Integrating Equity Work throughout Bioethics.
Integrating Equity Work throughout Bioethics.
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DOI：
10.1080/15265161.2021.2001108
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发表时间：
2022-01
影响因子：
13.4
通讯作者：
Klein, Eran
中科院分区：
文献类型：
--
作者：
Goering, Sara;Brown, Timothy Emmanuel;McCusker, Darcy;Montes, Natalia;Schonau, Andreas;Versalovic, Erika;Klein, Eran
作为NIH资助的神经伦理学研究小组的成员，我们响应Fabi和Goldberg（2022）的呼吁，要求在专业医疗技术的伦理与更广泛的人群健康伦理之间建立更大的资金平衡，特别是当它们涉及种族，种族主义和健康差异问题时。我们认识到，需要接受过生物伦理学培训的人更多地关注医学内外根深蒂固的不公正形式及其影响（例如，Wilson 2021; Danis et al. 2016; Hoberman 2016），并采取积极措施使生物伦理学从业者多样化（Ray 2020; Danis et al. 2016）。为了解决和改善结构性不平等和不公平的共同目标，我们主张这样一种立场，即用于调查新兴技术伦理的项目的资金也应该调查和关注健康/医疗差异，结构性压迫和不公正的遗留问题，这些问题将不可避免地影响并受到有关技术的影响（本杰明2019）。生物伦理学问题涉及资金充足，或者如作者所认为的，资金过剩，调查领域（例如，基因组学，人工智能，神经技术）必须涉及种族/种族主义，性别/性别歧视，残疾/残疾歧视等问题。例如，人工智能伦理的讨论必须包括关注算法偏见，训练集的多样性，研究人员的特征，以及关于问题制定和使用的假设，如果我们有任何机会避免重新记录和削减现有的不公正和刻板印象（例如，Buolamwini和Gebru 2018; Chase 2020）。类似的问题也出现在神经技术的发展中（Brown and Fink 2020），并且远远超出了公平获得未来技术的问题，包括有关问题制定，测量，标准用户的规范性假设，人类受试者研究中的代表性和程序正义的问题（Thompson 2019; Goering and Klein 2020）。这些都是Fabi和Goldberg承认和支持的例子。他们的主要关切是，与这些技术相比，对健康的社会决定因素的研究缺乏足够的资金，我们也主张解决这一差距。然而，在提出他们的论点时，Fabi和Goldberg有时似乎将基于种族主义的结构性不平等研究和开发技术研究的问题一分为二。我们的目标是推翻这种非此即彼的框架。他们写道：“然而，随着技术的进步，对未来可能出现的伦理挑战进行研究的重要性，不应超过对现有健康和健康促进资源分配不公的生物伦理调查。”将一个与另一个对立起来可能会过度简化这两个研究目标之间的相互作用，并忽视神经伦理学和遗传伦理学在它们之间必须承担的重要合作工作。我们认为，科学家、临床医生、技术人员和生物伦理学家必须确保神经和遗传技术的开发和分配是公正的。此外，至少其中一些技术已经是现有卫生资源的一部分。解决结构性不平等需要继续考虑公共卫生伦理、健康的社会决定因素和发展技术之间的合作和生产空间。我们认为，重要的是要激励在这两个领域工作的人关注结构性不公正、种族/性别/残疾压迫、健康不平等以及他们工作的其他“社会影响”问题。只是，
As members of a neuroethics research group funded by the NIH, we echo the call from Fabi and Goldberg (2022) for greater funding parity between the ethics of specialized medical technologies and broader, population health ethics, especially as they relate to issues of race, racism and health disparities. We appreciate the need for people trained in bioethics to devote more attention to entrenched forms of injustice and their effects inside and outside of medicine (eg, Wilson 2021; Danis et al. 2016; Hoberman 2016), and for active measures to be taken to diversify the practitioners of bioethics (Ray 2020; Danis et al. 2016). With the shared aim of addressing and ameliorating structural inequalities and inequities, we advocate for the position that funding directed to projects investigating the ethics of emerging technologies should also investigate and attend to health/healthcare disparities, structural oppression, and legacies of injustice that will inevitably affect and be affected by the technologies in question (Benjamin 2019). Bioethics questions related to the well-funded, or as the authors argue, overfunded, areas of inquiry (eg, genomics, AI, neurotechnology) must engage with issues of race/racism, gender/sexism, disability/ableism, etc. For example, discussions of AI ethics must include attention to algorithmic bias, diversity of training sets, researcher characteristics, and assumptions about problem formulation and use if we are to have any chance of avoiding a reinscription and retrenchment of existing injustices and stereotypes (eg, Buolamwini and Gebru 2018; Chase 2020). Similar issues arise in neurotechnology development (Brown and Fink 2020) and go well beyond issues of fair access to future technology, to include questions about problem formulation, measurement, normative assumptions about the standard user, representation in human subjects research, and procedural justice (Thompson 2019; Goering and Klein 2020). These are examples Fabi and Goldberg acknowledge and support. Their key concern is with the lack of sufficient funding of research into social determinants of health as compared to these technologies, a disparity we too advocate addressing. However, in making their argument, Fabi and Goldberg sometimes seem to frame issues regarding research on structural inequalities grounded in racism and research into developing technologies dichotomously. Our goal is to push back on this either/or framing.They write:“The importance of research into future ethical challenges that may come into existence as technologies advance should not, however, outweigh bioethical inquiry into the unjust distribution of existing health and health-promoting resources.” Pitting one against the other risks oversimplifying the interplay between these two research aims and overlooking the important collaborative work that neuroethics and genetic ethics must take on in the space between them. We contend that scientists, clinicians, technologists, and bioethicists must ensure that neural and genetic technologies are developed and distributed justly. Further, at least some of those technologies are already part of the existing health resources. Addressing structural inequalities requires continued consideration of the collaborative and productive spaces between the ethics of public health, social determinants of health, and developing technologies. In our view, it is important to motivate people working in both areas to attend to issues of structural injustice, race/gender/disability oppression, health inequities, and other “social impacts” of their work. Just how that
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影响因子：
13.4
作者：
Fabi, Rachel;Goldberg, Daniel S.
通讯作者：
Goldberg, Daniel S.
影响因子：
3.3
作者：
Hoberman, John
通讯作者：
Hoberman, John
影响因子：
2.4
作者：
Wilson YY
通讯作者：
Wilson YY
影响因子：
3.7
作者：
Thompson, Margaret C.
通讯作者：
Thompson, Margaret C.
影响因子：
13.4
作者：
Danis, Marion;Wilson, Yolonda;White, Amina
通讯作者：
White, Amina