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[1008] 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.

INTEGRITY

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.

 

ACCORD

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 :

  1. prendre conscience de l’intérêt d’anticiper les décisions de soins et se familiariser avec les termes et sujets liés aux directives anticipées
  2. initier des discussions avec leurs proches et leurs interlocuteurs dans les soins
  3. 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). L'outil final s'appelle Accordons-nous et est déjà disponible dans CONCERTO.

De plus, du 3 au 5 avril 2020, nous avons participé au hackathon national Versus Virus, qui visait à développer des solutions innovantes en lien avec la crise du coronavirus. Dans ce cadre, nous avons développé un prototype d’Anticip’action, un jeu de cartes,  pour soutenir les patients dans leurs réflexions sur leurs valeurs et préférences pour les soins et la fin de vie. Ce jeu pourra à terme être implémenté dans Accordons-nous. Ce projet a fait partie des highlights retenus par le jury du hackathon.

Christine Claviencoordonne ce projet en collaboration avec Catherine Bollondi, Pascale Lefuel et Thomas Fassier. L’équipe de projet inclut aussi  Florence Hartheiser,  Francois Pierre Robert, Vincent Clavien, Ines Serre, Pierre Sutter, Camille De La Serna, Laurence Buytaert, Céline Schöpfer, Frédéric Ehrler, Antoine Berger, Gora Da Rochat, Anne Dufey et Monica Escher.

Ce projet est financé par la Fondation des HUG et mené en collaboration avec le centre de l'innovation des HUG.

 

Outputs:

- Schöpfer C, Ehrler F, Berger A, Bollondi Pauly C, Buytaert L, De La Serna C, Hartheiser F, Fassier T, Clavien C. A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study. JMIR Hum Factors 2022;9(2):e34626. doi: 10.2196/34626

 - Clavien C, «Un outil pour soutenir l’anticipation des soins», REISO, Revue d'information sociale, mis en ligne le 14 avril 2022, https://www.reiso.org/document/8853

Internet of things for occupational health
An increasing number of organizations invest in biosensors and other wearable computing devices (Internet of Things - IoT) for improving the well-being of their personnel or as means for anticipating potential health and safety risks at work. The use of IoT at the workplace may be useful if purposefully used, but it is not unproblematic, since sensors create a massive data trail that organizations may harness and use for purposes other than occupational health or against the good of the personnel.
Our aim is to investigate, from three perspectives (information systems, legal, and ethical) the opportunities and risks when IoT is introduced in the workplace.
 
This interdisciplinary project is funded by the Swiss National Science Foundation and led in collaboration with Prof Tobias Mettler (head of the project) and Prof Sophie Weerts, both working at the IDHEAP (Lausanne University). Maeva El Bouchickhi is conducting her PhD on the legal and ethical aspects of this project. Here is the project's website.
Serious games and clinical reasoning

Clinical reasoning is at the heart of clinical practice. It is however a complex process which is often implicit, difficult to describe, and vulnerable to cognitive biases. The purpose of this project is to into investigate how serious games could be a potential tool to mitigate cognitive biases of physicians and improve their decision-making abilities.

The first part of the project is to investigate the efficacy of a serious game in medical education. It is important to identify the advantages and weaknesses of such teaching tools in order to optimize their implementation and transferability.

It is also important to identify possible ethical issues raised by the use of such games and address them ahead of their implementation in “real life clinical setting”. This is the second goal of the project.

 

This project is conducted by Julia Sader and co-supervised by Christine Clavien and Marie-Claude Audétat.

Outputs:

* 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.

The ethics of nudges

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).

Ouputs:

 - Christine Clavien (2018) Ethics of nudges: A general framework with a focus on shared preference justifications, Journal of Moral Education, 47:3, 366-382, DOI: 10.1080/03057240.2017.1408577

Completed project: Quelle législation pour le don d’organes ?

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.

Recherche conduite par Christine Clavien, l’étudiante de master Janine Kurzen, et Samia Hurst.

 Ouputs:

- Kurzen J, Clavien C, Hurst S. General public's view on opt-in, opt-out, and mandated choice organ donation policies: a qualitative study involving Swiss French-speaking citizens favourably disposed towards organ donation. Swiss Med Wkly. 2021 Nov 6;151:w30037. 10.4414/smw.2021.w30037

- Clavien, C. Une évaluation éthique du consentement présumé pour le don d'organes en Suisse. In: Revue médicale suisse, 2020, vol. 16, n° 682, p. 370-373. https://archive-ouverte.unige.ch/unige:139355

Completed: Projet Vaccins

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.

Ce projet vise à identifier les facteurs bloquants ou facilitant la motivation des adultes à contrôler et mettre à jour leur statut vaccinal, et à l’échelle locale de l’Université de Genève, à élaborer des incitations comportementales douces, destinées à augmenter la motivation à le faire.

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.

 Outpout:

- Papis Thibaut, Clavien Christine. Do Primary Care Physicians Contribute to the Immunization Status of Their Adult Patients? A Story of Patients' Overconfidence Coupled With Physicians' Passivity. Frontiers in Medicine, 8, 2021, DOI=10.3389/fmed.2021.655734

 

 

Completed project: Evolutionary psychology and Ethics

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.

This project is conducted by Christine Clavien in collaboration with Florian Cova

 Output:

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

Completed project: Altruism and moral motivation

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.

Conceptual work is needed in order to find a "workable" concpet of altruism that may be used in interdisciplinary reserach. For this, we have developed the notion of  “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 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 work, futur lines of research may be envisaged. 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

 Ouputs:

- Clavien, Christine (2018), «Altruisme (A)», dans Maxime Kristanek (dir.), l'Encyclopédie philosophique, consulté le ..., https://encyclo-philo.fr/11925-2

Completed project: Availability to others

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.

This project was conducted by Elodie Malbois and co-supervised by Christine Clavien. It was funded by the Swiss National Science Foundation.

 Outputs:

 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