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Niepewność w argumentacji bioetycznej: badania genetyczne, medycyna prewencyjna, decyzje prokreacyjne (BIOUNCERTAINTY)

Niepewność w argumentacji bioetycznej: badania genetyczne, medycyna prewencyjna, decyzje prokreacyjne (BIOUNCERTAINTY)

 

Projekt badawczy finansowany przez Europejską Radę ds. Badań Naukowych (European Research Council – ERC) w ramach konkursu Starting Grant w latach 2019-24, nr umowy: 805498.

Kierownik projektu: Tomasz Żuradzki.

 

 

 

 

Projekt

Niepewność w bioetyce: badania genetyczne, medycyna prewencyjna, decyzje prokreacyjne

Abstrakt

Postęp w badaniach oraz technologiach biomedycznych połączony jest często z niepewnością dotyczącą tego, w jaki sposób należy oceniać jego rezultaty. Niekiedy kontrowersje wywołuje też sama dopuszczalność prowadzenia danego typu badań lub legalizacji danego typu techniki. Hipoteza mojego projektu, który będę realizował dzięki finansowaniu z Europejskiej Rady ds. Badań Naukowych (ERC) w ramach konkursu Starting Grant, głosi, że niektóre badania naukowe w naukach biomedycznych wywołują specyficzne emocje i wyzwalają rozmaite sposoby przetwarzania informacji, wpływające na oceny normatywne i związane z nimi decyzje. Podstawowe pytanie badawcze, na które będę chciał odpowiedzieć jest takie: w jaki sposób heurystyki i błędy poznawcze udokumentowane przez psychologów wpływają na formułowanie ocen normatywnych w kontekście badań i technologii biomedycznych, a także jak rozgraniczyć od siebie zniekształcone i niezniekształcone sądy wartościujące w tego typu kontekstach. Hipotezą projektu jest to, że wiele istniejących zasad, regulacji i praktyk bioetycznych wynika z automatycznych i nieuzasadnionych reakcji psychologicznych, a nie z systemowych rozważań na temat możliwych uzasadnień alternatywnych sposobów decydowania w warunkach różnych, złożonych typów niepewności. Celem projektu jest więc reinterpretacja powszechnych osądów etycznych na temat najnowszych postępów w biomedycynie. Zamiast rozumieć te osądy jako przedłużenie tradycyjnych stanowisk normatywnych w etyce, projekt proponuje bardziej adekwatną interpretację, uwzględniającą wykorzystanie rozmaitych podejść normatywnych do podejmowania decyzji w warunkach fundamentalnej niepewności, czyli np. w sytuacjach niepewności normatywnej, niezdeterminowania czy wartościowania samego istnienia ludzkiego. Wyniki projektu mogą mieć praktyczne zastosowania np. w przypadku regulacji badań naukowych z zakresu biomedycyny.

Publikacje

Opublikowane

T. Żuradzki, P.G. Nowak (2019), Deep Uncertainties in the Criteria for Physician Aid-in-Dying for Psychiatric Patients, American Journal of Bioethics 10(19):54-56

In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between
an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare
that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of
others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution
depends on “a deep and difficult” question about comparing the worseness of two possible scenarios: letting
someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the  authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential. 
 

W przygotowaniu

T. Żuradzki, Regulating scientific research under deep uncertainty: the case of ontologically ambiguous entities

Human embryos in the early stages of development are ontologically ambiguous entities. The same concerns e.g. induced pluripotent stem cells reprogrammed from human somatic cells, embryo-like products of parthenogenesis, human-nonhuman chimeras, human organoids. This ontological ambiguity (an example of deep uncertainty) which has been discussed extensively by philosophers and bioethicists in recent years is an underlying reason for the uncertainty about the moral and legal status of these beings. In my presentation – a part of a larger project aimed at analyzing decision theory as a model for reasoning in ethics – I want to discuss whether this uncertainty about status cast doubt on the arguments claiming strong or even full protection of these beings. Or is it the other way around: does it give a reason for acting in a cautious way and treating these entities as if they had very high status (a higher-order precautionary principle). In recent years there have been a number of attempts to understand and to find the relevant criteria for making decisions under deep uncertainty, but this topic is still unexplored in the case of ontologically ambiguous entities. Some scholars have proposed the decision theoretic approach modeled on the cases of factual risk according to which we ought (although the very nature of this ought may be contested) to represent any higher-order uncertainties in terms of those first-order (e.g. that we ought to evaluate the subjective probabilities of different doctrines about ontologically ambiguous entities and combine them with the disvalues attached by these doctrines to the creation/destruction of these entities and/or social benefits of this kind of research). I will show that this approach faces serious objections (e.g. the problem of inter-theoretical comparisons of values) and the decision theoretic approach should be understood in this case as a metaphor (not a model).

 

T. Żuradzki, Reporting incidental findings under uncertainty

When conducting biomedical research (e.g. genomic), researchers may obtain information that is beyond the aims of the study but may be relevant to the participants. An emerging consensus says that reporting incidental findings to participants should be based on the potential for medical benefit. Schaefer & Savulescu (2018) have recently criticized this “best-medical-interests” standard as being too narrow. They have argued that research subjects have a right to know about any comprehensible piece of information about them which is generated by the research which they are participating in, even if it is of no direct medical benefit to them. In my paper I will criticize their three main arguments based on the notions of autonomy, interests and privacy. I will show that they use a very narrow concept of autonomy as the ability to make informed decisions; they do not take into account the psychology of genetic risk perception; and they rely on an overly individualistic approach to research ethics.

 

T. Żuradzki The conceptualization of vaccination refusals: between science denial and violation of rational choice

Vaccination programmes have been acknowledged as the greatest public health achievement of the last decades. Therefore, it may be surprising that growing number of people are opting not to vaccinate their children (Omer 2012).[1] On the one hand, vaccination refusals seem to be clear examples of science denial that may result, among others reasons, from exposure to scientific fraud (an infamous report linking the measles vaccine to autism, later retracted). On the other hand, some countries (e.g. the US and Australia) offer non-medical exemptions from mandatory vaccination. It is surprising, because these kinds of exceptions are usually limited to value disagreements, but are not accepted in cases of science denial (e.g. objections to teaching evolution in schools). Moreover, reputable journals in medicine, bioethics or social science publish papers defending parental “conscientious objection” to mandatory vaccination programmes (Salmon 2006; Navin, Largent 2017). In my presentation I show there are no good reasons to assume that anyone should be allowed to refuse “to vaccinate their dependants on conscientious grounds” (Clarke et al. 2017).

First, I want to analyze a suitable ethical framework for mandatory vaccination of children or specific populations (e.g. health care personnel): public health ethics (that implies a consequentialist approach) versus traditional bioethics (that concentrates on autonomous consent and individual risk-benefit ratio).

Second, I want to discuss vaccination refusals in the context of philosophical (or legal) theories of responsibility of those who opt out for harms to others, including: i) collective action problem (e.g. few persons being unvaccinated, where herd immunity is achieved, are very unlikely to cause harm); ii) responsibility for imposing mere risks of harm to others (Jamrozik et al. 2016).

Third, I want to analyze explanations of vaccination refusal (see systematic reviews: Mills et al. 2005; Wang et al. 2014). i) Free-riding without rejecting scientific consensus. Some individuals may be pro vaccination in general, but prefer to keep children unvaccinated as long as enough others are vaccinated and risks have largely been eliminated. I will show that even if someone agrees that free-riding is not always objectionable (Dare 1998), it would be hard to establish the content of beliefs about vaccination refusal (cf. Jamrozik 2017). ii) Religious reasons. Despite of the fact that no major organized religion prohibits vaccination (Grabenstein 2013), some Catholics have questioned some vaccines as “morally illicit” (Carson, Flood 2017), because they were developed in cell cultures derived from tissue originally taken from an aborted fetus (WI-38; MRC-5). The Catholic teaching permits parents to use a vaccine despite its “illicit origin” (CDF 2008), although every act of vaccination is “a form of very remote mediate material cooperation” (PAL 2006) with the evil. Both documents underline that parents “should take recourse… to the use of conscientious objection with regard to the use of vaccines produced by means of cell lines of aborted human fetal origin” (PAL 2006). But in this context “conscientious objection” does not mean vaccination refusal, but only a symbolic act (e.g. signing a petition). iii) A mistrust concerning the necessity, safety, and efficacy of vaccines. Some people may disagree about the authority of science, and same individuals reject only the orthodox account of the risks and benefits of immunization. But these views are clearly related to the different biases that make pro-vaccination beliefs more counter-intuitive, and anti-vaccination beliefs – more intuitive, especially once vaccinations have made some diseases rare (Miton, Mercier 2015). For example: omission bias (Wroe at al. 2005); in-group favoritism (Kahan et al. 2010); identified victim effect (Hare 2012).

Wydarzenia

Seminaria badawcze INCET

Seminaria badawcze INCET

Cotygodniowe seminaria badawcze Interdyscyplinarnego Centrum Etyki UJ (INCET) organizowane w ramach projektu BIOUNCERTAINTY odbywają się (zazwyczaj) w czwartki w godz. 17.30-19.00 w Instytucie Filozofii UJ, ul. Grodzka 52, sala im. Romana Ingardena (25). Komunikaty o kolejnych seminariach dostępne są w dziale Aktualności.

 

Konferencje

Konferencje

Międzynarodowa konferencja 'Evidence in Law and Ethics' (ELE2019), 4-5 kwietnia 2019

Keynote speakers:

Christian Dahlman (Lund)

Martin Smith (Edinburgh)

Topics:

Epistemic risk and the role of non-epistemic values in ethical and legal evidential reasoning.
Reasonable doubt, higher-order evidence, statistical evidence, evidentiary thresholds in law and ethics.
Models of evidential reasoning, standards of proof, and evidence-based heuristics in law and ethics.
The concept of testimony in ethical vs legal contexts.
Epistemology of legal (esp. court) disagreement.
The ethics of belief of laymen, experts, lawyers and the judicial system.

Zespół

Kierownik 

Tomasz Żuradzki

 

Adiunkt (postdok)

oferta pracy

 

Asystent (doktorant)

Mariusz Maziarz

Karolina Wiśniowska

Piotr Bystranowski (part-time)

Marta Maj (part-time)

 

Referent techniczny (student) 

Adrianna Beczek

Bartosz Biskup

 

Zespół doradczy

Małgorzata Kossowska

Włodek Rabinowicz

Jan Sprenger