Demographical changes in high income counties will increase the need of health care services but reduce the number of people to provide them. Welfare technology is launched as an important measure to meet this challenge. As with all types of technologies we must explore its ethical challenges. A literature review reveals that welfare technology is a generic term for a heterogeneous group of technologies and there are few studies documenting their efficacy, effectiveness and efficiency. Many (...) kinds of welfare technology break with the traditional organization of health care. It introduces technology in new areas, such as in private homes, and it provides new functions, e.g. offering social stimuli and entertainment. At the same time welfare technology is developed for groups that traditionally have not been extensive technology users. This raises a series of ethical questions with regard to the development and use of welfare technologies, which are presented in this review. The main challenges identified are: (1) Alienation when advanced technology is used at home, (2) conflicting goals, as welfare technologies have many stakeholders with several ends, (3) respecting confidentiality and privacy when third-party actors are involved, (4) guaranteeing equal access and just distribution, and (5) handling conflicts between instrumental rationality and care in terms of respecting dignity and vulnerability. Addressing these issues is important for developing and implementing welfare technologies in a morally acceptable manner. (shrink)

Digital health and welfare technologies and artificial intelligence are proposed to revolutionise healthcare systems around the world by enabling new models of care. Digital health and welfare technologies enable remote monitoring and treatments, and artificial intelligence is proposed as a means of prediction instead of reaction to individuals’ health and as an enabler of proactive care and rehabilitation. The digital transformation not only affects hospital and primary care but also how the community meets older people's (...) needs. Community care is often provided by informal and formal care‐givers, most of whom are women. Gender equality is at the heart of many national strategies, but do all genders have equal rights, responsibilities and opportunities when it comes to community care and its digital transformation? The digital transformation of community care is entangled with how care is provided to older people and the working conditions of community‐care professionals. Current and, even more so, future community‐care systems are and will be partly constituted by networks of technological artefacts. These health and welfare technological artefacts and the discourse surrounding them mediate and constitute social relations and community care. This article looks into how health and welfare technology and artificial intelligence‐based devices and systems mediate and constitute gender relations in community care and presents an argument for reflexivity, embodiment, pluralism, participation and ecology as an alternative strategy to treating community care as one‐size‐fit‐all and being blind to gender‐related issues. (shrink)

This study aims to compare and contrast how specific information health technologies (IHTs) have been debated, how they have proliferated, and what they have enabled in Germany’s and England’s healthcare systems. For this a discourse analysis was undertaken that specifically focussed on future-scenarios articulated in policy documents and strategy papers released by relevant actors from both healthcare systems. The study reveals that the way IHTs have been debated and how they have proliferated depends on country-specific regulatory structures, their respective (...) values, actors’ and institutions’ organized interests, and the status of health professionals. These conditions have enabled IHTs to promote a new and similar concept of patienthood in both countries, although they tend to affect practitioners’ practices more dramatically in England. The conclusion is drawn that with the usage of IHTs, healthcare systems reproduced existing patterns of health provision while also enabling a sort of convergence. Future research should investigate whether the new concept of patienthood emerging in both welfare states actually suits patients’ and professionals’ needs and requirements. (shrink)

This paper challenges traditional views which oppose health economics and medical ethics by arguing that economic assessment is a necessary complement to medical ethics and can help to improve public participation and democratic processes in choices about resource allocation for health care technologies. In support of this argument, four points are emphasized: (1) Most current biomedical ethical debates implicitly deal with economic issues of resource allocation. (2) Clinical decisions, which usually respect the Hippocratic code of ethics, are nevertheless (...) influenced by economic incentives and constraints. (3) Economic assessment is concerned with both efficiency and equity and potential trade-offs between the two, which means that ethical judgements are always embedded in welfare economics. (4) The real debate is not between economics on the one side and medical ethics on the other. Rather it is between different ethical conceptions of social justice and the contrasting approaches they entail to reconciling individual interests and preferences with collective goods and welfare. (shrink)

Many different professionals play a key role in maintaining welfare in a welfare society. These professionals engage in moral judgements when using (new) technologies. In doing so, they achieve that radical responsibility towards the other that Levinas describes as being at the very core of ethics. Also, professionals try to assess the possible consequences of the involvement of specific technologies and adjust their actions in order to ensure ethical responsibility. Thus, ethics is necessary in order to obtain and (...) sustain one's professionalism. This presents care institutions with the challenge to design work processes and technology work in ways that include a sense of ‘the Other’ and make moral judgement an indispensable part of professional competence in technology. This article provides new understandings of the way ethics are involved in care institutions. Nurses’ moral judgements are sophisticated with regard to ethical perspectives. In hospitals, nurses combine Latour's notion of symmetry in human/technology relations with an ethics implying ethical priority to human beings over other beings. This combination of ethics is not only sophisticated; it is also paradoxical, as it puts together mutually contradictory ethics. Instead of causing moral confusion, this ethical paradox is employed to produce a particularly refined notion of care situations, allowing nurses’ care to include patients and technology alike. (shrink)

The current viewpoint on technology seems to derive from the optimistic idea of the existence of pre-established harmony that any technological progress leads to people's health, and welfare. But history has shown us that this is not always the case, and that we must select the proper direction which leads to health and welfare. For that purpose, this article presents the viewpoint of technology as a kind of human care service, along with the lessons (...) from nursing theories. Five leading nursing theories are introduced as well as their implications for technology. ‘The nursing model of technology’ is then presented. (shrink)

In March 2022 the US Food and Drug Administration (FDA) published a risk assessment of a recent animal gene editing proposal submitted by Acceligen™. The proposal concerned the possibility of changing the cattle genome to obtain a slicker, shorter hair coat. Using CRISPR-Cas9 it was possible to introduce an intentional genomic alteration (IGA) to the prolactin receptor gene (PRLR), thereby producing PRLR-SLICK cattle. The goal was to diminish heat stress in the cattle by enhancing their heat-tolerance. With regard to unintended (...) alterations (i.e., off-target effects), the FDA stated that the IGA posed a low, but still present, risk to animal safety. The aim of this article is to present some initial insights into the welfare issues raised by PRLR-SLICK cattle by addressing the question: Do SLICK cattle have better welfare than non-SLICK cattle when exposed to heat stress? Two potential welfare concerns are examined. The first is pleiotropy, an issue that arises when one gene affects multiple traits. Given the pleiotropic nature of prolactin, it has been suggested that the IGA for SLICK cattle may also affect their hepatic and other functions. The second concern relates not primarily to direct effects on cattle health, but rather to the indirect risk that this more heat-tolerant animal would just be used in the livestock sector under farming conditions that are such that the net welfare improvement would be non-existent. (shrink)

Is there any ethical justification for limiting the reproductive autonomy and not make assisted reproductive technologies available to certain prospective parents? We present and discuss the results of an interdisciplinary clinical ethics study concerning access to assisted reproductive technologies (ART) in situations which are considered as ethically problematic in France (overage or sick parents, surrogate motherhood). The study focused on the arguments that people in these situations put forward when requesting access to ART. It shows that requester’s arguments are based (...) on sound ethical values, and that their legitimacy is at least as strong as that of those used by doctors to question access to ART. Results reveal that the three implicit normative arguments that founded the law in 1994, which are still in force after the bioethics law revision in July 2011—the welfare of the child, the illegitimacy of a “right to a child,” and the defense of the so called “social order”—are challenged on several grounds by requesters as reasons for limiting their reproductive autonomy. Although these results are limited to exceptional situations, they are of special interest insofar as they give voice to the requesters’ own ethical concerns in the ongoing political debate over access to ART. (shrink)

With the development of assisted reproductive technologies, medical, ethical, legal, and social issues have arisen that did not exist when natural conception was the only means of childbirth. In Japan, men tend to believe that assisted reproductive technologies are not directly related to them, with the literature showing that men are often reluctant to be involved in fertility treatment processes. To better understand this situation, this study analyzes the role of male consent during assisted reproductive technology procedures in Japan. (...) First, we examined Japanese court cases that dealt with issues related to male consent during assisted reproductive technology procedures and identified three situations in which problems related to male consent during such procedures may arise. Next, we analyzed the background of such issues and the implications of the lack of consent regarding men’s reproductive rights. Finally, we explored the need for legislation on assisted reproductive technologies. The study concludes that discussions on the scope of male partner rights in assisted reproductive technology procedures are key for minimizing unnecessary conflict between partners, thus ensuring both the rights of women who wish to have children and the welfare of their children. (shrink)

Changes in attitudes towards how animals are housed in agriculture are currently under question in the public eye—particularly for laying hens. Many arguments from the rights and utilitarian viewpoints have been made for changing environmental conditions and managerial practices for animals in an effort to respect the interests of the animal and better their welfare. Yet, these arguments have been based upon belief systems that were developed from information that can be collected by human perception only. Technological advancements can (...) facilitate animal welfare assessment by providing humans with new information about what the animal perceives. Yet, little has been discussed surrounding the thought process behind which technologies are conceived, how they are developed, and why they are implemented. Here, using the laying hen as a model, we turn to the philosophy of technology to address what role technological advancements may have in our capacity to understand animals, how technology can affect their welfare, and what role technology may play in furthering animal welfare assessment. (shrink)

Fundamental questions in value sensitive design include whether and how high-tech products/artefacts could embody values and ethical ideals, and how plural and incommensurable values of ethical and social importance could be chosen rationally and objectively at a collective level. By using a humanitarian cargo drone study as a starting point, this paper tackles the challenges that VSD’s lack of commitment to a specific ethical theory generates in practical applications. Besides, it highlights how mainstream ethical approaches usually related to VSD are (...) incapable of solving main ethical dilemmas raised by technological design for well-being in democratic settings. Accordingly, it is argued that VSD’s ethical-democratic import would substantially be enhanced by the espousal of a procedural ethics stance and the deliberative approach to value and welfare entailed by Amartya Sen’s capability approach. Differently from rival ethical–political theories, its normative and meta-ethical foundations better handle human diversity, value-goal pluralism, conflicting vested interests as well as the epistemic-moral disagreements typical of contemporary complex democracies. Particularly, Sen’s capability approach procedural-deliberative tenets result in an “objective-impartial” choice procedure selecting a “hierarchy” of plural incommensurable values and rational goals thus, suitable to validate an applied science such as welfare-oriented technological design in concrete social environments. Conclusions suggest that refining VSD with a capability-based procedural approach to ethics fosters the concern for democracy and social justice while preserving vital scientific-technical standards. Major advantages are at an applied level to delivering ethically and socially justified, but yet highly functional technologies and high-tech products/artefacts. (shrink)

This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited (...) and that—even with respect to their ‘autonomy enhancing’ potential—these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy and substantive-relational autonomy. While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation. (shrink)

Policy-makers have attempted to frame the ethical requirements that are relevant to the creation of human beings via reproductive technologies. Various reports and laws enacted in New Zealand, Canada, Australia, and Britain have introduced tests for how we should weigh child welfare when using these technologies. A number of bioethicists have argued that child welfare should be interpreted as a “best interests” test. Others have argued that there are ethical reasons why we should abandon this kind of test. (...) I will argue that at least some of the relevant policy can be interpreted as requiring those wishing to exercise their procreative liberty to have a reasonable plan to care and nurture any resulting child, thereby respecting the internal preconditions of that liberty. This interpretation of child welfare requirements answers some of the ethical worries about a child welfare test. (shrink)

In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

Some breeding technology applications are claimed to improve animal welfare: this includes potential applications of genomics and genome editing to improve animals’ resistance to environmental stress, to genetically alter features which in current practice are changed invasively, or to reduce animals’ capacity for suffering. Such applications challenge how breeding technologies are evaluated, which paradigmatically proceeds from a welfare perspective. Whether animal welfare will indeed improve may be unanswerable until proposed applications have been developed and tested sufficiently (...) and until agreement is reached on how to conceptualize animal welfare. Moreover, even if breeding technologies do improve animal welfare, they might be objected to on other ethical grounds. Ethical perspectives on earlier animal biotechnologies are relevant for today’s breeding technologies and their proposed applications, but may need reinterpretation. The current paper applies the concept of telos, which previously figured mainly in debates on classical genetic engineering, to genomic selection and genome editing aimed at improving animal welfare. It critiques current accounts of telos and offers an alternative conceptualization that applies to recently proposed applications of breeding technologies. This account rejects both removing the desire to pursue characteristic activities and altering animal bodies in ways that compromise their ability to perform such activities, but conditionally allows increasing robustness against environmental stress. Our account of telos enriches ethical debate on these breeding technology applications by insisting on the connection between the good life, an animal’s constitution, and its activities, thus countering reductive conceptions of welfare. (shrink)

This article attempts to descriptively characterize the impact of the sharing economy, using Uber as an example, on the social welfare of those people working via the app. For this purpose, the author proposes a theoretical concept of a technologically networked economy, which is a component of a broader heuristic model of a technologically networked reality. Furthermore, a critical review of the different approaches to the sharing economy and the diverse practices within it have been carried out. The results (...) of the theoretical exploration of this increasingly popular phenomenon revealed parallels with the problems of nondigital labor markets in the field of the workforce. The clear separation of grassroots sharing practices from those in name only like Uber suggest that the latter do not realize social welfare more broadly than ordinary capitalist enterprises. (shrink)

Werkhoven’s ‘A Dispositional Theory of Health’ is an important and original contribution to debates about the disease concept, which persuasively demonstrates that dispositions must play some role in a full account of what it is to be healthy or ill. Unfortunately, as a theory, it cannot as it stands be correct.I first demonstrate what appears to be a significant, and possibly fatal, flaw; the proliferation of dispositions which Werkhoven’s theory requires makes impossible, at least in the absence of significant (...) further metaphysical work, the comparative numerical judgements on which its account of health and illness are based. I then demonstrate two further problems, concerning the exclusion of ‘technological’ dispositions from those under consideration, and a large class of compensatory biological functions which Werkhoven’s theory seems to have overlooked. (shrink)

“HTA is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused, and seek to achieve best value” (EUnetHTA 2007). Even though the assessment of ethical aspects of a health technology is listed as one of the objectives of a HTA (...) process, in practice, the integration of these dimensions into reports remains limited. The article is focused on four points: 1. the HTA concept; 2. the difficult HTA-ethics relationship; 3. the ethical issues in HTA; 4. the methods for integrating ethical analysis into HTA. (shrink)

In this paper, we explore the idea of digital technologies as truth‐bearers in health care and argue that devices like SenseCam, which facilitate reflection and memory recall, have a potentially vital role in healthcare situations when questions of veracity are at stake (e.g., when best interest decisions are being made). We discuss the role of digital technologies as truth‐bearers in the context of nursing people with dementia, as this is one area of health care in which the topic (...) of truth‐telling has been hotly debated. People with dementia have been excluded from research studies and decisions that affect their lives because they are not regarded as truth‐bearers—that is, as being capable of giving truthful accounts of their experiences. Also, considerable research has focused on the ethics of lying to and deceiving people with dementia. Given their increasing prominence in healthcare settings, there has been surprisingly little discussion of what role digital technologies might play in relation to these questions of truth and deception. Drawing on theories from science and technology studies (STS), we explore their possible future role in some of the truth‐making processes of health care. In particular, we discuss the potential value of constraints on use of SenseCam to support the accounts of people with dementia as part of their care. (shrink)

Every emerging technology has its pros and cons; health-conscious users pay more importance to healthy and environment-friendly technologies. Based on the UTAUT2 model, we proposed a comprehensive novel model to study the factors influencing consumers’ decision-making to adopt the technology. Compared to prior studies that focused on linear models to investigate consumers’ technology adoption intentions and use behavior. This study used a Structural Equation Modeling-fuzzy set qualitative comparative analysis approach to account for the complexity of customers’ (...) decision-making processes in adopting new technology. We collected valid responses from 830 consumers, analyzed them, and evaluated them using a deep learning SEM-fsQCA technique to capture symmetric and asymmetric relations between variables. We have extensively incorporated a health-consciousness attitude as a predictor and mediator to understand better the decision-making toward technology adoption, specifically 5G technology. All the factors tested in our model are statistically significant except the economic factors. Health-consciousness attitude and behavioral intention found significant predictors and valid mediators in the process of 5G technology adoption. FsQCA provided six configurations to achieve high 5G adoption. The findings have significant practical ramifications for telecom corporations, advertisers, government officials, and key policymakers. Additionally, the study added substantial theoretical literature to technology adoption, particularly the adoption of 5G technology. (shrink)

Going through reproductive experiences (especially pregnancy and childbirth) in contemporary Western societies almost inevitably involves interaction with medical practitioners and various medical technologies in institutional context. This has important consequences for women as embodied subjects. A critical appraisal of these consequences—coming dominantly from feminist scholarship—relied on a problematic theory of both technology and the subject, which are in contemporary approaches no longer considered as given, coherent and well individualized wholes, but as complex constellations that are locally situated and that (...) can only be described empirically. In this study, we will be relying on the developments in phenomenological theory to reconceptualize women as technologically mediated embodied subjects and on the new paradigms in philosophy of technology and STS to reconstruct medical technology as situated—with the aim of reconceptualizing their relationship and exploring different possibilities for the mediating role of medical technology. It will be argued that technologization of female reproductive processes and alienating consequences for women are not necessary or directly interrelated. The role of technology varies from case to case and depends mainly on the nontechnological and relational aspects of institutional context, in which medical practitioners play a decisive role. (shrink)

William M. Epstein charges that most current social welfare programs are not held to credible standards in their design or their results. Rather than spending less on such research and programs, however, Epstein suggests we should spend much more, and do the job right. The American public and policymakers need to rely on social science research for objective, credible information when trying to solve problems of employment, affordable housing, effective health care, and family integrity. But, Epstein contends, politicians (...) treat welfare issues as ideological battlegrounds; they demand immediate results from questionable data and implement policies long before social researchers can complete their analyses. Social scientists often play into the political agenda, supporting poorly conceived programs and doing little to test and revise them. Analyzing Aid to Families with Dependent Children (AFDC) and the recent welfare reform act, Food Stamps, Medicaid, job training, social services, and other programs, Epstein systematically challenges the conservative’s vain hope that neglect is therapeutic for the poor, as well as the liberal’s conceit that a little bit of assistance is sufficient. (shrink)

Winds of change, from the political perspective in Mexico, invite us to reformulate the methodological vision for the direction of public policy in the field of social development, directing their actions towards the construction of a methodological proposal that allows us to direct ourselves towards achieving higher levels of Well-being Social in our country, as a desirable objective of public policy and which is expected to be inclusive, participatory and democratic. -/- In this sense, it is important to recognize that (...) the current debate, in the academic and political sphere, questions what is being well? What is the life that is worth living? And that, additionally, the recognition of the satisfaction of life goals, at an individual and collective level, which invites us to reflect, if the current economic and social policy and strategy has produced results in what we envision as social welfare? Is a new approach necessary to solve the problem? What strategy should it be to consider the new methodological approach that seeks social welfare? And what components should be considered in the measurement of social welfare? This document is an invitation to review the concept of social welfare, as a proposal whose purpose is to correct the deficiencies or historical deficiencies suffered by the population, in the elemental enjoyment of social rights, a situation that causes social backwardness, marginalization, and that it is aimed at the impossibility of participating in the social decisions of the community and in collective decisions, such as: speaking, proposing, being heard and demanding compliance with fundamental human rights such as: health, food, housing, employment and security, among others. These deficiencies in the enjoyment of social and human rights are seen in the presence of social exclusion, and that together these social deficiencies explain the degree of multidimensional poverty suffered by the population in rural and urban areas. It is here that he invites us to reflect: what is the problem that social welfare seeks to solve? Multidimensional poverty, social exclusion, social backwardness or social inequality? And consequently, how to define the components to identify social welfare? -/- The document is made up of three sections: i) Social welfare: A retrospective look; ii) Social Welfare, an integrative view: The contribution of Sen, Naussbam, Rawls, Actis Di Pasquale and Keyes; and iii) Social Welfare: The recognition of limits in economic development -/- The first section presents a review of the proposals, which in the area of economic development have been presented since 1968 in the Human Condition Project, until the 2015 proposal of Sustainable Development Goals. -/- In the second section, the contributions of (Rawls, 1995), (Sen, 1982), (Nussbaum, 2011), (Keyes, 1998) , (Actis Di Pasquale, 2015) and (Actis Di Pasquale, 2017) are presented in order to present an integrative approach to the concept of social welfare. And finally, the third section presents the recognition of limits in development, as well as an invitation for action from a transdisciplinary and interdisciplinary perspective in the study of social welfare. -/- August 2020 DOI: 10.13140/RG.2.2.24147.20006/1 LicenseCC BY-SA 4.0 -/- . (shrink)

The interests or welfare of the child are rightly central to anydiscussion of the ethics of reproduction. The problematic nature of thislegitimate concern is seldom, if ever, noticed or if it is, it ismisunderstood. A prominent example of this sort of misunderstandingoccurs in the Department of Health's recent and important `SurrogacyReview' chaired by Margaret Brazier (The Brazier Report) and thesame misunderstanding makes nonsense of at least one provision of theHuman Fertilization and Embryology Act 1990. (The HFE Act).This paper (...) explores and hopefully resolves this misunderstandingand sets out the ways in which the idea of theinterests of the child can legitimately function inbioethics. (shrink)

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using (...) five key ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare. (shrink)

Information and computer technology has come to play an increasingly important role in medicine, to the extent that e-health has been described as a disruptive innovation or revolution in healthcare. The attention is very much focused on the technology itself, and advances that have been made in genetics and biology. This leads to the question: What is changing in medicine today concerning e-health? To what degree could these changes be characterized as a ‘revolution’? We will apply (...) the work of Thomas Kuhn, Larry Laudan, Michel Foucault and other philosophers—which offers an alternative understanding of progress and revolution in medicine to the classic discovery-oriented approach—to our analysis. Nowadays, the long-standing curative or reactive paradigm in medicine is facing a crisis due to an aging population, a significant increase in chronic diseases and the development of more expensive diagnostic tools and therapies. This promotes the evolution towards a new paradigm with an emphasis on preventive medicine. E-health constitutes an essential part of this new paradigm that seeks to solve the challenges presented by an aging population, skyrocketing costs and so forth. Our approach changes the focus from the technology itself toward the underlying paradigm shift in medicine. We will discuss the relevance of this approach by applying it to the surge in digital self-tracking through health apps and wearables: the recognition of the underlying paradigm shift leads to a more comprehensive understanding of self-tracking than a solely discovery-oriented or technology-focused view can provide. (shrink)

This article illustrates the relationships between political parties and the healthcare sector in Italy since the 1950s. The several was though which parties have "exploited" health policics are explored, ranging from the selective extension of care entitlements to the various occupational categories to the clientelistic ties with doctors, from the placement of party personnell in the various administrative posts to illegal financing. The author argues that the partitocratie exploitation of the health care sector has greatly contributed to the (...) failure of the 1978 reform establishing a National Health Service. This failure has in its turn backlashed against the partitocratic government, accellerating its demise in the early 1990s. The article concludes with some considerations on the future of Italy's health policy and, more generally, welfare state policy. (shrink)

This article challenges the widespread contention - promoted by the World Health Organization, the U.N. Human Rights Commission, and certain non-governmental organizations - that health care should be regarded as an individual human right. Like other "post-modern" rights, the asserted individual right to health care is a positive claim on the resources of others; it is unlimited by corresponding responsibilities; and it pertains exclusively to the individual. In fact, an individual human right to health, enforceable against (...) either governments or corporations, does not currently exist in law. If established, such a right would portend a dramatic expansion of government control over health care, with negative consequences for efficiency and patient welfare. Voluntary efforts based on partnership, rather than the imposition of legal requirements, are the most productive means of expanding access to health care while preserving incentives for continued development of innovative health technologies. (shrink)

Child welfare clinics established in a rural Jamaican community for research purposes are described. These special clinics were able to devote more resources to the care of their children than is usual, yet the growth and health of these children were very similar to those in another group to whom this service was not available and who attended routine government welfare clinics only infrequently.

– Pharmacy sales of over‐the‐counter medicines in the UK represent an economically significant and important mechanism by which customers self‐medicate. Sales are supervised in pharmacies, but this paper seeks to question whether patients' electronic health records – due to be introduced nationally – could be used, ethically, by pharmacists to ensure safe medicines sales., – Using theoretical arguments, three areas of ethical concern are identified and explored in relation to pharmacists' access to EHRs‐consequentialsim, analogies and confidentiality/privacy., – Consequentialist arguments (...) include positive benefits to customer's welfare and control of medicine of abuse, but negative economic healthcare burdens and consequences due to potentially increased or paradoxically, decreased presentation of patients to doctors. Socially accepted analogous practices – credit checks, existing pharmacy access to information and hospital treatment – are then argued to be ethically relevant and supportive of access. Privacy and confidentiality are then considered as reasons not to allow EHR access. A contrasting view is that pharmacy access to EHRs is another form of surveillance and hence the question of pharmacists' assess to EHRs may be answered negatively by empirical research that locates pharmacy customers as expert users and identifies confidentiality and privacy concerns about information technology in healthcare more generally., – This paper offers a unique and valuable contribution to the debate about healthcare professionals' role‐based access to patients' medical records and offers a reflection on the ethical concerns surrounding patient information and the rival concerns of patient qua customer autonomy and safety. (shrink)

What is animal welfare? Why has it proved so difficult to find a definition that everyone can agree on? This concise and accessible guide is for anyone who is interested in animals and who has wondered how we can assess their welfare scientifically. It defines animal welfare as 'health and animals having what they want', a definition that can be easily understood by scientists and non-scientists alike, expresses in simple words what underlies many existing definitions, and (...) shows what evidence we need to collect to improve animal welfare in practice. Above all, it puts the animal's own point of view at the heart of an assessment of its welfare. But, can we really understand what animals want? A consistent theme running through the book is that not only is it possible to establish what animals want, but that this information is vital in helping us to make sense of the long and often confusing list of welfare measures that are now in use such as 'stress' and 'feel good hormones', expressive sounds and gestures, natural behaviour, cognitive bias, and stereotypies. Defining welfare as 'health and what animals want' allows us to distinguish between measures that are simply what an animal does when it is alert, aroused, or active and those measures that genuinely allow us to distinguish between situations the animals themselves see as positive or negative. Sentience (conscious feelings of pleasure, pain, and suffering) is for many people the essence of what is meant by welfare, but studying consciousness is notoriously difficult, particularly in non-human species. These difficulties are discussed in the context of our current - and as yet incomplete - knowledge of human and animal consciousness. Finally, the book highlights some key ideas in the relationship between animal welfare science and animal ethics and shows how closely the well-being of humans is linked to that of other animals. The Science of Animal Welfare is an ideal companion for undergraduate and graduate students taking courses in animal behaviour and welfare, as well as for professional researchers, practitioners and animal welfare consultants. At the same time, it is easily understandable to non-scientists and anyone without prior knowledge but with an interest in animals and the rapidly evolving science of animal welfare. (shrink)

Current advances in connectivity, sensor technology, computing power and the development of complex algorithms for processing health-related data are paving the way for the delivery of innovative long-term health care services in the future. Such technological developments will, in particular, assist the elderly and infirm to live independently, at home, for much longer periods. The home is, in fact, becoming a locus for health care innovation that may in the future compete with the hospital. However, along (...) with these advances come valid privacy and security questions arising from the fact that the data collected and transmitted through these technologies could also allow for individual monitoring as well as unauthorized access to critical diagnostic and other health data. (shrink)

COVID-19 has created additional challenges in mental health services, including the impact of social distancing measures on care and treatment. For situations where a detention under mental health legislation is required to keep an individual safe, psychiatrists may consider whether to conduct an assessment in person or using video technology. The Mental Health (Care and Treatment) (Scotland) Act 2003 does not stipulate that an assessment has to be conducted in person. Yet, the Code of Practice envisions (...) that detention assessments would be conducted face to face in all circumstances. During the pandemic, the Mental Welfare Commission for Scotland, a statutory body with a duty to promote best practice of the Act, has been asked whether it may be acceptable and indeed preferable for some assessments to be conducted via video technology. Where an assessment is needed to determine if a patient needs to be detained, and where there is a need for social distancing or the need for ‘shielding’, remote assessments may in some circumstances be preferable. In this article, we outline the modification of the Mental Welfare Commission’s previous outright rejection of virtual assessments as the pandemic progressed and discuss the ethical and legal issues the possibility of remote assessments has exposed. We also discuss the limits and when a virtual assessment is not considered ethical. As the pandemic moves from a state of emergency into a ‘new normal’ in psychiatric services during second, or subsequent, waves, the use and place (if any) of remote assessments for detention needs to be considered. (shrink)

Werkhoven’s ‘A Dispositional Theory of Health’ is an important and original contribution to debates about the disease concept, which persuasively demonstrates that dispositions must play some role in a full account of what it is to be healthy or ill. Unfortunately, as a theory, it cannot as it stands be correct.I first demonstrate what appears to be a significant, and possibly fatal, flaw; the proliferation of dispositions which Werkhoven’s theory requires makes impossible, at least in the absence of significant (...) further metaphysical work, the comparative numerical judgements on which its account of health and illness are based. I then demonstrate two further problems, concerning the exclusion of ‘technological’ dispositions from those under consideration, and a large class of compensatory biological functions which Werkhoven’s theory seems to have overlooked. (shrink)

Mourning exists at the nexus between individual experience, professional discourses, research, and culture, making it a complex issue for health services that has shown vibrant change in recent years. By contrast, bereavement discourse in intellectual disability is suffused by dogmatic assertions about correct intervention: we describe four vignettes to illustrate bereavement issues in intellectual disability. Suggestions concerning issues and management are made, but the article focuses primarily on the conceptual issues that underpin clinical intervention. The analysis shows how challenges (...) to the meaning of the disabled life, and to the understandings carers and staff draw on, tend to be resisted. We hypothesize this is most likely to surround issues that evoke cultural uncertainty, such as bereavement. The thesis is that the field of intellectual disability tends to be isolationist because meaning is difficult to create and easily dissolved, especially when addressing culturally contested topics. Dialogue with other disciplines is necessary to stop the field from atrophying, but needs to be carried out in ways that enable carers and clinicians to continue providing the support that people with intellectual disability require. (shrink)

Technology is believed to have liberated health care from dogmas, myths and speculations of earlier times. However, we are accused of using technology in an excessive, futile and even detrimental way, as if technology is compelling our actions. It appears to be like the monster threatening Dr. Frankenstein or like the socerer’s broom in the hand of the apprentice. That is, the same technology that should liberate us from myths, appears to be mythical. The objective (...) of this article is to investigate the background for the re-entrance of the myth: How we encounter it and how we can explain it. The main point is that a myth of technology is normative: it relates ‘is’ and ‘ought’ and directs our actions. This becomes particularly clear in health care. Hence, if there is a myth of technology, it is an ethical issue, and should be taken seriously. (shrink)

Health technology assessment consists of thesystematic study of the consequences of theintroduction or continued use of the technology in aparticular context, with the explicit objective toarrive at a judgment of the value or merit of thetechnology. Ideally, it is aimed at assessing allaspects of a given technology or group oftechnologies, including non-technical, e.g.socio-ethical, aspects. However, methods for assessingsocio-ethical implications of health technology arerelatively undeveloped and few mechanisms exist totake action based on the results of (...) such evaluations.Still, the examples of cochlear inplants and other cases illustratethat HTA is not a matter of merely collecting thefacts about a technology. The facts must beplausible and relevant from a particular framework,which is not always shared by different groups. It ishere that socio-ethical aspects are encountered. Ifhealth technology assessment aims to enhance theaccountability of the decision making processregarding funding and use of health technology, it isa major challenge to assessors of health technologiesto deal adequately with existing value pluralism. Inthis respect interactive evaluation may have somethingto offer. (shrink)

Recent publications on digital health technologies highlight the importance of ‘responsible’ use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted (...) a scoping review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher’s Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing ‘role responsibilities’ among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a ‘responsibility gap’ where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients’ accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health. (shrink)

Daniel Callahan's life time work in bioethics has again and again returned to the root problems of health, progress, technology, and death. How we think about each of them individually and in relation to each other will shape the way we approach and deal with the most common dilemmas of modern medicine. They are at the roots of the field.

Scale is central to understanding nanotechnologies. These technologies are usually described as the understanding and control of matter at the nanoscale, with one nanometer being 10^-9 meter. At this scale, some materials gain new properties that can be used in the creation of new products. These properties may contribute to economic growth and social welfare but, conversely, they may also create negative effects, such as new risks to human health and the environment. As an emerging field whose consequences (...) are still uncertain, the meanings of nanotechnologies are hotly contested. (shrink)

Review of Andrew Webster, Health, Technology and Society: A Sociological Critique. Hampshire: Palgrave MacMillan, 2007. Pp. 213. UK£20.99 PB.

Control of wild animals may give rise to controversy, as is seen in the case of badger control to manage TB in cattle in the UK. However, it is striking that concerns about the potential suffering of the affected animals themselves are often given little attention or completely ignored in policies aimed at dealing with wild animals. McCulloch and Reiss argue that this could be remedied by means of a “mandatory application of formal and systematic Animal Welfare Impact Assessment (...) ”. Optimistically, they consider that an AWIA could help to resolve controversies involving wild animals. The aim of this paper is to evaluate the potential of AWIA. We begin by showing how ideas akin to AWIA already play a significant role in other animal ethics controversies, particularly those concerning laboratory animal use and livestock production; and we bring in lessons learnt from these controversies. Then we comment on the suggested development and application of AWIA in the case of badger control. Finally, we discuss the prospects of applying AWIA to other sorts of wild animal controversy. We argue that the AIWA, as developed by McCulloch and Reiss, relies on several dubious premises, including that killing is a welfare issue. Furthermore, we argue that AWIA is unlikely to prevent serious moral disagreements over how to weigh concerns about wild animals against priorities in human health, the health of domestic and farm animals, and biodiversity, but that it may nonetheless serve to limit harms imposed on the wild animals. (shrink)