Design Bioethics: A Theoretical Framework and Argument for Innovation in Bioethics Research

Good empirical research is essential to providing sound answers about the facts of the matter, thereby informing bioethical theory and policy. Nevertheless, relatively few topics have been addressed adequately and the most powerful methods have not been exploited to maximize the potential contribution of this work to the field.

Since its origin, bioethics has attracted the collaboration of few social scientists, and social scientific methods of gathering empirical data have remained unfamiliar to ethicists. Recently, however, the clouded relations between the empirical and normative perspectives on bioethics appear to be changing. Three reasons explain why there was no easy and consistent input of empirical evidence in bioethics. Firstly, interdisciplinary dialogue runs the risk of communication problems and divergent objectives. Secondly, the social sciences were absent partners since the beginning of bioethics. Thirdly, the meta-ethical distinction between 'is' and 'ought' created a 'natural' border between the disciplines. Now, bioethics tends to accommodate more empirical research. Three hypotheses explain this emergence. Firstly, dissatisfaction with a foundationalist interpretation of applied ethics created a stimulus to incorporate empirical research in bioethics. Secondly, clinical ethicists became engaged in empirical research due to their strong integration in the medical setting. Thirdly, the rise of the evidence-based paradigm had an influence on the practice of bioethics. However, a problematic relationship cannot simply and easily evolve into a perfect interaction. A new and positive climate for empirical approaches has arisen, but the original difficulties have not disappeared.

This article provides a commentary on Standards of practice in empirical bioethics research by Ives and colleagues (in this Issue). There is much to admire in the paper, and in the demanding consensus-building process on which it reports. I discuss the problems and limits of methodological standardisation, and a central conceptual tension that appears to have divided participants. I suggest that the finished product should be understood as a record of a methodological conversation, rather than being used as a disciplinary tool to limit the evolution of empirical bioethics.

The integration of normative analysis with empirical data often remains unclear despite the availability of many empirical bioethics methodologies. This paper sought bioethics scholars’ experiences and reflections of doing empirical bioethics research to feed these practical insights into the debate on methods. We interviewed twenty-six participants who revealed their process of integrating the normative and the empirical. From the analysis of the data, we first used the themes to identify the methodological content. That is, we show participants’ use of familiar methods explained as “back-and-forth” methods (reflective equilibrium), followed by dialogical methods where collaboration was seen as a better way of doing integration. Thereafter, we highlight methods that were deemed as inherent integration approaches, where the normative and the empirical were intertwined from the start of the research project. Second, we used the themes to express not only how we interpreted what was said but also how things were said. In this, we describe an air of uncertainty and overall vagueness that surrounded the above methods. We conclude that the indeterminacy of integration methods is a double-edged sword. It allows for flexibility but also risks obscuring a lack of understanding of the theoretical-methodological underpinnings of empirical bioethics research methods.

Mass incarceration and the aging prison population in the United States is an ethical crisis, understudied in empirical bioethics research. In this article, I share one woman’s narrative to illustrate how older Black women describe accessing healthcare while incarcerated and identify sites for bioethical exploration. I argue that, due to the punitive nature of prison healthcare interactions, wherein women are seen as inmates first and patients second, healthcare providers are caught in a trap of competing ethical commitments to their patients and the state. As the prison population ages, these challenges will become more acute. Feminist bioethics has a critical role to play in imagining new possibilities for accessing, giving, and receiving care in the carceral context.

Empirical data can be an extremely powerful and influential tool in bioethical research. However, when researchers or policy makers look for answers to ethical questions by engaging with empirical research, there can be a tendency (conscious or unconscious) to shape, report, and use empirical research in a way that confirms their own preferred ethical conclusions. This skewing effect - what we call ‘normative bias’ - is often so subtle it falls short of clear misconduct and thus can be difficult to call out. However, we argue that this subtle influence of bias has the potential to significantly influence debate and policy around highly sensitive ethical issues and must be guarded against. In this paper we share the lessons we have learned through a journey of self-reflection around the effect that normative bias can have when reporting on and referring to empirical data relating to ethical issues. We use a variety of papers from our area of the ethics of routine prenatal screening to illustrate these subtle but often powerfully distorting effects of bias. Our aim in doing so is not to criticise the work of others, as we recognise our own normative bias, but to improve awareness of this issue, remind the need for reflexivity to guard against our own biases, and introduce a new criterion - the idea of a ‘limitation prominence assessment’ - that can work as a practical way to evaluate the seriousness of the limitations of an empirical study and thus, the risks of the study being misread or misinterpreted through superficial reading.

With the rapid development of digital technologies, education is faced with the need to integrate modern digital tools into the learning process, which makes cyberpedagogy a prominent area of research. The purpose of the present study was to identify the effects of digital educational technologies on student engagement and academic performance, and to analyse the effectiveness of the Kahoot platform in the learning process. To fulfil this purpose, the study employed the methods of theoretical analysis of scientific literature, empirical research with questionnaire survey of students, as well as comparative analysis of control and experimental groups. The study assessed students’ digital competences before and after training in the use of the Kahoot platform. The study found that pre-training in digital tools positively influenced the level of mastery: in the experimental group, the number of students confidently using the platform increased by 46%, while in the control group the changes were minimal. The analysis revealed that digital educational tools helped to increase the engagement and interactivity of the learning process and improved the perception of learning material. It was found that the use of interactive platforms contributed to the development of students’ independence, stimulated their cognitive activity, and helped to form critical thinking skills. The key competences of a teacher necessary for the effective use of digital technologies in educational activities were identified, including technological literacy, adaptability, and the ability to integrate digital teaching methods. The practical value of the study lies in the possibility of using its findings by university and college teachers to optimise the educational process, as well as in the development of methodological recommendations for the implementation of digital educational tools in teaching practice, which will make learning more accessible, interactive, and effective

Background Over the last decades, the neurosciences, behavioral sciences, and the social sciences have all seen a rapid development of innovative research methods. The field of bioethics, however, has trailed behind in methodological innovation. Despite the so-called “empirical turn” in bioethics, research methodology for project development, data collection and analysis, and dissemination has remained largely restricted to surveys, interviews, and research papers. We have previously argued for a “Design Bioethics” approach to empirical bioethics methodology, which develops purpose-built methods for investigation of bioethical concerns. In this paper we compare a research tool created using a design bioethics approach to a “methods-as-usual” approach in empirical bioethics. Methods Our study compared dimensions of engagement with a digital game we created, called “Tracing Tomorrow,” to a standard vignette survey. The two tools investigated the same subject matter, digital phenotyping for mental health, in a sample of 301 UK adolescents. Results Participants who played the game reported a greater sense of presence, emotional engagement, cognitive absorption, and mental health ethics insight, compared to participants who completed the vignette survey. Perceived authenticity and curiosity/motivation to learn more was equivalent for both methods. Conclusion The results of this study highlights the importance of purpose-built methodology for empirical bioethics research.

Inappropriate authorship is a common problem in biomedical research and may be becoming one in bioethics, due to the increase in multiple authorship. This paper investigates the authorship policies of...

Prior research in psychology and accounting suggests that features of the decision-making task and context affect information processing, yet the decision-making context is often ignored in tax judgment and decision-making research. Two primary decision contexts in the tax setting are planning and compliance. If these two contexts differ on significant features, the information processing of tax professionals in the settings also is likely to differ. An analysis of the characteristics of tax planning and compliance contexts suggests that planning problems are generally characterized by greater complexity, ambiguity, and justifiability demands than are compliance problems. Experienced tax professionals' knowledge of these differences in complexity, ambiguity, and justifiability demands of problems in the planning and compliance contexts was tested in an experiment in which decision-making context was manipulated. Each participant rated the complexity, ambiguity, and justifiability demands of six research cases. As predicted, participants in the planning condition rated the cases as higher in complexity, ambiguity, and justifiability demands than did participants in the compliance condition. Behavioral implications of these differences were demonstrated in that managers in the planning context budgeted significantly more time for staff to complete tax research than did those in the compliance context.

Digital innovations and interventions can potentially revolutionize agri-food systems, especially in coping with climate challenges. On a similar note, digital research tools and methods are increasingly popular for the efficient collection and analysis of real-time, large-scale data. It is claimed that these methods can also minimize subjective biases that are prevalent in traditional qualitative research. However, given the digital divide, especially affecting women and marginalized communities, these innovations could potentially introduce further disparities. To assess these contradictions, we piloted SenseMaker, a digital ethnography tool designed to capture individual, embodied experiences, biases, and perceptions to map vulnerabilities and resilience to climate impacts in the Gaya District in Bihar. Our research shows that this digital tool allows for a systematic co-design of the research framework, allows for the collection of large volumes of data in a relatively short time, and a co-analysis of the research data by the researchers and the researched. This process allowed us to map and capture the complexities of intersectional inequalities in relation to climate change vulnerability. However, we also noted that the application of the tool is influenced by the prior exposure to technology (digital devices) of both the enumerators and researched groups and requires significant resources when implemented in contexts where there is a need to translate the data from local dialects and languages to more dominant languages (English). Most importantly, perceptions, positionalities, and biases of researchers can significantly impact the design of the tool’s signification framework, reiterating the fact that researcher bias persists regardless of technological innovations in research methodology.

Aim: The aim of this study is to analyse the digital patient journey in medical tourism, with a particular focus on Ukraine’s experience under conditions of military challenges and global crises. The study examines how digital tools support inclusivity, accessibility, continuity of care, and patient trust, with special attention to rehabilitation services and vulnerable patient groups affected by war. Methods: The study employs a mixed-methods approach combining a review of scientific literature with empirical research and modelling of the digital patient journey. Primary data were collected through an online survey of 150 healthcare consumers and semi-structured interviews with 15 experts representing medical institutions involved in medical tourism. Quantitative and qualitative analyses were used to examine patient experience, inclusivity barriers, and the role of digital services. Results: The results indicate that key stages of the digital patient journey include online information search and clinic selection, remote consultations, digital support for travel and treatment organization, and post-treatment follow-up and rehabilitation. Ukrainian clinics actively implement CRM systems, telemedicine solutions, and digital communication tools, enabling continuous patient engagement even during crisis conditions. At the same time, significant barriers were identified, including limited inclusiveness of digital services, data security concerns, uneven digital literacy, and infrastructural constraints. Based on the findings, a conceptual model of the digital patient journey integrating service quality, inclusivity, and AI-supported personalization was developed. Conclusions: The findings demonstrate that the digital patient journey is becoming critically important for the development of medical tourism under conditions of global uncertainty. The integration of digital tools with inclusive and patient-centred approaches enhances the resilience of medical services, strengthens patient trust, and provides competitive advantages for medical institutions. The proposed model may be useful for countries experiencing military conflicts or systemic crises and contributes to the broader development of digital and inclusive healthcare.

A moral crisis poses significant challenges to the success and sustainable development of a corporation. In this context, managers’ moral decision-making becomes paramount. Managers’ moral choices and actions directly impact the corporation‘s ability to effectively address these crises, ultimately shaping its outcomes and prospects. This study employs the extended theory of planned behavior (TPB) as a theoretical framework to explore the determinants that influence the moral decision-making process of managers. Specifically, the study introduces two new variables, namely, moral climate and moral self-efficacy, to enrich the existing theory. By employing structural equation modeling (SEM), the study examines the interrelationships among moral attitudes, subjective norms, perceived behavioral control, moral intentions, moral decision-making, and the two new variables. The research findings provide compelling evidence that both moral climate and moral self-efficacy have a substantial impact on the moral decision-making process of managers. Notably, moral self-efficacy emerges as a mediating variable in the relationship between moral climate and moral intention. The findings of this study hold significant value for the development of moral decision-making models and the theory of planned behavior, with practical implications that can assist organizations in achieving sustainable growth and success.

The growth in online and distance education has focused increased attention on unbundling faculty roles in delivering instruction, yet unbundling related to faculty work has been occurring in higher education for over three centuries. In this paper, we examine unbundling of the faculty role in higher education to provide scholars, university leaders, faculty, disciplinary leaders, and policy makers with historical context, theoretical frameworks, and gaps in the empirical literature to inform research and decision-making pertaining to the differentiation of university and faculty tasks. We describe unbundling historically in order to highlight how the faculty role has shifted over time, demonstrating this is not a new phenomenon. We also review theoretical frameworks and their mechanisms to inform our understanding of the history and future of unbundling and suggest the importance of multiple theories to best understand this complex phenomenon. We then examine the limited empirical research findings on unbundling the faculty role, which have not been synthesized to date. We conclude by offering directions for future research regarding unbundling based on the history, theory, and empirical research reviewed, as well as recommendations for policy.

SummaryThe autonomy of the students refers to the control that the student has in the learning process, to decide on the content, the goals and the way of learning and is connected with the concepts of self-direction and self-regulation. The concept of autonomy presupposes the development of a psychological relationship with the process and the content of the learning act, while the autonomous student is able to make decisions, to distance himself but also to reflect critically. Autonomy is related to the notion of personal responsibility that the learner assumes in his learning process, while two dimensions are distinguished. The first is autonomous learning, in which the learner assumes responsibility for the design, organization and evaluation of the educational process, which concerns its external characteristics. The second is the autonomous student, which refers to the internal characteristics of the learner. However, an important factor for the autonomy of the students is considered to be the context in which the educational process takes place, ie when the general socio-political and learning context encourages the learners to take responsibility for their learning, then their autonomy is promoted.In the context of distance education, students are at a distance from their teachers, their classmates and the institution that provides education, but they are called to meet the requirements of the study program they choose. And while the concept of autonomy is intertwined with the method of distance education, the factors that hinder its realization have not been sufficiently explored. This empirical research, therefore, comes to fill the gap in the literature on the obstacles that students themselves face in the realization of autonomy.This paper explores the barriers faced by distance education students in achieving their autonomy. In particular, it focuses on exploring the obstacles that students face with regard to autonomy in distance education and the factors that contribute to removing the obstacles to student autonomy in distance education. The quantitative approach was chosen and the tool of our research was the online questionnaire, which was completed by 215 research participants, postgraduate and undergraduate students of the Hellenic Open University. The selection of the sample was random sampling as the questionnaire was published on a social networking page (facebook) in specific groups formed by the Hellenic Open University students and the participants chose to answer and complete the questionnaire. The empirical research took place in March - April 2019.The questionnaire included two axes. The first axis concerned demographic data. The second axis included twenty-one (21) questions that answered the research questions. Seventeen (17) of the questions were closed-ended, graded Likert scale, one (1) question with answer options, while three (3) questions were open-ended. Open-ended questions were included in order for participants to express their views on the obstacles they face, and to enrich the data from the closed-ended questions.For the analysis of the data collected from the closed-ended questions of the questionnaire, the statistical program SPSS and the descriptive statistics were used. Regarding the data of the open-ended questions, after their inclusion in broader categories, the next step was to codify the conversion of the data from nominal to numerical. In order to identify any differences in the answers of the participants, depending on the gender and the level of studies, correlations were used.The theoretical framework of the present study is closely related to the empirical research carried out. Obstacles to the autonomy of distance learning students identified in the theoretical part are confirmed by the empirical research, with the difference that the empirical research has shown that students' personal characteristics as well as the "distance" factor do not constitute a significant obstacle to the realization of their autonomy.However, the empirical research also revealed several factors that were not identified in the bibliographic review as barriers to student autonomy, such as inadequate administrative organization, financial factors, the small number of group meetings, the lack of different types of papers, exams based on memorization and exams with books closed. It is also worth noting that while the majority of students consider that they have developed skills in order to be autonomous, they agree that a preparatory course that would prepare them for the requirements of distance education would be very helpful. The analysis and discussion of the results highlighted the prominent role of the teacher in distance education, as the lack of support for students can impede their autonomy, however, the teacher has the potential to contribute to its realization by guiding and encouraging students. The multidimensional role of the teacher in distance education also emerges from our research, as described in the theoretical part of our work, since the participants expressed the need for teachers combining a number of characteristics in order to promote their autonomy.Another important finding of the research is that students feel their personal characteristics and personal abilities can help them realize their autonomy. In line with the bibliographic review, the factors that are an obstacle to the autonomy of the students of distance education, as well as the factors contributing to the removal of these obstacles, are related both to the students themselves and to the educational process.As for the factors that contribute to the removal of barriers to the autonomy of distance learning students, they coincide with the factors that have a positive effect on the realization of autonomy and have been identified in the theoretical framework of our work. The most important factor is the personal characteristics of the students themselves and their own personal effort. Following, the support, guidance from the teacher on a psychological and practical level and communication with him. Also very important factors are the existence of appropriate educational material and the conduct of group meetings, which students ask to be more frequent.The need for a digital learning framework to promote student autonomy, as found in the theoretical framework, is confirmed by the empirical research, as well as the need for electronic group meetings and the use of electronic libraries, access to specialized digital material, and easier access to the Hellenic Open University platforms.A very important factor in removing the barriers to student autonomy as it emerged from the empirical research is more flexible schedules concerning the delivery of papers, while access to educational material and a better administrative organization are also considered important.Regarding the correlation of the curriculum with the factors that constitute an obstacle to autonomy, the majority of postgraduate and undergraduate students agree with some differentiation regarding the factors "comments of the teacher on written work", "educational material", "psychological support from the teacher ”and“ lack of psychological support from the teacher” while gender did not appear to have any particular effect on the factors that impede students’ autonomy