Bioethics Digest

In this feature, our team provides you with an overview of the most recent publications in the field of bioethics, with a particular focus on contributions coming from (or having relevance for) Switzerland.

Buona lettura! Bonne lecture! Viel Spass beim Lesen! Enjoy your reading!

The editors: Andrea Martani, Maddalena Favaretto, and Felix Pageau

CLINICAL ETHICS

CLINICAL ETHICS

“Is Virtually Everything Possible? The Relevance of Ethics and Human Rights for Introducing Extended Reality in Forensic Psychiatry”

A group of lawyers and ethicists from the Netherlands and Switzerland discuss in this article the legal and ethical aspects of using extended reality (XR) in forensic psychiatry. XR is the name associated to a series of technological tools which allow users to interact with a virtual reality, and which are often used in the medical context for helping with psychiatric disorders (both for diagnosis and for treatment). According to the authors, however, the use of XR in forensic psychiatry (e.g. “for safely monitoring sexual offenders in a virtual supermarket where they encounter a child”) raises different ethical issues. On one hand, XR could help offenders in their resocialisation and reinforce their agency. On the other hand, it could infringe on their mental integrity and worsen their vulnerability and stigmatisation. After reflecting on these arguments, the authors conclude by calling for a user-centred development of XR, which “should take into account the users’ fundamental rights and embedding them into the technology”.

Ligthart S, Meynen G, Biller-Andorno N, Kooijmans T, Kellmeyer P. Is Virtually Everything Possible? The Relevance of Ethics and Human Rights for Introducing Extended Reality in Forensic Psychiatry. AJOB Neurosci. 2021 Mar 29:1-14. doi: 10.1080/21507740.2021.1898489. Online ahead of print.

DIGITAL ETHICS

DIGITAL ETIHICS

“Can we know if donor trust expires? About trust relationships and time in the context of open consent for future data use”

Authors of this paper discuss data donors’ trust when providing their personal data in medical research by reflecting whether this has an expiration date and if there are ways to ensure continuous trust in the distant future. They first argue that providing data through broad or open consent is de facto an expression of trust by data donors, assuming that their data will be handled fairly in future research. Such trust – the authors claim – must be in society as a whole and its safeguards, as the specific actors involved in handling the data (researchers, biobanks, healthcare system institutions) might change in the near future. On the contrary, society and its safeguards are supposed to be more stable and remain substantially unchanged. For this reason, authors assume that donors’ trust does not necessarily expire even after their death, if society does not change so fundamentally as to undermine the initial trust in it. Finally, the authors propose a few measures to ensure that trust in society and in research on personal data is achieved in the first place.

Gille F, Brall C. Can we know if donor trust expires? About trust relationships and time in the context of open consent for future data use. Journal of Medical Ethics. Published Online First: 15 March 2021. doi: 10.1136/medethics-2020-106244

PUBLIC HEALTH ETHICS

public health ethics

“WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal”

In this article, a group of bioethicists suggest several updates to the current WHO ‘Guidance for the management of ethical issues during an infectious disease outbreak’. These authors are either from Switzerland or have had previous collaborations with the World Health Organisation (WHO). After describing the ‘Guidance’ content (originally published after the Ebola Virus Disease outbreak), the authors propose modifications based on the lessons learned during the COVID-19 pandemic. For example, the authors suggest that the ‘Guidance’ should not only mention the important ethical principles relevant to public health measures, but also indicate how they can be balanced with one another. Also, the authors underline that the guidance should provide suggestions on how to ensure that at-risk-populations are actively involved in decision making in times of pandemic. The importance of adding reflections on the ethical issues generated by science communication and use of digital technologies in public health is also underscored.

Saxena A, Bouvier PA, Shamsi-Gooshki E, et al. WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal. Journal of Medical Ethics. Published Online First: 31 March 2021. doi: 10.1136/medethics-2020-106959