David 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.

The ambivalence of human-animal-relationships culminates in our eating habits; most people disapprove of factory farming, but most animal products that are consumed come from factory farming. While psychology and sociology offer several theoretical explanations for this phenomenon our study presents an experimental approach: an attempt to challenge people’s attitude by confronting them with the animals’ perspective of the consumption process. We confronted our participants with a fictional scenario that could result in them being turned into an animal. In the scenario, a wicked fairy forces them to choose a ticket. Depending on their choice of ticket they have equal chances of becoming a human being with a certain consumption behaviour (meat eater, organic eater, vegetarian, vegan) or, correspondingly, becoming a certain kind of animal (factory farmed meat animal, organically farmed meat animal, animal for dairy/egg production, free living animal). Our results indicate a strong discrepancy between people’s actual consumption habits (mostly regular meat eaters) and their choices in the experiment (strong preferences for the organic or vegan life style). The data reveal a broad spectrum of explanations for people’s decisions in the experiment. We investigated the influence of four different factors on the participant’s choices in addition to reasons they gave as open-ended answers. Correspondingly, different coping strategies to overcome the tension (cognitive dissonance) between real-life consumption choices and attitudes towards nonhuman animals could be detected. Furthermore, many participants indicated a lack of knowledge concerning living conditions in farming but also concerning capacities and properties of nonhuman animals.

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.

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.

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.

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.

It is well known that prisoners’ human rights are often violated. In this chapter we examine whether guidelines can be effective in preventing such violations and in helping physicians resolve the significant conflicts of interest that they often face in trying to protect prisoners’ rights. We begin by explaining the role of clinical and ethical guidelines outside prisons, in the context of healthcare for non-incarcerated prisoners, and then the specific role of such guidelines within prisons, where the main concerns are ensuring respect for the principle of equivalence of care, and for a prisoner patient’s autonomy in health care decisions. After reviewing and analysing various national and international guidelines, we review the literature and assess whether the good practices set out in these guidelines actually translate into changes in professional behaviour and consequent benefits for prisoners. It emerges that physicians both outside and within prisons tend to be insufficiently familiar with the relevant guidelines, and that they too infrequently use the guidance to make decisions, preferring instead to use personal codes of conduct. Guidelines designed specifically for the prison context are important to ensure equivalence of care and should be better known by health care personnel and other professional groups working in prison. Further guidelines should be developed that describe challenging situations and provide concrete guidance as to how to deal with them.

In this article the predominant, purely theoretical perspectives on animal ethics are questioned and two important sources for empirical data in the context of animal ethics are discussed: methods of the social and methods of the natural sciences. Including these methods can lead to an empirical animal ethics approach that is far more adapted to the needs of humans and nonhuman animals and more appropriate in different circumstances than a purely theoretical concept solely premised on rational arguments. However, the potential tension between lay people’s moral judgements and ethical theory must be handled with care. The thorough analysis of qualitative data can lead to a deep insight into e.g. ethical problems with the application of laws and guidelines, practicality issues with ethical theories, personal ambivalence, and cognitive biases. The interaction between animal ethics theory and empirical findings can lead to both a more context-sensitive and applicable ethical theory and a less arbitrary folk moral system. Findings from the natural sciences can also contribute valuable information to animal ethics theory—the more we know about the properties and preferences of nonhuman animals the better we can respect them. Here, however, it is vital not to justify invasive procedures for the sake of “ethical progress”. It might be ethically required to forego some scientific findings about nonhuman animals if it is not clear how much a procedure would harm them. Only with robust empirical methods will light ultimately be shed on the nature of our moral relationship with animals

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.

Switzerland has very detailed laws regulating the use of animals in agriculture, entertainment and science. There are also many Swiss laws governing the genetic modification of animals, protecting human embryos, and criminalising the creation of human/animal chimeras or hybrids. Despite all these regulations, the creation of an animal embryo that will develop a human organ using induced pluripotent stem cells and the subsequent birth of the resulting chimera would actually be permitted by current legislation. While this might appear to be an unhappy accident due to insufficient scientific foresight, I argue here that this loophole should not be closed, as the creation of human organs inside animals will probably be possible within 10 years, and Swiss laws would currently enable the use of this process to save human lives through this allogenic or autologous organ source.

The importance of medical confidentiality is obvious to anyone who has ever been a patient, and protecting private information about patients is one of the key responsibilities of healthcare professionals. However, maintaining the confidentiality of patients who are incarcerated in prisons poses several ethical challenges. In this chapter we explain the importance of confidentiality in general, and the dilemmas that sometimes face doctors with regard to it, before describing some of the specific difficulties faced by prison doctors. Although healthcare professionals working in prisons have the same duty to respect confidentiality as those working in the wider community, the conflicts of interest caused by their dual loyalty to prisoners and to prison authorities can make it very difficult to strike the right balance between respecting confidentiality and protecting prisoners and third parties. We illustrate some of the dilemmas facing prison doctors with a series of case discussions before providing suggestions for resolving these difficult situations. Ideally, a combination of great ethical and legal sensitivity on the part of healthcare professionals and general respect for prisoners’ rights on the part of other prison staff enables most issues to be resolved without the need to compromise patients’ confidentiality.

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.

Despite the heavy emphasis on consent in the ethical code of the General Dental Council (GDC), it is often overlooked that communication difficulties between patient and dentist can cause problems in maintaining genuine consent during interventions. Inconsistencies in the GDC's Standards for dental professionals and Principles of patient consent guidelines are examined in this article, and it is concluded that more emphasis must be placed on continuous consent as an ongoing process essential to maintaining patients' dignity in dentistry.

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.

Background While the theoretical benefits and harms of Artificial Intelligence (AI) have been widely discussed in academic literature, empirical evidence remains elusive regarding the practical ethical challenges of developing AI for healthcare. Bridging the gap between theory and practice is an essential step in understanding how to ethically align AI for healthcare. Therefore, this research examines the concerns and challenges perceived by experts in developing ethical AI that addresses the healthcare context and needs. Methods We conducted semi-structured interviews with 41 AI experts and analyzed the data using reflective thematic analysis. Results We developed three themes that expressed the considerations perceived by experts as essential for ensuring AI aligns with ethical practices within healthcare. The first theme explores the ethical significance of introducing AI with a clear and purposeful objective. The second theme focuses on how experts are concerned about the tension that exists between economic incentives and the importance of prioritizing the interests of doctors and patients. The third theme illustrates the need to develop context-sensitive AI for healthcare that is informed by its underlying theoretical foundations. Conclusions The three themes collectively emphasized that beyond being innovative, AI must genuinely benefit healthcare and its stakeholders, meaning AI also aligns with intricate and context-specific healthcare practices. Our findings signal that instead of narrow product-specific AI guidance, ethical AI development may need a systemic, proactive perspective that includes the ethical considerations (objectives, actors, and context) and focuses on healthcare applications. Ethically developing AI involves a complex interplay between AI, ethics, healthcare, and multiple stakeholders.

The convergence of human and artificial intelligence is currently receiving considerable scholarly attention. Much debate about the resulting _Hybrid Minds_ focuses on the integration of artificial intelligence into the human brain through intelligent brain-computer interfaces as they enter clinical use. In this contribution we discuss a complementary development: the integration of a functional in vitro network of human neurons into an _in silico_ computing environment. To do so, we draw on a recent experiment reporting the creation of silico-biological intelligence as a case study (Kagan et al., 2022b ). In this experiment, multielectrode arrays were plated with stem cell-derived human neurons, creating a system which the authors call _DishBrain_. By embedding the system into a virtual game-world, neural clusters were able to receive electrical input signals from the game-world and to respond appropriately with output signals from pre-assigned motor regions. Using this design, the authors demonstrate how the _DishBrain_ self-organises and successfully learns to play the computer game ‘Pong’, exhibiting ‘sentient’ and intelligent behaviour in its virtual environment. The creation of such hybrid, silico-biological intelligence raises numerous ethical challenges. Following the neuroscientific framework embraced by the authors themselves, we discuss the arising ethical challenges in the context of Karl Friston’s Free Energy Principle, focusing on the risk of creating synthetic phenomenology. Following the _DishBrain’s_ creator’s neuroscientific assumptions, we highlight how DishBrain’s design may risk bringing about artificial suffering and argue for a congruently cautious approach to such synthetic biological intelligence.

The Ebola epidemic in Western Africa has highlighted issues related to weak health systems, the politics of drug and vaccine development and the need for transparent and ethical criteria for use of scarce local and global resources during public health emergency. In this paper we explore two key themes. First, we argue that independent of any use of experimental drugs or vaccine interventions, simultaneous implementation of proven public health principles, community engagement and culturally sensitive communication are critical as these measures represent the most cost-effective and fair utilization of available resources. Second, we attempt to clarify the ethical issues related to use of scarce experimental drugs or vaccines and explore in detail the most critical ethical question related to Ebola drug or vaccine distribution in the current outbreak: who among those infected or at risk should be prioritized to receive any new experimental drugs or vaccines? We conclude that healthcare workers should be prioritised for these experimental interventions, for a variety of reasons

[V]isibility is central to the shaping of political, medical, and socioeconomic decisions. Who will be treated—how and where—are the central questions whose answers are often entwined with issues of visibility … [and] the effects that media visibility has on the perception of particular bodies .In a documentary entitled Paris: The Luminous Years , writer Janet Flanner describes the intense friendship of Pablo Picasso and Georges Braque. Both were inspired by Paul Cézanne and his retrospective at the 1907 Salon d’Automne—which, according to Paris: The Luminous Years, marked in Janus-like fashion the end of the 19th and the beginning of the 20th centuries in art. Flanner tells of the frequent visits between the two painters, where they “talked and talked … two or three months that they just spent gabbling, gabbling.” And from their camaraderie and gabble emerged someth ..