Roberto Andorno

This chapter discusses whether our moral decisions should be conceived as the mere application of abstract moral principles or rather as practical knowledge derived from our moral experience and grounded in the complexity of concrete situations in which principles are embedded. Appealing to Aristotle, this chapter argues that, although principles play a key role in our moral judgments, these latter cannot be reduced to the result of purely deductive reasoning, since they previously require another kind of rationality: instead of being purely deductive, our moral decisions appear to be the result of a combined inductive-deductive process. This claim is developed in two parts. The first part briefly presents some of the criticisms levelled in recent decades against purely deductive moral theories. The second part claims that an inductive-deductive model provides a more realistic account of how sound moral judgments are actually made. This discussion has direct relevance to medical ethics, especially in the context of the criticisms levelled against the principlist approach proposed by Beauchamp and Childress.

Human rights and bioethics are conceptually and operationally much closer than usually assumed. This is not surprising as both normative frameworks emerged from the same dramatic events: the Second World War, the Holocaust, and the Nuremberg trials. The Universal Declaration of Human Rights (UDHR) of 1948, which would become the cornerstone of the international human rights law, was to a significant extent informed by the horror caused by the revelation that prisoners of concentration camps, including children, were used by Nazi physicians as subjects of brutal experiments. This shocking discovery led the Nuremberg trial to develop in 1947 the famous ten principles for medical research, which have come to be known as the Nuremberg Code. In this regard, it has been reported that “the details revealed daily at Nuremberg gave content to the rights recognized by Articles 4 through 20 of the Declaration” (Baker 2001, p. 242). Similarly, it has been pointed out that “World War II was the crucible in which both human rights and bioethics were forged, and they have been related by blood ever since.” (Annas 2005, p. 160) The fact is that at present all major international ethical and policy instruments relating to bioethics adopt a human rights approach.

The increasing availability of brain data within and outside the biomedical field, combined with the application of artificial intelligence (AI) to brain data analysis, poses a challenge for ethics and governance. We identify distinctive ethical implications of brain data acquisition and processing, and outline a multi-level governance framework. This framework is aimed at maximizing the benefits of facilitated brain data collection and further processing for science and medicine whilst minimizing risks and preventing harmful use. The framework consists of four primary areas of regulatory intervention: binding regulation, ethics and soft law, responsible innovation, and human rights.

This article reviews educational efforts to promote a responsible conduct of research (RCR) that were reported in scientific publications between 1990 and early 2020. Unlike previous reviews that were exploratory in nature, this review aimed to test eleven hypotheses on effective training strategies. The achievement of different learning outcomes was analyzed independently using moderator analysis and meta-regression, whereby 75 effect sizes from 30 studies were considered. The analysis shows that the achievement of different learning outcomes ought to be investigated separately. The attainment of knowledge strongly benefited from individualized learning, as well as from the discussion and practical application of ethical standards. Contrarily, not covering ethical standards tended to be a feature of successful courses, when looking at other learning outcomes. Overall, experiential learning approaches where learners were emotionally involved in thinking about how to deal with problems were most effective. Primarily intellectual deliberation about ethical problems, often considered the “gold standard” of ethics education, was significantly less effective. Several findings from previous reviews, e.g., the preferability of mono-disciplinary groups, could not be replicated with multivariate analysis. Several avenues for future research efforts are suggested to advance knowledge on the effectiveness of research integrity training.

The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty – often framed as “neurorights” in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.

Introduction Switzerland lacks specific legal regulation of assistance in suicide. The practice has, however, developed since the 1980s as a consequence of a gap in the Swiss Criminal Code and is performed by private right-to-die organisations. Traditionally, assistance in suicide is considered contrary to the philosophy of palliative care. Nonetheless, Swiss palliative care physicians regularly receive patient requests for suicide assistance. Their attitudes towards the legal regulations of this practice and their experience in this context remain unclear. Objectives Our study aimed to explore and describe the attitudes and experiences of Swiss palliative care physicians concerning the legal situation of suicide assistance. Methods In 2019, we performed an exploratory interview study with 12 Swiss palliative care physicians on palliative sedation as an alternative to assisted suicide. In this paper, we present the results that emerged from a thematic subanalysis of the data. Results Participants stated that assistance in suicide and palliative care are based on opposing philosophies, but they admitted a shift in paradigm over the last years in the sense that one practice does not necessarily exclude the other. They reported various roles in suicide assistance and considered that the current activities of Swiss right-to-die organisations were problematic and needed to be regulated by law. Discussion and conclusion These results could enrich national and international reflection on suicide assistance in the context of palliative care by reducing confusion between the two practices and strengthening the confidence of patients and their relatives.

The overall argument of this chapter is that human rights norms are primarily focused on preventing the worst forms of human suffering, even if they only concern a small portion of the population. This task has moral priority over the promotion of the maximum well-being of the majority of people. Starting from the assumption that there is a moral duty to prevent suffering, this chapter first argues that the entire human rights enterprise can be regarded as a social response to suffering; second, it claims that although suffering is not the foundation of human rights, it is a factor that crucially contributes to their recognition and effective protection; finally, it analyzes how three concrete forms of extreme human suffering are addressed by human rights instruments: torture, starvation, and terminal illness.

A discussion with Roberto Andorno about global bioethics and biolaw, the Coronavirus pandemic, and its impact on human dignity and rights. Can we foresee the emerging new profile of global bioethics and biolaw in the post-Coronavirus era? How significant are they going to be in the future, after the enormous pressure that the Coronavirus pandemic has exercised on key political, legal, and ethical values? Must the voice of bioethicists -compared to the ‘hard’ scientific data- be louder in the future concerning decisions about emergency social and medical measures? Is there a hope that public empowerment will support robust, global public engagement and meaningful deliberation? How much does Roberto Andorno’s view on human dignity reveal a supposed commitment to moral realism? The massive deaths of elderly people living in hospices of Sweden, Spain, and Italy, based on an implicit ‘fair innings’ view, has recently posed certain questions on the moral unacceptability of such practices. The same questions arise in the case of the legalization of euthanasia grounded on the implicit acceptance of the view that life is not worth living under certain circumstances. Is it possible that the human rights bodies worldwide will acquire executive power, and how could this become possible? How influential the ‘precautionary principle’ can become regarding clinical and research ethics in the future? How urgent is the importance of the introduction of bioethical education in the curricula of ‘hard’ empirical studies? Roberto Andorno discusses with us all these controversial and under heated public debate issues, giving sometimes provocative answers.

El artículo destaca la importancia de distinguir entre dos roles diversos que la noción de dignidad humana juega en bioética: uno, como principio de orden jurídico-político, y otro, como estándar moral del trato debido al paciente. Cuando la dignidad es entendida en el primer sentido, nos encontramos con un concepto muy general, que cumple un rol fundacional y de orientación de las normas relacionadas con las prácticas biomédicas. En cambio, cuando es utilizada en el segundo sentido, intenta captar la exigencia moral de tratar siempre al paciente como “persona”, es decir, con el mayor cuidado y respeto. Para clarificar el significado de la dignidad como principio, se apela a la distinción entre principios y normas elaborada en el campo de la filosofía jurídica. La dignidad como estándar moral de la relación médico-paciente se ilustra en base a una serie de estudios empíricos.

Rapid advancements in human neuroscience and neurotechnology open unprecedented possibilities for accessing, collecting, sharing and manipulating information from the human brain. Such applications raise important challenges to human rights principles that need to be addressed to prevent unintended consequences. This paper assesses the implications of emerging neurotechnology applications in the context of the human rights framework and suggests that existing human rights may not be sufficient to respond to these emerging issues. After analysing the relationship between neuroscience and human rights, we identify four new rights that may become of great relevance in the coming decades: the right to cognitive liberty, the right to mental privacy, the right to mental integrity, and the right to psychological continuity.

The emerging international biomedical law tends to recognise the right not to know one’s genetic status. However, the basis and conditions for the exercise of this right remain unclear in domestic laws. In addition to this, such a right has been criticised at the theoretical level as being in contradiction with patient’s autonomy, with doctors’ duty to inform patients, and with solidarity with family members. This happens especially when non-disclosure poses a risk of serious harm to the patient’s relatives who, without that vital information, could be deprived of preventive or therapeutic measures. This paper argues, firstly, that individuals may have a legitimate interest in not knowing their genetic make up to avoid serious psychological consequences; secondly, that this interest, far from being contrary to autonomy, may constitute an enhancement of autonomy; thirdly, that the right not to know cannot be presumed, but must be “activated” by the individual’s explicit choice, and fourthly, that this is not an absolute right, in the sense that it may be restricted when disclosure to the patient is necessary in order to avoid a risk of serious harm to third persons