The normative basis of (health) technology assessment and the role of ethical expertise

The role of normative reflection and the possibilities of ethical inquiry in technology assessment have been under discussion in the TA community for several years. As an outcome of this discussion the necessity of explicitly dealing with normativity in TA has widely been acknowledged. However, it is still quite unclear in which way this should be done. This paper is dedicated to the role (and limitations) of ethical expertise in this field, especially in HTA. By methodological analysis an approach is developed to show how entry points for ethical expertise could be identified. The result is that ethical expertise can inform moral debates by uncovering underlying assumptions, by making the normative structure of argumentation transparent, and by weighing the strength of the arguments. In this way moral debates in HTA can become more transparent and opened to argumentative reasoning instead of consisting of bargaining processes determined by power distributions. Ethical reflection, however, does not replace decision-making.     

Shaping the societal impacts of engineering sciences: a reflection on the role of public funding agencies

There is a growing public policy interest in responsible innovation, which implies an enforcement of interdisciplinary communication between the engineering sciences and the social sciences or humanities anticipating and assessing the societal impacts of engineering research. This article focuses on an innovative brand of ethical technology assessment (TA), which offers (1) an initial interpretive framework for understanding what “societal impacts” are within a good life perspective to ethics and (2) a broad guideline for constituting a realistic conception of the future impacts of a technology that is still under research. Both aspects are employed to formulate ethical recommendations intended to influence the shape of technological products by means of modulating techno-scientific research activities. In this article, attention is drawn to an obstacle faced by this type of TA using a specific case study. In this case, the scientific engineers accepted the reasons offered by this ethical TA as good reasons, ones that were relevant to them, but they decided not to act on them because that would have meant breaking a commitment to the institution subsidizing their research. In this article, it is argued that public research funding agencies concerned with the societal impacts of the technologies resulting from the research they fund should reconsider their role to make it easier for scientific engineers to accommodate recommendations provided by ethical TA, e.g. by creating a feedback loop from the ethicist to the funding agency.     

The social sciences and the population problem

Four essentially independent conceptions of the population problem are visible in current discussions. One is derived from macroeconomics, one from microeconomics, one from the health sciences, and one from ethical concerns about the just relation between man and nature. After describing these conceptions, this paper addresses the population problem principally using the economic definitions. It cites five reasons why discussions of the economic hazards posed by population growth have become markedly less alarmist in the past decade. Failures of highly quantified input-output models to account for human progress are emphasized. The paper presents examples of how technical demography has shed light on the dimensions of and solutions to the population problem and concludes with a brief discussion of contemporary population problems in the U.S.The real world consists not of numbers but of shapes and sizes. It is topological rather than quantitative. Quantification for the most part is a prosthetic device of the human mind, though certainly a very useful one. Anyone who thinks that numbers constitute the real world, however, is under an illusion, and this is an illusion that is by no means uncommon (Boulding, 1980:833).     

Social shaping of technology in TA and HTA

The social shaping of technology (SST) approach to analysing technological development lends itself to an understanding of the relatively negotiated, heterogeneous, and local character of technologies, politicising the mediated nature of sociotechnical change. Here, conditions of actor engagement lie at the heart of analysing technology in social context—that is, the occasions, strategies, and scope of influence that are afforded different actors, by way of how particular problems come to be defined and resolved. In this paper we examine the framing of a number of concrete technology assessments (TAs) from Denmark, from the realms of general TA and health technology assessment (HTA). Our examination of the TA initiatives is directed towards the relatively open-ended and consequently explorative and qualitative stance that SST takes in characterising the boundaries between the technical and the social. The paper goes on to discuss a possible place of ethical inquiry in TA, based on the understanding of technological development that SST affords. In the reflexive approach to addressing technology’s relation to society, technology no longer maintains a universally reducible character in time or in social space. Through the possibility of analytically and practically opening up for otherwise seemingly locked actor-positions SST gives room for a more differentiated questioning and treatment of ethical issues in which technology may be implicated.     

Argumentation integrity in intercultural education: a teaching project about a religious-ideological dialogue as challenge for school

In this article, we describe the multiple phases of a teaching project that was constructed around an actual request by a Muslim community in the Federal Republic of Germany (FRG) to establish an Islamic cultural centre. The request provoked a sometimes heated discussion among politicians and citizens that was published in daily newspapers. A large number of the arguments that appeared in the newspapers failed to meet fair argumentation standards and strategies. The teaching project described here therefore aimed to sensitize future teachers to issues of argumentation integrity in dialogues, especially between persons with different religious and ideological convictions. The project was subdivided into three main phases, which treated the topic from different perspectives and with different methods: a simulation game dealing with the request by the Muslim community, a theory-based phase in which participants became acquainted with a construct of argumentation integrity and from this deduced standards and strategies relating to unfair argumentation, and an application phase in which the participants had to examine published arguments by politicians relating to the request by the Muslim community in order to identify rule violations in argumentations. The empirical results suggest that the project promoted insight into unfair argumentation. Such insight can improve interreligious and intercultural communication processes at school.     

Service robots in the mirror of reflective research

Service robotics has increasingly become the focus of reflective research on new technologies over the last decade. The current state of technology is characterized by prototypical robot systems developed for specific application scenarios outside factories. This has enabled context-based Science and Technology Studies and technology assessments of service robotic systems. This contribution describes the status quo of this reflective research as the starting point for interdisciplinary technology assessment (TA), taking account of TA studies and, in particular, of publications from the ethical and empirical social science perspective. Finally, based on this status quo, evaluation criteria for service robots are developed, which are relevant for further reflective research.     

Ethics and defense agency funding: some considerations

The author, an anthropologist working in a military defense science and technology funding agency, offers four guidelines for social scientists for evaluating the ethical problems in defense funding opportunities. These guidelines address what social scientists need to know in order to evaluate the ethical risks involved in accepting defense funding: (1) the need to understand the code of ethics of social science organizations and their limits in dealing with ethical problems of new technologies; (2) the need to understand the implications of working in “classified” contexts; (3) the need to understand the funding program's goals and objectives; (4) the need to develop an ethical imagination about technological advances and research and develop an appropriately supportive environment for promoting ethical behavior in the scientific community.     

A Dialectic Technological Science Perspective: Reply to Bell

Abstract Bell's (1995) critique of our discussion of a technological science perspective for sociology is a helpful effort to maintain a balance between our emphasis on agency and creativity and on the constraining side of society. We emphasize agency as part of a dialectic between human effort and societal resistance for three reasons. First, it forces reconceptualization of the nature of the science of sociology by shifting from a positivist mode to one that is pragmatic. The meaning of scientific findings changes. Second, agency has been ignored historically while constraint has been over-emphasized. We seek to establish a balance by reentering the notion of agency into sociological discourse. Third, agency is a mechanism for modifying constraints and solving the problems associated with social technologies. In the closing paragraphs of the reply, we suggest that the view under discussion be seen as an ethical pragmatism. Agency forces us to ethical questions and a pragmatic understanding of science.     

Ethical implications of network data in business and management settings

Reflecting on the compilation and analysis of a range of network datasets drawn from our own work and some prominent examples, we consider the ethical challenges in dealing with network data in business and management settings. We argue that the managerial processes that characterize such settings introduce particular ethical sensitivities in the stages of commissioning and research design, and when collecting, analyzing and reporting network data. These sensitivities arise from the imperatives of business, motivations for commissioning network analyses and the legal authority that managers have over employees. We argue that ethical considerations are much more pervasive in business and management network research than in many other fields.In this contribution, we present a range of ethical challenges in network research in business and management settings that arise at several stages of the research process. For each issue identified, we describe the ethical problem and propose mitigation remedies. From this reflection, we suggest guidelines for other researchers to consider when designing research projects in this application area.     

Arguing for Democracy: A Multimodal Approach to Argumentative Writing Instruction in the Social Studies Classroom

Democratic societies require a citizenry skilled in argumentation. At present, the written argument maintains primacy among communicative modes. Because of its cognitive demands, written argumentation is often difficult to teach. A multimodal approach to writing instruction carries the potential to assist struggling learners. This article outlines an instructional approach in which students engage with a visual argument to better understand the essentials of argumentation, as specified by the Toulmin Method. It asserts that once students have deepened their understanding of argument via a visual mode, they will then be able to apply this understanding to the written mode of argumentation. It concludes with a brief discussion of how students may apply their understanding of multimodal argumentation toward civic engagement.     

An interdisciplinary approach to the development of professional identity through digital storytelling in health and social care and teacher education

The present article presents a study based on an interdisciplinary approach to research into reflection on identity construction. This multiple case study explores the narrative of professional identities in digital artefacts. It is aimed at exploring in what way digital storytelling can be used as a suitable pedagogical strategy for the construction of professional identity. The students involved in the innovative learning activity comprise two groups of Health and Social Care students in the UK, two groups of Primary Education student-teachers and one group of Secondary Education student-teachers in Spain. Thematic analysis is used to identify the topics addressed by students in exploring their professional identities, including values and the process of learning itself. Finally, the lessons learned from this interdisciplinary approach to reflection on identity and the implications these have not only for teaching and learning design but also for future collaborative research projects are set out in the discussion and conclusions.     

An Interdisciplinary Ethics Module for MSW and Nursing Students

The teaching of ethics in social work can be incorporated in the curriculum in multiple ways. This article outlines an interdisciplinary module with nursing and social work students at a small United States Midwestern university as a means of developing awareness of multiple perspectives surrounding ethical dilemmas in healthcare. Background information related to teaching interdisciplinary ethics and use of case studies is presented. Discussion of the interdisciplinary ethics exercise includes a summary of observations relative to the exercise and challenges in its implementation are outlined.     

Moments of Uncertainty: Ethical Considerations and Emerging Contaminants

Science on emerging environmental health threats involves numerous ethical concerns related to scientific uncertainty about conducting, interpreting, communicating, and acting upon research findings, but the connections between ethical decision making and scientific uncertainty are under‐studied in sociology. Under conditions of scientific uncertainty, researcher conduct is not fully prescribed by formal ethical codes of conduct, increasing the importance of ethical reflection by researchers, conflicts over research conduct, and reliance on informal ethical standards. This article draws on in‐depth interviews with scientists, regulators, activists, industry representatives, and fire safety experts to explore ethical considerations of moments of uncertainty using a case study of flame retardants, chemicals widely used in consumer products with potential negative health and environmental impacts. We focus on the uncertainty that arises in measuring people's exposure to these chemicals through testing of their personal environments or bodies. We identify four sources of ethical concerns relevant to scientific uncertainty: 1) choosing research questions or methods, 2) interpreting scientific results, 3) communicating results to multiple publics, and 4) applying results for policy making. This research offers lessons about professional conduct under conditions of uncertainty, ethical research practice, democratization of scientific knowledge, and science's impact on policy.     

Biomedical and bioethical issues in Parliamentary TA and in Health Technology Assessment

HTA and TA institutions at national parliaments (PTA) both share the same origin and of course have objectives and some of their methods in common. Nevertheless both TA branches developed in some distance during the 1970s and 1980s. Drawing on the case of biomedicine this paper outlines the differences between HTA and PTA, highlighting the “clinical perspective” of HTA and the “societal perspective” of PTA. It is shown that biomedicine which has developed rapidly during the last decade has hardly been dealt with by HTA, whereas it ranked quite prominent on the agendas of PTA institutions. Biomedical technologies became a subject of policy making beyond the boundaries of health care politics since biomedicine is perceived as an ethical challenge to society and not only as a medical innovation that has to be assessed by clinical experts. It is argued that there may however be good reasons to integrate the HTA and the PTA perspective in future TA on biomedical technologies.     

The Clinician's Voice and the Limits of Bioethics

The bioethics movement has long promulgated a model of ‘principled decision‐making’ in which ethical dilemmas and conflicts between various rights, interests, and ethical principles are central. In many respects this movement has had a laudatory impact on health care and on health professionals, but we will also argue that the bioethical model of ethical analysis has important limitations. The model's theoretical orientation is discontinuous with the training and skills of health professionals, the manner in which health professionals conceptualise and solve problems that arise in a clinical setting, and the time constraints inherent in most clinical situations. As such, the model is not readily applicable to much of the day‐to‐day work of clinicians and, in particular, to the routine ethical questions and situations that arise in caring for patients. What we suggest is that the bioethical model does not take into account that health care professionals, as part of their daily work, encounter and manage difficult, often conflictual situations and that they do so by bringing to bear conceptual frameworks and therapeutic techniques that have, embedded within them, the ethical values and goals of their own fields, as well as established ways of dealing with problems and addressing competing priorities. We further argue that from a systems perspective, the bioethical model and the pragmatic, problem‐focused ethical decision‐making of clinicians operate on different levels of complexity; whereas the former is especially appropriate for situations that resist consensus or that raise significant issues of public policy, the latter serves as an effective framework in less difficult or complex situations that can be moved effectively toward consensus and closure.     

The need for explicit argumentation in ethical decision-making in social work

This article addresses the need for social workers' explicit argumentation in ethical decision-making, i.e. the justification offered in adopting a particular course of action with their clients. It is the main assumption of this article that social workers need to be aware and explicit of the personal and professional ideas, concepts, values, and assumptions that guide their practice. In the following sections we clarify central concepts such as argumentation and its explicitness, present a conceptual framework for analyzing ethical decisions in social work, illustrate its applicability on social work dilemmas, and discuss possible implications for social work practice and education. Finally, we recommend that social work education put emphasis on: (1) developing more awareness for inner deliberations and making these explicit and amenable for evaluation; and (2) developing specific skills for explicit argumentation in ethical decision-making.     

Ethical problems in program evaluation: Advice for trapped evaluators

This paper argues that ethical problems in program evaluation are increased when conflicting or incompatible evaluation models are applied concurrently. Three models are illustrated: an Amelioration Model, generating better information for a program's own decision makers; an Accountability Model, focusing on public data disclosure and citizen participation in evaluation; and an Advocacy Model, in which the evaluation is designed to advance the program's interests in the competition for resources. Ethical problems inherent in each model, and arising from combining models are presented, along with case examples and discussion. The authors suggest several directions that program evaluators can consider to reduce their vulnerability to ethical problems.     

Narrative Psychiatry and Family Therapy: Promoting Resilience and Collaboration with Persons with Intense Mental and Emotional Experiences at Risk of Causing Violence

Narrative psychiatry identifies meaning‐making as a primal force in our lives and guides family therapists and psychiatrists in cultivating narratives of resilience that support safety and wellbeing when working with families in which a member is dealing with intense mental and emotional experiences and may be at risk of causing violence. These contexts are fraught with implications about power, control, identity, and ethical responsibilities of care for those consulting with us and for the wider community. Offering benefits distinct from pathology‐focused psychiatric practice, narrative psychiatry applies the practices of narrative therapy in psychiatric contexts, focusing on strengths and meaning and honouring how values, intentions, and commitments compel and constrain our actions. Illustrated by case conversations, this paper describes five key practices of narrative psychiatry, including emotional attunement, understanding the person without the problem, externalising problems, creating narratives of resilience, and collaborative treatment planning. It shows how narrative psychiatry facilitates risk reduction through helping a person identify values and narratives that support non‐violence and strengthening abilities, relationships and resources that help them stay true to this commitment. Practical ways that family therapists and psychiatrists can use conversations about resources, including medicines, to deconstruct damaging discourses and generate narratives of resilience are described. Discussion is offered about how narrative psychiatry can support clinicians in ethically negotiating clinical dilemmas in which the preferences of the person or family are in conflict with the clinician's ethical and legal duty to protect life.     

Die „ökologische Dynamik“ der Sozialstruktur in Organisationen

The article is dealing with the association of labor market mobility and the dissolution rate of the employing organization. Several hypotheses concerning the impact of age, size, distribution of educational credentials and ecological dynamics on the organizational dissolution rate are derived from organizational ecology theory. But the theoretical discussion shows that a more sophisticated argumentation is needed. In the first step a dynamic multilevel model supplies evidence that the impact of size and age on the organizational dissolution rate varies between the contexts in which organizations are embedded. In the second step evidence of a positive association of the organizational dissolution rate and the rate of internal mobility in almost each direction is provided. Simulations clarify that ecological conditions of organizations have a momentous impact upon mobility and for this reason the theory of labor market mobility should be systematically enhanced with propositions about the ecology of organizations.