Txetxu Ausin

Parafraseando el afamado libro de Ronald Dworkin, Taking rights seriously, me propongo,en este trabajo, defender el carácter pleno, fundamental y universal de los derechos debienestar, muchas veces relegados a un papel secundario en el análisis de los derechoshumanos y observados con sospecha y recelo, sobre todo cuando colisionan con los derechosciviles y políticos. Para ello rechazaré la dicotomía radical que suele establecerseentre uno y otro tipo de derechos, atendiendo a cuatro argumentos: el costo de los derechos,su universalidad, su relatividad y su justiciabilidad. Abundamos así en la doctrinade las Naciones Unidas sobre la indivisibilidad e interdependencia de todos los derechoshumanos.

As essentially social beings, we humans are fragile and dependent on what is outside ourselves—others, institutions and sustained and sustainable environments—. Vulnerability acquires for us a social role (not a mere contingency or a subjective disposition) and hence the positive social obligations arise to minimize instability and its differential distribution, to demand basic support (food, shelter, work, healthcare, education, mobility, expression) and to reduce avoidable damage. We are a social species, with reciprocal links (rights and duties), built on the interdependence; not a group of solitary individuals whose mutual obligations are limited to not invading other people’s space. Care-related obligations by the (social) state come into play here, as in the case of healthcare systems. These can be characterized as “due cares” (due actions) because the action is an expected event within a social context of values and guidelines. In that context, the omission that causes or enables harm, as in exclusion from healthcare, qualifies as an “undue inaction”. In the criminal legal sense, the idea of “nonfeasance” refers to bringing about a result by not avoiding it, by violating a special duty, which equates with its causation—the prototypical example is the crime of failing to assist. Here the question not only of intentional omission but of neglect and abandonment comes into play. One example is the exclusion from healthcare and drugs of wide sectors of the Spanish population, not only undocumented migrants but also poor and unemployed people. The State is shamelessly neglecting important segments of the population, and causing harm—especially to the most vulnerable—by an ethically reprehensible omission of care. This case illustrates the need for defining what we have called “a public ethics of care” combining public ethics obligations with the responsibilities of care—since the ethics of care shapes government.

The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility.

To assess—from a qualitative perspective—the perceptions and attitudes of Spanish rehabilitation professionals (e.g. rehabilitation doctors, speech therapists, physical therapists) about Brain–Computer Interface (BCI) technology. A qualitative, exploratory and descriptive study was carried out by means of interviews and analysis of textual content with mixed generation of categories and segmentation into frequency of topics. We present the results of three in-depth interviews that were conducted with Spanish speaking individuals who had previously completed a survey as part of a larger, 3-country/language, survey on BCI perceptions. 11 out of 15 of these Spanish respondents (survey) either strongly or somewhat accept the use of BCI in rehabilitation therapy. However, the results of our three in-depth interviews show how, due to a strong inertia of attitudes and perceptions about BCI technology, most professionals feel reluctant to use BCI technology in their daily practice (interview).

The increasing application of artificial intelligence (AI) to healthcare raises both hope and ethical concerns. Some advanced machine learning methods provide accurate clinical predictions at the expense of a significant lack of explainability. Alex John London has defended that accuracy is a more important value than explainability in AI medicine. In this article, we locate the trade-off between accurate performance and explainable algorithms in the context of distributive justice. We acknowledge that accuracy is cardinal from outcome-oriented justice because it helps to maximize patients’ benefits and optimizes limited resources. However, we claim that the opaqueness of the algorithmic black box and its absence of explainability threatens core commitments of procedural fairness such as accountability, avoidance of bias, and transparency. To illustrate this, we discuss liver transplantation as a case of critical medical resources in which the lack of explainability in AI-based allocation algorithms is procedurally unfair. Finally, we provide a number of ethical recommendations for when considering the use of unexplainable algorithms in the distribution of health-related resources.

Interview with Philip Brey in which he clarifies and exemplifies the concept of ‘socially disruptive technology’, offering a series of key aspects for its present and future analysis from the disciplinary perspective of technology ethics. Philip Brey is Professor of Philosophy of Technology at the Department of Philosophy at the University of Twente. He has been a keynote speaker of the International Workshop on Controversies and Polarization on Disruptive Technologies, that took place virtually and in Granada, on October 5th and 6th 2020. His key-talk was titled “Disruptive Technologies: Social, Moral and Ontological Consequences”.

To analyze which ethically relevant biases have been identified by academic literature in artificial intelligence algorithms developed either for patient risk prediction and triage, or for contact tracing to deal with the COVID-19 pandemic. Additionally, to specifically investigate whether the role of social determinants of health have been considered in these AI developments or not. We conducted a scoping review of the literature, which covered publications from March 2020 to April 2021. ​Studies mentioning biases on AI algorithms developed for contact tracing and medical triage or risk prediction regarding COVID-19 were included. From 1054 identified articles, 20 studies were finally included. We propose a typology of biases identified in the literature based on bias, limitations and other ethical issues in both areas of analysis. Results on health disparities and SDOH were classified into five categories: racial disparities, biased data, socio-economic disparities, unequal accessibility and workforce, and information communication. SDOH needs to be considered in the clinical context, where they still seem underestimated. Epidemiological conditions depend on geographic location, so the use of local data in studies to develop international solutions may increase some biases. Gender bias was not specifically addressed in the articles included. The main biases are related to data collection and management. Ethical problems related to privacy, consent, and lack of regulation have been identified in contact tracing while some bias-related health inequalities have been highlighted. There is a need for further research focusing on SDOH and these specific AI apps.

The main aim of this article is to reflect on the impact of biases related to artificial intelligence (AI) systems developed to tackle issues arising from the COVID-19 pandemic, with special focus on those developed for triage and risk prediction. A secondary aim is to review assessment tools that have been developed to prevent biases in AI systems. In addition, we provide a conceptual clarification for some terms related to biases in this particular context. We focus mainly on nonracial biases that may be less considered when addressing biases in AI systems in the existing literature. In the manuscript, we found that the existence of bias in AI systems used for COVID-19 can result in algorithmic justice and that the legal frameworks and strategies developed to prevent the apparition of bias have failed to adequately consider social determinants of health. Finally, we make some recommendations on how to include more diverse professional profiles in order to develop AI systems that increase the epistemic diversity needed to tackle AI biases during the COVID-19 pandemic and beyond.

Hay dos tipos de bienes y derechos: de bienestar y de libertad. Los primeros, irrenunciables, acarrean deberes positivos, de dar o hacer. Los derechos de libertad, en cambio, sólo imponen a otros deberes negativos, dejando a su titular libre para ejercerlos o no según quiera. Sostenemos que el derecho a la vida es un derecho de libertad. De ahí se sigue que no es obligatorio aceptar el don de la vida salvo cuando el ordenamiento permite a los progenitores presumir el futuro consentimiento retroactivo del nuevo ser humano por nacer. Cuando las circunstancias hagan irrazonable tal presunción, es ilícita toda acción causal que contribuya a ese nacimiento salvo únicamente la acción voluntaria y libre de la madre de no abortar —por ser ése un derecho suyo. Matizamos nuestra teoría y la articulamos en un enfoque gradualista que da cuenta de la existencia de conflictos jurídicos.

Prácticamente cualquier propiedad o estado de cosas implicado en el debate bioético —así como en la vida cotidiana y en la mayoría de las ciencias— posee unos límites difusos y comprende casos fronterizos, sin unas líneas de demarcación precisas, como sucede con la eutanasia, el aborto, la investigación con embriones, los híbridos, la experimentación con animales, etc. Sin embargo, existe una profunda discordancia entre una realidad continua y gradual, caracterizada por los matices y las transiciones, una realidad en grises, y una lógica, un análisis descriptivo de esta realidad, bivalente, cifrado entre la verdad absoluta y la completa falsedad, en términos de “todo- o-nada”, blanco o negro. Como alternativa a este ‘principio de bivalencia’ que caracteriza en general el análisis estándar de la realidad y, en particular, de la bioética, sostenemos el ‘principio de gradualidad’ según el cual todo es cuestión de grado, por lo que un enfoque lógico-gradualista sería el método apropiado para la bioética.

Comer y beber son necesidades esenciales de todo ser humano, en toda cultura y sociedad, y su carencia produce, evidentemente, daños graves y objetivos. Por ello, el alimento y el agua potable devienen en exigencias morales universales en términos del derecho humano a comer y a beber, uno de esos derechos que dan y preservan la vida. Sin embargo, la humanidad vive sumida en una gravísima e intolerable situación de hambruna a la que contribuyen algunos factores estructurales como las políticas comerciales y financieras internacionales, la producción de biocombustibles y el abandono de la agricultura de consumo, entre otros. Este panorama obliga a una profunda reformulación de las políticas públicas sobre el alimento y el agua potable, que partan de su conceptualización como bienes públicos y no meras mercancías.

Millones de personas viven atrapadas en el círculo crónico de la enfermedad y la pobreza y no tienen acceso a los medicamentos esenciales que podrían aliviar o curar sus enfermedades. El motivo es doble: la falta de investigación en enfermedades de pobres (enfermedades olvidadas) y el rígido sistema de propiedad intelectual farmacéutica (patentes). Sin embargo, el derecho a la atención sanitaria primaria y su corolario, el derecho a los medicamentos esenciales, constituyen la piedra angular del derecho humano fundamental y primario: el derecho a la vida. Por ello, han de primarse las consideraciones de salud pública frente a la lógica del mercado en el ámbito de la investigación farmacéutica, buscando fórmulas que estimulen la innovación y la viabilidad empresarial junto con el desarrollo y la distribución de fármacos para el mayor número de enfermos.

For almost 30 years, until 2012, Spain had benefitted from a public healthcare system with universal coverage. That year, a new law denied ordinary healthcare for undocumented adult migrants. This law is in blunt contradiction to the idea that healthcare is a fundamental human right. We argue in this chapter that not only a deep and flagrant injustice results from that law, but also an ineffective health system, because important population groups remain out of health control, treatment and prevention, and because denying healthcare to undocumented migrants has not been translated into significant savings. This situation has provoked a strong backlash, from the Spanish society at large and, in particular, among health professionals who have decided to become conscientious objectors against the governmental request to withdraw healthcare from undocumented migrants. Interestingly, in this case, claims of conscience are not associated with personal interest or convictions—as they usually are—but rather with an ethical decision by professionals to take care of their patients, regardless of their administrative status. Promoting social justice is a foundational purpose of welfare states. When they fail in this objective, conscientious objection may become an instrument of last resort to uphold people’s rights.