Science and Ethics
We investigate moral cognition, judgement and behavior within a science-based philosophical approach.
- How do people evaluate moral situations? What is the role and functioning of intuition in these evaluations? What primary psychological mechanisms are involved?
- What motivates people to follow moral standards and sanction deviances?
- What is altruistic behaviour and how does it work?
- What are the drivers of availability to others?
- How can we better communicate, understand others’ needs and provide adequate help?
Based on our ethical analyses and on empirical data, we develop practical solutions to promote respectful behaviour and appropriate communication in a variety of academic and professional contexts.
- How can students and researchers be nudged towards integrity ?
- How can communication and interaction between patients and health professionals be optimized to ensure quality of care and mutual respect?
We are interested in the ethical issues generated by new technologies and scientific knowledge.
- On the basis of what criteria can we evaluate the acceptability of science-based nudging interventions and technologies aimed at orienting people’s behavior?
- How can we ensure an adequate use of new technologies and medical advances that are available on a large scale?
We work across disciplines and merge knowledge and research methods specific to various disciplines, including philosophy, biology, psychology, sociology, behavioural economics and mathematical modelling.
Scientific integrity should be a cornerstone of research. Unfortunately, the teaching of Responsible Conduct of Research (RCR) remains fragmented. It too often depends on the personal interest and willingness of teachers who have not had the opportunity to receive a full training themselves. The INTEGRITY project aims at developing pedagogical tools that will then be made available to teachers. It also aims at developing strategies for motivating teachers and students to address RCR topics.
Within this project, our group will design and test nudging interventions for promoting the teaching of RCR topics and for facilitating integer behavior itself.
The project entitled “INTEGRITY: development of innovative, evidence-based tools for teaching research integrity to students and early career researchers” is funded by the European Union, has started in January 2019. It is led by Mariëtte van den Hoven (Utrecht University) and Christine Clavien’s group (involving Abha Saxena, Aurélien Allard, and Céline Schöpfer) is one of the main partners of the consortium.
Les projets de soins anticipés sont une thématique importante sous l’angle éthique, à la fois pour améliorer le respect de l’autonomie des personnes et éviter des prises en charge inappropriées. Cette importance a été soulignée et cette approche promue par de nombreuses instances médicales et éthiques en Suisse, parmi lesquelles la Commission nationale d’éthique, l’Académie Suisse des Sciences Médicales, et l’Office Fédéral de la Santé Publique. L’implémentation des projets de soins anticipés n’est cependant pas évidente et requiert le développement de pratiques et d’outils.
Pour répondre à ce besoin, nous développons une application mobile pour permettre aux patients de :
- prendre conscience de l’intérêt d’anticiper les décisions de soins et se familiariser avec les termes et sujets liés aux directives anticipées
- initier des discussions avec leurs proches et leurs interlocuteurs dans les soins
- rédiger leurs directives anticipées et les joindre à leur dossier électronique
Nous avons développé un premier prototype qui a obtenu le « Prix pour le partenariat avec nos patients » au Hackathon des HUG #4 (2019)
Christine Clavien est cheffe de projet en collaboration avec Thomas Fassier. L’équipe de projet inclut aussi Florence Hartheiser, Catherine Bollondi, Francois Pierre Robert, Vincent Clavien, Ines Serre, Camille De La Serna, Laurence Buytaert, Céline Schöpfer
Ce projet est financé par la Fondation des HUG
The doctor-patient relationship has been researched in many disciplines. This very relationship is at the heart of care. However, the understanding of the context and what surrounds this relationship has not been investigated. More specifically through the angle of the process of clinical reasoning and the impact of nudging during longitudinal care.
Clinical reasoning is at the heart of the clinician’s day-to-day practice. Clinical reasoning refers to the collection of cues as well as the process of the information, to then come to an understanding of the patient’s problem and/or situation. With the aim to implement or plan an intervention for the care of the patient.
Nudging is a concept, which proposes indirect suggestion to influence the decision making of individuals, only if the individual chooses to.
Multi morbidity is a condition which demands a longitudinal care, through time the relationship and reasoning may change and the factor of time is one that could be fascinating to explore in an effort to improve not only the understanding of this dynamic but also to identify and clarify what ethical issues and implications are at stake.
The purpose of this research is to investigate the process of clinical reasoning in a longitudinal care with patients with multi morbidity, and how/which nudges are used during this process. In order to conduct this research it is crucial to integrate the analysis through two lenses the first being grounded on a philosophical analysis the second grounded on a qualitative analysis. In an effort to further bridge the gap between the practical implications and the theory of nudging in a medical clinical reasoning setting.
Themes: Nudges, ethical implications, clinical reasoning, the doctor-patient relationship with patients suffering with a multi morbid conditions in longitudinal care. Limits of paternalism.
* Julia Sader, Marie-Claude Audétat, Mathieu Nendaz, Samia Hurst & Christine Clavien, "Design Bioethics, Not Only as a Research Tool but Also a Pedagogical Tool", The American Journal of Bioethics, 2021, 21, pp. 69-71.
* Julia Sader, Christine Clavien, James Korris, Samia Hurst, Mathieu Nendaz, Mathieu, Marie-Claude Audetat Voirol, "Serious game training in medical education: potential to mitigate cognitive biases of healthcare professionals", Diagnosis, 2021.
Humans and non-human animals are capable of spectacular as well as ordinary helping actions. Can these actions or their underlying behavioural tendencies be described as altruistic? Some will and some won’t, and the answer will greatly depend on one’s definition of altruism.
Altruism, broadly conceived as unilateral giving behaviour, has been investigated by disciplines as different as psychology, philosophy, sociology, neurosciences, economics, or biology. However, a close analysis readily shows that these disciplines conceive the phenomenon of altruism very differently. As a consequence, the same action or behaviour may fall under the altruism category in one research area but not in the other, which leads to major misunderstandings across disciplines. Do these disciplinary specificities impede a full understanding of the general phenomenon of human altruism or do they each shed an original and irreplaceable light on the phenomenon? In this project, we aim at investigating the latter hypothesis.
We start with an explicitly broad concept that we label “ordinary altruism”, which is close to the common sense and moral use of the term. Human ordinary altruistic actions fulfil the three following conditions:
- They result from actors’ intention to help: i.e. the helping does not come about as an unplanned incidental effect while the actors are doing something else.
- They are produced voluntarily: i.e. actors can choose between various options (e.g. to help or no to help) and are not pressured by obvious external constraints while forming their intention to help (e.g. threat of punishment against non-helpers).
- They are “prima facie disinterested”: i.e. there is no obvious evidence that actors help only as a mean to obtain external rewards such as personal reputation or expected benefits from future cooperation.
We will recruit interdisciplinary knowledge in order to highlight the phenomenon of ordinary altruism from (1) an evolutionary ultimate point of view, (2) a mechanistic proximate point of view, and (3) a phenomenological points of view.
On the basis of this conceptual and empirical work, we will extend our investigation to practical issues. In which areas of action is ordinary altruism most likely to occur? Which environmental and psychological features do facilitate (or impede) the production of altruistic actions? Is it ethically appropriate to promote altruism? What practical measures could be applied in order to promote altruism in contemporary societies? More particularly, how could altruism be encouraged in medical contexts?
This project is conducted by Christine Clavien
Nudges are soft interventions designed to influence people’s choices in desired directions while leaving them the choice to do otherwise. These interventions exploit (i.e. eliminate, bypass or elicit) fast automatic and often unconscious decision-making pathways, such as risk aversion, compliance to authority, tendency to stick to default options, or hyperbolic discounting. For example, the risk aversion bias leads patients to underestimate the gains of a drug compared to its possible side effects. This reasoning failure may be corrected by using a framing nudge, that is, by presenting medical information so as to emphasize the risks associated to non-consumption of the drug.
Most nudging interventions can be applied with little administrative difficulties, and since they preserve freedom of choice, they are often seen as ethical ways to fix problems. Therefore, nudges are increasingly considered as attractive solutions by policy-makers in all sorts of domains.
However, despite their attractive features, nudges may raise difficulties. First, due to their variety and the variety of their application, there is often unclear evidence of the efficiency of particular nudges. Second, while some nudges seem benign, other raise serious ethical concerns. The default organ donation policy discussed and rejected by Swiss politicians in 2015 is an illustration. One persistent question is the extent to which nudges are manipulative and thereby a treat to autonomous decision-making.
Ethical issues raised by the use of nudges have been extensively discussed in moral philosophy circles, but little work has been done in practical ethics. Can we transpose relevant philosophical considerations into workable evaluation procedures that policy-makers could use ahead of their decisions do apply a nudge?
We aim at bridging the gap between theory and practice. Our goal is to help policy-makers (in particular decision-makers in the health care system) to develop effective and ethically acceptable nudging intervention.
This project is conducted by Christine Clavien as external research partner on the ERASME projet "INFLUEnTHICS: Ethique de l’influence", led by Malik Bozzo-Rey at Lille Catholic University (2019-2025).
Les progrès impressionnants de la médecine de transplantation ont pour effet d’offrir de nouvelles options de soins. Mais les patients voulant en bénéficier se heurtent au douloureux problème de la pénurie d’organes. En réponse à cette difficulté, les initiatives en faveur de l’option législative du « consentement présumé » sont régulièrement proposées. Elles soulèvent cependant un certain nombre de difficultés, évoquées notamment dans la prise de position de la Commission Nationale d’Ethique.
Dans ce projet, nous examinons les raisons de se prononcer en faveur ou contre différentes politiques du don d’organes. A l’aide d’une étude qualitative, son objectif est de collecter les points de vue des citoyens par rapport à différents modèles de législation du don d’organe (système actuel, système de consentement présumé, système d’incitation, ou système d’obligation de choix). Ses résultats seront utiles pour mener une réflexion éthique informée et pour anticiper les arguments susceptibles de convaincre lors de débats publics sur le sujet.
A l’ère des vérités et contre-vérités dispersées sur la toile, le mouvement des anti-vaccins gagne en importance dans les pays occidentaux. Il s’ensuit une baisse de couverture vaccinale qui génère d’importants problèmes de santé publique, notamment à l’image de l’augmentation des cas de rougeole.
A l’échelle locale de l’Université de Genève, ce projet vise à élaborer et tester l’efficacité d’incitations comportementales douces, destinées à augmenter la motivation des étudiants à contrôler et ajuster leur couverture vaccinale.
Recherche conduite par l’étudiant de master Thibaut Papis, sous la supervision de Christine Clavien et en collaboration avec le Projet Vaccins de l'AEMG.
Attempts to bridge evolutionary psychology and ethics generate heated debates. On the one hand, there is the worry that old social-darwinian or eugenic ideas are brought back under the cover of a dubious pseudo-scientific rhetoric. On the other hand, it seems that one cannot reasonably take a stance on what is morally expected and required while ignoring growing knowledge about the human natural (and evolved) faculties involved in social interactions.
We aim at developing a systematic overview of how knowledge and arguments stemming from evolutionary psychology can (and have been) recruited in three main domains of ethics: descriptive ethics, normative ethics, and practical ethics.
Christine Clavien & Florian Cova, “Evolutionary Psychology and Ethics”, in T. K. Shackelford (ed.), The SAGE Handbook of Evolutionary Psychology, SAGE Publications, 2021, pp. 379-402
The importance of being open and present to another, or, as Gabriel Marcel calls it, being available, is widely acknowledged, both in and outside academia. This attitude is taken to be important to develop a non-conflictual relationship where the other feels understood and valued. However, it is usually not explained what it means to be open and present.
While the affective side of our relationships with others has attracted a lot of academic attention, especially empathy and compassion, the role that our cognitive attitude towards the other plays in our relationship has not raised as much interest. Being open and present seems indeed to be related to the way we pay attention to the other and try to understand her, but it is not clear what type of attention or understanding is at stake and what its impact on our relationships with others is.
There was a burst of interest in this question in the first half of the 20th century and authors such as Martin Buber, Gabriel Marcel and Simone Weil discussed it. But none of them provided a systematic account of this attitude and attention to it remained marginal. However, if availability toward others play the important role it is taken to have in our relationships with others, it deserves more attention and it needs to be more precisely studied.
The aim of this research project is first to describe more precisely the attitude of availability in order to get a good grasp of the phenomenon and understand what is meant when we speak about being open and present. This will enable us to clarify the role that this attitude plays in our relationships with others. Second, if the importance of availability for successful relationships is confirmed, we will see how the new understanding of availability its impacts can be used to teach and promote this attitude more effectively. For this project we will look at one context in which availability seems especially important: the relationship between patients and health care professionals.
Elodie Malbois' PhD completed in 2020
- Elodie Malbois & Christine Clavien. “Overcoming the Limits of Empathic Concern: The Case for Availability and Its Application to the Medical Domain”, Medicine, Health Care and Philosophy 23, 191–203 (2020).
- Elodie Malbois & Nicolas Foureur, “La contention nocturne en gériatrie : faut-il toujours l’éviter ou oser se poser la question au cas par cas ? ” Bioethica Forum, Bioethica Forum, 12:3/4 (2019).
- Elodie Malbois “Gabriel Marcel: Intersubjectivity as Reciprocal Availability”, in Phenomenological Approaches to Intersubjectivity and Values, Luis Aguiar de Sousa and Ana Falcato eds., Cambridge Scholar Publishing: Cambridge, 2019