they allow their members in their practice, and their commitment to achieving ambitious financial targets. This article uses Thomas More's _Utopia_ (1516) as an analytical framework for understanding the utopian visions of management consulting that some business graduates form, and for exploring how alternative, perhaps better, visions might be imagined.

Changing relationships with nonhuman animals have led to important modifications in animal welfare legislations, including the protection of animal life. However, animal research regulations are largely based on welfarist assumptions, neglecting the idea that death can constitute a harm to animals. In this article, four different cases of killing animals in research contexts are identified and discussed against the background of philosophical, societal, and scientific-practical discourses: 1. Animals killed during experimentation, 2. Animals killed before research, 3. “Surplus” animals and 4. “Leftover” animals. The scientific community and, accordingly, animal research regulations such as the internationally acknowledged framework 3R (“Replace”, “Reduce”, “Refine”) tend to aim at the reduction of “surplus” and, to some extent, “leftover” animals, whereas the first two classes are rather neglected. However, the perspective that animal death matters morally is supported by both societal moral intuitions and certain theoretical accounts in animal ethics. Therefore, we suggest the implementation of the 3Rs in regulations, so that they: 1. Make their underlying philosophical position transparent; 2. Are based on a weighing account of animal death; 3. Are applicable to procedures on living and dead animals; 4. Apply the “reduction” principle to procedures on dead animals; 5. Entail that methods using (parts of) dead animals need to be replaced by animal free methods, if possible; 6. Do not suggest replacing research on living animals by research on killed animals; 7. Include all kinds of animals, depending on the respective harm of death; 8. Are applied to the broader context of experimentation, including breeding and the fate of the animals after the experiment.

Oncologists frequently have to break bad news to patients. Although they are not normally the ones who tell patients that they have cancer, they are the ones who have to tell patients that treatment is not working, and they are almost always the ones who have to tell them that they are going to die and that nothing more can be done to cure them. Perhaps the most difficult cases are those where further treatment is almost certainly futile, but there remains an extremely slim chance of yet more aggressive treatment having a near-miraculous effect. In such situations, it can be difficult for the oncologist to decide how to explain things to the patient, and how much to tell them. It can also be very difficult to achieve the correct balance between respecting the patient's autonomy and not exposing them to harm. This paper examines an example of one such case and makes three suggestions. First, that respecting autonomy cannot be achieved by maximizing information sharing only to deny patients the chance to make decisions based on that information; second, that the simplistic application of the principles of non-maleficence and respect for autonomy can lead to erroneous conclusions about the most ethical course of action; and third, that there is an extra reason, in addition to respecting patients' autonomy, for attempting near-futile last-ditch interventions: when treating rare conditions, useful evidence can be generated that will benefit future patients.

Sacrificial dilemmas such as the trolley problem play an important role in experimental philosophy (x-phi). But it is increasingly argued that, since we are not likely to encounter runaway trolleys in our daily life, the usefulness of such thought experiments for understanding moral judgments in more ecologically valid contexts may be limited. However, similar sacrificial dilemmas are experienced in real life by animal research decision makers. As part of their job, they must make decisions about the suffering, and often the death, of many non-human animals. For this reason, a context-specific investigation of so-called “3R dilemmas” (i.e., dilemmas where there is a conflict between the principles of replacement, reduction, and refinement of the use of animals in research) is essential to improve the situation of both non-human animals and human stakeholders. An approach well suited for such investigation is experimental philosophical bioethics (“bioxphi”), which draws on methods similar to x-phi to probe more realistic, practical scenarios with an eye to informing normative debates and ethical policy. In this article, we argue for a need to investigate 3R dilemmas among professional decision-makers using the tools of bioxphi. In a first step, we define 3R dilemmas and discuss previous investigations of professionals’ attitudes in such cases. In a second step, we show how bioxphi is a promising method to investigate the whys and hows of professional decision-making in 3R dilemmas. In a last step, we provide a bioxphi template for 3R dilemmas, give recommendations on its use, explore the normative relevance of data collected by such means, and discuss important limitations.

In Switzerland, the importance of transparency in animal experimentation is emphasized by the Swiss Federal Council, recognizing the public’s great interest in this matter. Federal reporting on animal experimentation indicates a total of 585,991 animals used in experiments in Switzerland in 2022. By Swiss law, the report enables the public to learn about many aspects such as the species and degree of suffering experienced by the animals, but some information of interest to the public is missing, such as the fate of the animals at the end of the experiment (e.g., euthanized, rehomed in a private home, reused in another experiment). When it comes to animals bred in facilities but not used in experiments, further information of interest is not required to be made public according to Swiss law, for example, the number and fate of “surplus” animals (i.e., animals bred but not used in experiments for a variety of reasons such as not carrying the phenotypical properties needed). Considering that the Swiss government has a duty to provide a full accounting of animal experimentation conducted on the public’s behalf, further relevant information should be disclosed. While efforts toward transparency, such as the STAAR Agreement, have been made in the scientific community, these mostly reflect the legal requirements already in force. If Switzerland is to move toward more transparency in public information on animal experimentation, an update of the legal requirements is needed. In this article, we give recommendations for Swiss law to move toward more transparency in public information on seven aspects: (1) the fate of the animals at the end of the experiment; (2) the sources of funding for animal experimentation; (3) the harm-benefit analysis performed by researchers and ethics committees to justify an experiment using animals; (4) the number of breeding/surplus animals; (5) the fate of breeding/surplus animals; (6) the harms experienced by animals in facilities; and (7) the funding of animal facilities.

Rodger et al have interestingly argued that xenotransplantation should, if possible, entail the use of genetic pain disenhancement to prevent otherwise unavoidable pain in ‘donor’ animals.1 Their argument relies on the empirical assumption that xenotransplantation offers a realistic solution to organ shortage, and that, due to the recent clinical developments and the lack of human donors, it will thus continue for the foreseeable future. We argue below that other options should be prioritised over xenotransplantation, and that so-called ‘non-sentientist’ harms are undervalued in discussions on disenhancement. We do not challenge the empirical claim made by the authors. That is, xenotransplantation research might continue for the foreseeable future since organ demand is increasing. However, we disagree with the priority given to xenotransplantation over other solutions that are more morally desirable. We argue that, if we comply with the 3R principles (Replacement, Reduction, and Refinement of the use of animals in research) and follow a minimal welfarist reasoning (to which the authors seem to adhere), then (1) the principle of replacement demands the use of non-animal alternatives if possible and (2) there are alternative solutions that lead to morally better consequences. Schematically, there are four ways to …

Pro-life and pro-choice advocates battle for rational dominance in abortion debates. Yet, public polling (and general legal opinion) demonstrates the public’s preference for the middle ground: that abortions are acceptable in certain circumstances and during early pregnancy. Implicit in this, are two contradictory intuitions: (1) that we were all early fetuses, and (2) abortion kills no one. To hold these positions together, Harman and Räsänen have argued for the Actual Future Principle (AFP) which distinguishes between fetuses that will develop into persons and those that will never develop into persons. However intellectually ingenious their solutions are, they fail to account for a third intuition: that the death of a wanted fetus – e.g. through termination or miscarriage – is of moral significance. Not only is this practically important, but it is also supported by public opinion. The authors of this paper argue that relational ontology can modify the AFP to better account for all three intuitions. Furthermore, it further emphasizes the pivotal role of the pregnant person who relates to their own fetus in either personal or impersonal ways. Addressing the fundamental challenges of relational ontology, the authors defend the position that human personal identity is ultimately relational.

The ability to exchange samples and data is crucial for the rapidly growth of biobanking. However, sharing is based on the assumption that the donor has given consent to a given use of her or his sample. Biobanking stakeholders, therefore, must choose 1 of 3 options: obtain general consent enabling multiple future uses before taking a sample from the donor, try to obtain consent again before sharing a previously obtained sample, or look for a legally endorsed way to share a sample without the donor's consent. In this study, we present the results of 36 semistructured qualitative interviews with Swiss biobanking stakeholders regarding these options and the role of ethics committees in the process of authorizing sharing. Our results show that despite a lack of legal or guideline-based barriers to general consent, some stakeholders and ethics committees have reservations about this method of consent. In most cases, however, a general consent form is already in use. Many interviewees describe processes involving the ethics committees as time-consuming and cumbersome and their requirements as too demanding for donors/patients. Greater awareness of donors' opinions and preferences and the content of guidelines and recommendations could therefore be helpful for a better justified perspective of biobanking stakeholders and ethical committee members, equally. Finally, it may be necessary to differentiate between procedures governing future samples, where general consent is clearly desirable, and the use of old yet still relevant samples, where the option of using them without consent can be highly beneficial for research.

MacDougall has argued that Rawls’s liberal social theory suggests that parents who hold certain religious convictions can legitimately refuse blood transfusion on their children’s behalf. This paper argues that this is wrong for at least five reasons. First, MacDougall neglects the possibility that true freedom of conscience entails the right to choose one’s own religion rather than have it dictated by one’s parents. Second, he conveniently ignores the fact that children in such situations are much more likely to die than to survive without blood. Third, he relies on an ambiguous understanding of what is "rational" and treats children as mere extensions of their parents. Fourth, he neglects the fact that those in the original position would seek to protect themselves from persecution and enslavement and thus would not allow groups of children to be killed because of their parents’ beliefs. Finally, Rawls makes it clear that we should choose for children as we would choose for ourselves in the original position, with no particular conception of the good (such as that held by Jehovah’s Witnesses)

Doctors and dentists have traditionally used antibiotic prophylaxis in certain patient groups in order to prevent infective endocarditis (IE). New guidelines, however, suggest that the risk to patients from using antibiotics is higher than the risk from IE. This paper analyses the relative risks of prescribing and not prescribing antibiotic prophylaxis against the background of Pascal’s Wager, the infamous assertion that it is better to believe in God regardless of evidence, because of the prospective benefits should He exist. Many doctors seem to believe the parallel proposition that it is better to prescribe antibiotics, regardless of evidence, because of the prospective benefit conferred upon the patient. This has been called the “no lose philosophy” in medicine: better safe than sorry, even if the evidence inconveniently suggests that following this mantra is potentially more likely to result in sorry than safe. It transpires that, just as Pascal’s Wager fails to convince because of a lack of evidence to support it and the costs incurred by trying to believe, so the “belts and braces” approach of prescribing antibiotic prophylaxis is unjustifiable given the actual evidence of potential risk and benefit to the patient. Ultimately, there is no no-lose if your clinical decisions, like Pascal’s Wager, are based on faith rather than evidence.

While the technologies that enable Artificial Intelligence (AI) continue to advance rapidly, there are increasing promises regarding AI’s beneficial outputs and concerns about the challenges of human–computer interaction in healthcare. To address these concerns, institutions have increasingly resorted to publishing AI guidelines for healthcare, aiming to align AI with ethical practices. However, guidelines as a form of written language can be analyzed to recognize the reciprocal links between its textual communication and underlying societal ideas. From this perspective, we conducted a discourse analysis to understand how these guidelines construct, articulate, and frame ethics for AI in healthcare. We included eight guidelines and identified three prevalent and interwoven discourses: (1) AI is unavoidable and desirable; (2) AI needs to be guided with (some forms of) principles (3) trust in AI is instrumental and primary. These discourses signal an over-spillage of technical ideals to AI ethics, such as over-optimism and resulting hyper-criticism. This research provides insights into the underlying ideas present in AI guidelines and how guidelines influence the practice and alignment of AI with ethical, legal, and societal values expected to shape AI in healthcare.

This manuscript reports on a landmark symposium on the ethical, legal and technical challenges of xenotransplantation in the UK. King’s College London, with endorsement from the British Transplantation Society (BTS), and the European Society of Organ Transplantation (ESOT), brought together a group of experts in xenotransplantation science, ethics and law to discuss the ethical, regulatory and technical challenges surrounding translating xenotransplantation into the clinical setting. The symposium was the first of its kind in the UK for 20 years. This paper summarises the content of the expert lectures showcasing the progress which has been made in xenotransplantation including—the history of xenotransplantation, advances in gene edited animals and progress towards clinical xenotransplantation. We then set out the ethical and legal issues still to be resolved. Finally, we report the themes of the roundtable discussion highlighting areas of consensus and controversy. While the detail of the legal discussion was directed towards the UK, the principles and summary reported here are intended to be applicable to any jurisdiction seeking to implement clinical xenotransplantation.