In this paper I examine two limit cases in which the body is threatened: the experience of emergency as described by Antoine de Saint-Exupéry’s Flight to Arras, and the experience of illness as described by Jean-Luc Nancy in his autobiographical essay The Intruder. In the first case, the everyday relationship to the body is revealed to be illusionary; the body becomes a powerful yet obedient machine. In the second case, the everyday relationship to the body is also suspended, but (...) this time in favor of a weak and objectified body. I argue that these apparently opposite experiences actually presuppose a similar notion of the everyday body, which I further conceptualize, through Merleau-Ponty and his analysis of the body, as deficient and therefore inherently repressed. The paper concludes with the suggestion that writing about one’s own body may be seen as a way to fight the everyday tendency towards repression, and I propose overwriting as a term that can capture this process. (shrink)

Social isolation and loneliness are growing concerns around the globe that put people at increased risk of disease and early death. One much‐touted approach to addressing them is deploying artificially intelligent agents to serve as companions for socially isolated and lonely people. Focusing on digital humans, we consider evidence and ethical arguments for and against this approach. We set forth and defend public health policies that respond to concerns about replacing humans, establishing inferior relationships, algorithmic bias, distributive justice, and data (...) privacy. (shrink)

This letter replies to the letter “Colonial and Neocolonial Barriers to Companion Digital Humans in Africa,” by Luís Cordeiro‐Rodrigues, in the same, May‐June 2024, issue of the Hastings Center Report.

The Buddhist Jātaka tells the tale of a hare lounging under a palm tree who becomes convinced the Earth is coming to an end when a ripe bael fruit falls on its head. Soon all the hares are running; other animals join them, forming a stampede of deer, boar, elk, buffalo, wild oxen, rhinoceros, tigers and elephants, loudly proclaiming the earth is ending.1 In the American retelling, the hare is ‘chicken little,’ and the exaggerated fear is that the sky is (...) falling. The story offers a cautionary tale for considering the trend towards calamity thinking in artificial intelligence (AI). A growing chorus of tech leaders has warned that AI poses existential risk (X-Risk) that could result in the extinction of the human species, the collapse of civilisation, or a colossal decline in human potential and culture. In 2014, Hawking told the Washington Post that AI, ‘could spell the end of the human race’.2 Musk has repeatedly warned about AI’s perils, calling AI, ‘more dangerous than nukes’, recommending colonising Mars to ensure ‘a bolt-hole if AI goes rogue and turns on humanity’,3 and donating 10 million dollars to the Future of Life Institute to jumpstart research on AI’s X-Risk. Gates has stated, ‘I am in the camp…concerned about super intelligence…I agree with … Musk and some others on this and don’t understand why some people are not concerned’.4 Altman, CEO of OpenAI, has fretted that technologies OpenAI was building could endanger humanity—‘even destroying the world as we know it’.5 This paper offers a critical appraisal of the rise of calamity thinking in the scholarly AI ethics literature. It cautions against viewing X-Risk in isolation and highlights ethical considerations sidelined when X-Risk takes centre stage. Section I introduces a working definition of X-Risk, considers its likelihood and …. (shrink)

Do neurosurgical procedures ever result in the patient prior to the procedure not being identical with the individual who wakes up postsurgery in the hospital bed? We address this question by offering an analysis of the persistence of persons that emphasizes narrative, rather than numerical, identity. We argue that a narrative analysis carries the advantage of highlighting what matters to patients in their ordinary lives, explaining the varying degrees of persistence of personal identity, and enhancing our understanding of patients' experiences. (...) We illustrate these points in cases involving temporal lobectomy for treatment of refractory epilepsy and deep brain stimulation for refractory Parkinson's disease. (shrink)

As average lifespans stretch to new lengths, how are human values impacted? Should our values change over the course of our ever-increasing lifespans? Nancy S. Jecker introduces a new concept, the life stage relativity of values, which holds that at different life stages, different ethical concerns should take center stage. For Jecker, the privileging of midlife values raises fundamental problems of fairness, and reveals large gaps in ethical principles and theories. Jecker introduces a new philosophical framework that reflects the (...) life stage relativity of values and shows its relevance to practice and policy. (shrink)

The requirement of randomization in experimental design was first stated by R. A. Fisher, statistician and geneticist, in 1925 in his book Statistical Methods for Research Workers. Earlier designs were systematic and involved the judgment of the experimenter; this led to possible bias and inaccurate interpretation of the data. Fisher's dictum was that randomization eliminates bias and permits a valid test of significance. Randomization in experimenting had been used by Charles Sanders Peirce in 1885 but the practice was not continued. (...) Fisher developed his concepts of randomizing as he considered the mathematics of small samples, in discussions with "Student," William Sealy Gosset. Fisher published extensively. His principles of experimental design were spread worldwide by the many "voluntary workers" who came from other institutions to Rothamsted Agricultural Station in England to learn Fisher's methods. (shrink)

This paper presents an African relational view of social robots’ moral standing which draws on the philosophy of ubuntu. The introduction places the question of moral standing in historical and cultural contexts. Section 2 demonstrates an ubuntu framework by applying it to the fictional case of a social robot named Klara, taken from Ishiguro’s novel, Klara and the Sun. We argue that an ubuntu ethic assigns moral standing to Klara, based on her relational qualities and pro-social virtues. Section 3 introduces (...) a second fictional case, taken from McKeown’s novel, Machines Like Me, in which a social robot named Adam displays intrinsic qualities, such as sentience, rationality, and deductive moral reasoning, yet lacks close social ties to particular people. We argue that Adam is not a person in the African sense; however, he qualifies as a person according to many standard Western views, such as Kantian and utilitarian ethics. Section 4 further elaborates the African relational view by comparing the moral standing of social robots and humans in a forced choice scenario. Section 5 replies to objections. We conclude that an African relational approach captures important insights about the moral standing of social robots that many Western accounts miss and should be better incorporated into global frameworks for designing and deploying social robots. (shrink)

This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics’ (IAB’s) selection of Qatar to host the 2024 World Congress of Bioethics. IAB’s choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets (...) forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles.One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing? (shrink)

This paper gives an ethical argument for temporarily waiving intellectual property protections for COVID-19 vaccines. It examines two proposals under discussion at the World Trade Organization : the India/South Africa proposal and the WTO Director General proposal. Section I explains the background leading up to the WTO debate. Section II rebuts ethical arguments for retaining current IP protections, which appeal to benefiting society by spurring innovation and protecting rightful ownership. It sets forth positive ethical arguments for a temporary waiver that (...) appeal to standing in solidarity and holding companies accountable. After examining built-in exceptions to existing agreements and finding them inadequate, the paper replies to objections to a temporary waiver and concludes, in section III, that the ethical argument for temporarily waiving IP protection for COVID-19 vaccines is strong. There are no data in this work. (shrink)

This paper argues that we can see our lives as a snapshot happening now or as a moving picture extending across time. These dual ways of seeing our lives inform how we conceive of the problem of age group justice. A snapshot view sees age group justice as an interpersonal problem between distinct age groups. A moving picture view sees age group justice as a first-person problem of prudential choice. This paper explores these different ways of thinking about age group (...) justice and illustrates them using a principle of respect for human dignity, understood in terms of reasonable support for floor level central human capabilities at each stage of life. I argue that different frames are suitable for different kinds of decisions, and each provides a true, but partial, picture of aging and age group justice. (shrink)

How should healthcare systems prepare to care for growing numbers and proportions of older people? Older people generally suffer worse health than younger people do. Should societies take steps to reduce age-related health inequalities? Some express concern that doing so would increase age-related inequalities in healthcare. This paper addresses this debate by presenting an argument in support of three principles for distributing scarce resources between age groups; framing these principles of age group justice in terms of life stages; and indicating (...) policy implications that merit further attention in light of rapidly aging societies. (shrink)

Societies of the East are often contrasted with those of the West in their stances toward technology. This paper explores these perceived differences in the context of international ethics guidance for artificial intelligence (AI) and robotics. Japan serves as an example of the East, while Europe and North America serve as examples of the West. The paper’s principal aim is to demonstrate that Western values predominate in international ethics guidance and that Japanese values serve as a much-needed corrective. We recommend (...) a hybrid approach that is more inclusive and truly ‘international’. Following an introduction, the paper examines distinct stances toward robots that emerged in the West and Japan, respectively, during the aftermath of the Second World War, reflecting history and popular culture, socio-economic conditions, and religious worldviews. It shows how international ethics guidelines reflect these disparate stances, drawing on a 2019 scoping review that examined 84 international AI ethics documents. These documents are heavily skewed toward precautionary values associated with the West and cite the optimistic values associated with Japan less frequently. Drawing insights from Japan’s so-called ‘moonshot goals’, the paper fleshes out Japanese values in greater detail and shows how to incorporate them more effectively in international ethics guidelines for AI and robotics. (shrink)

While people are still alive, we owe them respect. Yet what, if anything, do we owe the newly dead? This question is an urgent practical concern for aged societies, because older people die at higher rates than any other age group. One novel way in which Japan, the frontrunner of aged societies, meets its need to accommodate high numbers of newly dead is itai hoteru or corpse hotels. Itai hoteru offer families a way to wait for space in over‐crowded crematoriums (...) while affording an environment conducive to grieving. Drawing on conversations with itai hoteru employees, we delineate the values this contemporary death practice expresses and show how these values comprise part of the broader idea of a good death. A good death implies duties on both sides of death's divide: to both the dying and the newly dead. (shrink)

This paper asks whether adult children have aduty of justice to act as caregivers for theirfrail, elderly parents. I begin (Sections I.and II.) by locating the historical reasons whyrelationships within families were not thoughtto raise issues of justice. I argue that thesereasons are misguided. The paper next presentsspecific examples showing the relevance ofjustice to family relationships. I point outthat in the United States today, the burden ofcaregiving for dependent parents fallsdisproportionately on women (Sections III. andIV.). The paper goes on to (...) use Rawls''theoretical tool of the veil of ignorance toargue that caring for parents should not belinked to a person''s sex and more generally,that there is no duty of justice to assume therole of caregiver for dependent parents(Sections V.). Although justice does notprovide the moral foundations for parent care,I show that it nonetheless places importantlimits on the instinct to care. I concludethat the voice of justice should be audible,and is intrinsically present, withinfamilies. (shrink)

The indiscriminate use of cardiopulmonary resuscitation (CPR), untempered by evidence about outcomes, has been called “irrational exuberance” (Rosoff and Schneiderman 2017). There is much to be sai...

This paper addresses the just distribution of vaccines against the SARS-CoV-2 virus and sets forth an ethical framework that prioritises frontline and essential workers, people at high risk of severe disease or death, and people at high risk of infection. Section I makes the case that vaccine distribution should occur at a global level in order to accelerate development and fair, efficient vaccine allocation. Section II puts forth ethical values to guide vaccine distribution including helping people with the greatest need, (...) reducing health disparity, saving the most lives and promoting narrow social utility. It also responds to objections which claim that earlier years have more value than later years. Section III puts forth a practical ethical framework to aid decision-makers and compares it with alternatives. (shrink)

Social isolation and loneliness are ongoing threats to health made worse by the coronavirus disease 2019 pandemic. During the pandemic, half the globe's population have been placed under strict physical distancing orders and many long-term care facilities serving older adults went into lockdown mode, restricting access to all visitors, including family members. Before the pandemic emerged, a 2020 National Academy of Sciences, Engineering and Medicine report warned of the underappreciated adverse effects of social isolation and loneliness on health, especially among (...) older populations. Social isolation and loneliness predict all-cause mortality at rates that rival clinical risk factors, such as obesity and smoking; they are associated with greater incidence of psychological, cognitive, and physical morbidities. This paper sets forth a proposal to design robots to function as companions and friends for socially isolated and lonely older people during pandemic emergencies and in aging societies more generally. “The proposal” section presents and defends the proposal. The “Replies to objections” section answers objections based on coercive design, replacement of humans with robots, privacy incursions, and counterfeit companionship. The “Conclusion” section submits that sociable robots offer a promising avenue for addressing social isolation and loneliness during pandemics and hold promise for aging societies more broadly. (shrink)

Societal aging raises challenging ethical questions regarding the just distribution of health care between young and old. This article considers a proposal for age-based rationing of health care, which is based on the prudential life span account of justice between age groups. While important objections have been raised against the prudential life span account, it continues to dominate scholarly debates. This article introduces a new objection, one that develops out of the well-established disability critique of social contract theories. I show (...) the implications of this critique for the prudential life span account and for the special case of age-group justice. The result is that age-based rationing based on the prudential life span approach is not supported, and that the prudential life span approach itself is not the best way to think about allocating health care between age groups. I propose an alternative approach that avoids the disability objection, and consider its implications for specific proposals for age-based rationing of health care. (shrink)

This paper replies to a commentary by John-Stewart Gordon on our paper, “The Moral Standing of Social Robots: Untapped Insights from Africa.” In the original paper, we set forth an African relational view of personhood and show its implica- tions for the moral standing of social robots. This reply clarifies our position and answers three objections. The objections concern (1) the ethical significance of intelligence, (2) the meaning of ‘pro-social,’ and (3) the justification for prioritizing humans over pro-social robots.

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand in (...) a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant. (shrink)

Baconian science, a tool for plundering nature, has impelled physicians to insist on medical treatment even when it is futile. The Hippocratic tradition of medicine teaches us instead to acknowledge nature's limits.

In this paper I argue that a narrow view of justice dominates the bioethics literature. I urge a broader view. As bioethicists, we often conceive of justice using a medical model. This model focuses attention at a particular point in time, namely, when someone who is already sick seeks access to scarce or expensive services. A medical model asks how we can fairly distribute those services. The broader view I endorse requires looking upstream, and asking how disease and suffering came (...) about. In contrast to a medical model, a social model of justice considers how social determinants affect the health of a population. For example, social factors such as access to clean drinking water, education, safe workplaces, and police protection, profoundly affect risk for disease and early death. I examine one important social determinant of health, health care coverage, to show the limits of a medical model and the merits of a broader view. (shrink)

Book reviewed in this article: Medicine and Culture: Varieties of Treatment in the United States, England, West Germany, and France. By Lynn Payer. Health Care Systems: Moral Conflicts in European and American Public Policy. Edited by Hans‐Martin Sass and Robert U. Massey.

Volume 20, Issue 7, July 2020, Page 128-132.

This paper raises health equity concerns about the use of passports for domestic and international travel to certify COVID-19 vaccination. Part I argues that for international travel, health equity objections undercut arguments defending vaccine passports, which are based on tholding people responsible, protecting global health, safeguarding individual liberty and continuing current practice. Part II entertains a proposal for a scaled down vaccine passport for domestic use in countries where vaccines are widely and equitably available. It raises health equity concerns related (...) to racial profiling and fairness to people who are vaccine cautious. Part III sets forth a proposal for a flexible pass that certifies people who have been vaccinated, tested, previously infected or granted a conscientious objection. It sets ethical guidelines for the timing and use of flexible passes that promote equity, public health education, antidiscrimination, privacy and flexibility. (shrink)

With the development of increasingly sophisticated sociable robots, robot-human relationships are being transformed. Not only can sociable robots furnish emotional support and companionship for humans, humans can also form relationships with robots that they value highly. It is natural to ask, do robots that stand in close relationships with us have any moral standing over and above their purely instrumental value as means to human ends. We might ask our question this way, ‘Are there ways we can act towards robots (...) that would be wrong to the robot?’ To address this, Part I lays out standard approaches to moral standing: appealing to intrinsic properties, human responses, and values inhering in relationships. Part II explores the third, relational strategy in detail. Looking beyond Western analyses, it considers Eastern philosophy and the environmental philosophy of 'deep ecology' and extends these approaches to sociable robots. Part III examines practical implications for the case of Samantha, a sex robot that was allegedly raped. Part IV identifies and replies to objections. (shrink)

In 2022, the International Association of Bioethics (IAB) announced that the 17th World Congress of Bioethics would be held in Doha, Qatar. In response to ethical concerns expressed about the Qatar selection, the IAB Board of Directors developed and posted to the IAB website a response using a Q&A format. In this Letter, we (the IAB President and Vice President) address concerns about the ethics of bioethics conferencing raised in a 2023 Letter to the Editor of Bioethics by Van der (...) Graaf et al. We do not represent the Board of Directors, and this Letter expresses solely our own views. (shrink)

Is age discrimination ethically objectionable? One puzzle is that we sometimes assume that the target of both age discrimination and ageism must be older people, yet in poorer nations, older people are generally shown more respect. This article explores the ethical question. It looks first at ethical arguments favoring age discrimination toward younger people in low‐income, less industrialized countries of the global South, using sub‐Saharan Africa as an illustration. It contrasts these with arguments favoring age discrimination toward older people in (...) high‐income, more industrialized countries of the global North, particularly the United States and United Kingdom. Finally, it considers what role, if any, differences in life expectancy, infant and child mortality, and prospects for healthy lives should play in the moral embrace of a particular view by a community. It argues that there can be reasons to favor different types of discrimination in different parts of the world. (shrink)

Since the World Health Organization first declared the novel coronavirus a pandemic, diverse strategies have emerged to address it. This paper focuses on two leading strategies, elimination and mitigation, and examines their ethical basis. Elimination or ‘Zero-COVID’ dominates policies in Pacific Rim societies. It sets as a goal zero deaths and seeks to contain transmission using stringent short-term lockdowns, followed by strict find, test, trace and isolate methods. Mitigation, which dominates in the US and most European nations, sets targets for (...) community transmission and lifts restrictions once targets are met. This approach takes calculated risks and regards a certain amount of disease and death as ethically justified. Section I examines different societal responses to risk that underlie these different policy approaches. Section II focuses on ethical arguments favouring Zero-COVID and raises health equity objections. Section III proposes a long-term strategy that balances the twin goals of promoting population health and health equity. There are no data available for this work. (shrink)

Partly because physicians can “never say never,” partly because of the seduction of modern technology, and partly out of misplaced fear of litigation, physicians have increasingly shown a tendency to undertake treatments that have no realistic expectation of success. For this reason, we have articulated common sense criteria for medical futility. If a treatment can be shown not to have worked in the last 100 cases, we propose that it be regarded as medically futile. Also, if the treatment fails to (...) restore consciousness or alleviate total dependence on intensive care, we propose such treatment be judged futile. This definition provides clear end points and encourages the profession to review data from the past and perform, prospective clinical studies that not only report treatments that work but also treatments that do not work. We have also argued that, in a variety of settings, physicians have no ordinary ethical obligation to offer futile interventions. Although physicians should inform, and discuss all decisions to withhold or withdraw medical treatments with patients, they need not obtain the patient's permission to desist from futile interventions. (shrink)

Collingwood’s “Libellus de Generatione: An Essay in Absolute Empiricism” was a tract of strenuous philosophical revisionism; never published, perhaps unpublishable, supposedly destroyed, it survived. He begins by stressing his obligations to David Hume; he offers his thematic: “absolute denial of any such concept as substance and the resolution of all reality into the reality of experience.” “The reality of mind is the process of its experience, its life, and nothing else”. Or, “the mind is a mirror... whose being is solely (...) the activity of reflecting”; it has no “substance of its own of which this activity is only a reflection”. Collingwood’s entire career as student and teacher... (shrink)

An analysis of the exemplary strategy of Pasquier reveals an intriguing shift in the premises, procedures, and goals of his history, arising from the superimposition of an internalized medieval task on a very different humanist, or classicist, task. Machiavelli's classicizing exempla undermine his theory, while Pasquier's medieval exempla make sense of the Machiavellian project, and can be seen to disconnect the reader from the exemplary. Pasquier retains the Machiavellian analysis of efficiency while subverting the duty of heroic imitation. The priority (...) of consensual purpose over individual action which David assigned to the medieval exemplum reinforces the priority of community over citizen in Pasquier's historical politics. Pasquier's exempla impose on the French reader the obligation of assimilating his or her own laws and history. His initiative is felicitous in comparison with modern projects as well; he reaffirms morality as essentially public, shared, and refuses the inconsistency of deriving a public morality from an infinity of personal acts. (shrink)

This paper describes a global pattern of declining academic freedom, often driven by powerful political interference with core functions of academic communities. It argues that countering threats to academic freedom requires doubling down on ethics, specifically standards of justice and fairness in pursuing knowledge and assigning warrant to beliefs. Using the example of the selection of a Qatari university to host the 2024 World Congress of Bioethics, the authors urge fairness towards diverse groups over time and efforts to counter injustices (...) that conferences generate. (shrink)

Our aims are to set forth a multiprinciple system for selecting among clinical trials competing for limited space in an immunotherapy production facility that supplies products under investigation by scientific investigators; defend this system by appealing to justice principles; and illustrate our proposal by showing how it might be implemented. Our overarching aim is to assist manufacturers of immunotherapeutic products and other potentially breakthrough experimental therapies with the ethical task of prioritizing requests from scientific investigators when production capacity is limited.

Growing demand for direct care workers to assist care-dependent elderly people has created an opening for migrant workers from low- income nations to sell their services to middle and high-income nations. Using Singapore as a case example, we draw on capability theory to make the case that receiving nations that import direct care workers should be held to global justice standards that protect workers’ floor level human capabilities. Specifically, we (1) show that Singapore and other receiving nations fail to protect (...) human capabilities at a threshold level required by dignity; (2) identify specific human capabilities placed at risk; and (3) recommend standards for receiving nations that support central capabilities. As populations in both developed and developing nations are rapidly aging, these concerns could not be timelier. (shrink)

This paper questions an exclusively state-centred framing of global health justice and proposes a multilateral alternative. Using the distribution of COVID-19 vaccines to illustrate, we bring to light a broad range of global actors up and down the chain of vaccine development who contribute to global vaccine inequities. Section 1 (Background) presents an overview of moments in which diverse global actors, each with their own priorities and aims, shaped subsequent vaccine distribution. Section 2 (Collective action failures) characterises collective action failures (...) at each phase of vaccine development that contributed to global vaccine disparities. It identifies as critical the task of establishing upstream strategies to coordinate collective action at multiple stages across a range of actors. Section 3 (A Multilateral model of global health governance) takes up this task, identifying a convergence of interests among a range of stakeholders and proposing ways to realise them. Appealing to a responsibility to protect (R2P), a doctrine developed in response to human rights atrocities during the 1990s, we show how to operationalise R2P through a principle of subsidiarity and present ethical arguments in support of this approach. (shrink)

This Commentary critiques an extremely relational view of robot moral status, drawing out its practical implications for ethics and law. It also suggests next steps for AI ethics if extremely relational reasoning is compelling. Section I introduces the topic, distinguishing an ‘extremely relational’ view from more moderate relational views. Section II illustrates extremely relational views using the example of embodiment. Section III explores practical implications of extremely relational views for ethics and law. Section IV offers possible responses to extreme relationism. (...) Section V concludes by suggesting next steps for AI ethics. (shrink)

In “How the Neuroscience of Decision Making Informs Our Conception of Autonomy,” Gidon Felsen and Peter Reiner (2011) argue that decisions typically regarded as rational and autonomous are in fact...