In the real world, ethics is rarely if ever the primary focus. People engaging with practical issues may need guidance or prompts to engage with ethical questions, as well as appropriate levels of governance.
@JPSlosar calls for
“a set of easily recognizable ethics indicators that would signal the presence of an ethics issue before it becomes entrenched, irresolvable or even just obviously apparent”.
Slosar’s particular interest is in healthcare. He wants to proactively integrate ethics in person-centered care, as a key enabler of the multiple (and sometimes conflicting) objectives of healthcare: improved outcomes, reduced costs and the best possible patient and provider experience. These four objectives are known as the Quadruple Aim.
According to Slosar, ethics can be understood as a service aimed at reducing, minimizing or avoiding harm. Harm can sometimes be caused deliberately, or blamed on human inattentiveness, but it is more commonly caused by system and process errors.
A team of researchers at Carnegie-Mellon, Berkeley and Microsoft Research have proposed an approach to ethics-as-a-service involving crowd-sourcing ethical decisions. This was presented at an Ethics-By-Design workshop in 2013.
Meanwhile, Ozdemir and Knoppers distinguish between two types of Upstream Ethics: Type 1 refers to early ethical engagement, while Type 2 refers to the choice of ethical principles, which they call “prenormative”, part of the process by which “normativity” is achieved. Given that most of the discussion of EthicsByDesign assumes early ethical engagement in a project (Type 1), their Type 2 might be better called EthicsByFiat.
Cristian Bravo-Lillo, Serge Egelman, Cormac Herley, Stuart Schechter and Janice Tsai, Reusable Ethics‐Compliance Infrastructure for Human Subjects Research (CREDS 2013)
Derek Feeley, The Triple Aim or the Quadruple Aim? Four Points to Help Set Your Strategy (IHI, 28 November 2017)
Vural Ozdemir and Bartha Maria Knoppers, One Size Does Not Fit All: Toward “Upstream Ethics”? (The American Journal of Bioethics, Volume 10 Issue 6, 2010) https://doi.org/10.1080/15265161.2010.482639
John Paul Slosar, Embedding Clinical Ethics Upstream: What Non-Ethicists Need to Know (Health Care Ethics, Vol 24 No 3, Summer 2016)