Journal of Social Philosophy, EarlyView.

This chapter sets forth an interpretation of public reason that appeals to our central capabilities as human beings. I argue that appealing to central human capabilities and to the related idea of respect for threshold capabilities is the best way to understand public reason. My defense of this position advances stepwise: first, I consider a central alternative to a capability account, which regards public reason as a matter of contracting; next, I describe central concerns with contract views and show how (...) a capability view can avoid them; lastly, I consider extending public reason beyond national borders and test the two views in this context. (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)

This chapter addresses the close association between withholding and withdrawing futile life-sustaining medical treatments and assisting patients with hastening ending their lives. Section 12.2 sets forth a definition of medical futility and places this concept in the broader context of bioethical principles of autonomy, beneficence, nonmaleficence and justice. Section 12.3 draws out futility’s ethical implications and considers the view that physicians are ethically permitted to refrain from medically futile treatments, should be encouraged to refrain, or have a duty to refrain. (...) Section 12.4 examines ethical arguments that physicians also have a positive duty to assist patients with terminal conditions who are imminently dying to end their lives. It explores ethical arguments for assisted dying that appeal to the physicians’ significant responsibility and relationship with patients, the claimed moral equivalence of actions and omissions, and the medical goal of helping patients have a peaceful and dignified death. (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)

Using the principles of John Rawls' theory of justice, this book offers an alternative political vision; one which describes a mode of governance that will enable communities to implement a sustainable and socially just future. Rawls described a theory of justice that not only describes the sort of society in which anyone would like to live but that any society can create a society based on just institutions. While philosophers have demonstrated that Rawls's theory can provide a framework for the (...) discussion of questions of environmental justice, the problem for many philosophical theories is that discussions of sustainable development open the need to address questions of ecological interdependence, historical inequality in past resource use and the recognition that we cannot afford to ignore the limitations of growth. These ideas do not fit in comfortably in standard discourse about theories of justice. In contrast, this book frames the discussion of global justice in terms of environmental sustainability. The author argues that these ideas can be used to develop a coherent political theory which reconciles cosmopolitan arguments and the non-cosmopolitan or nationalist arguments concerning social and environmental justice. This book will be of great interest to students and scholars of environment philosophy and ethics, moral and political philosophy, global studies and sustainable development. (shrink)

In situations where experience shows that a particular intervention will not benefit a patient, common sense seems to suggest that the intervention should not be used. Yet it is precisely in these situations that a peculiar ethic begins to operate, an ethic that Eddy calls “the criterion of potential benefit.” According to this ethic, “a treatment is appropriate if it might have some benefit.” Thus, the various maxims learned in medical school instruct physicians that “‘an error of commission is to (...) be preferred to an error of omission,’ or ‘when in doubt, cut it out’ or ‘if but one patient is helped, then the treatment is worthwhile.’”. (shrink)

Intelligent neurotechnology is an emerging field that combines neurotechnologies like brain-computer interface (BCI) with artificial intelligence. This paper introduces a capability framework to assess the responsible use of intelligent BCI systems and provide practical ethical guidance. It proposes two tests, the threshold and flourishing tests, that BCI applications must meet, and illustrates them in a series of cases. After a brief introduction (Section 1), Section 2 sets forth the capability view and the two tests. It illustrates the threshold test using (...) examples from clinical medicine of BCI applications that enable patients with profound disabilities to function at a threshold level through computer mediation. Section 3 illustrates the flourishing test by exploring possible future applications of BCI involving neuroenhancements for healthy people, using examples adapted from research currently underway in the US military. Section 3 applies a capability lens to a complex case involving dual effects, both therapeutic and non-therapeutic, showing how the threshold and flourishing tests resolve the case. Section 4 replies to three objections: neurorights are the best tool for assessing BCI; the two tests are moving targets; and the analysis utilizes a capability view to do work it is not designed for. The paper concludes that a capability view offers unique advantages and gives practical guidance for evaluating the responsible use of present and future BCI applications. Extrapolating from our analysis may help guide other emerging technologies, such as germline gene editing, expected to impact central human capabilities. (shrink)

We examined the ethical justification for a national policy governing public funding for the induced pluripotent stem cell stock project in Japan and argue that the initiation of the iPSC stock project in 2012, when no clinical trial using iPSC-derived products had yet succeeded, was premature and unethical. Our analysis considers a generally accepted justice criterion and shows it fails to justify public funding of the iPSC stock project. We also raise concerns related to the massive amounts of public funding (...) at stake and the absence of evidence supporting claimed success rates. We conclude that the iPSC stock project should be re-considered and deferred until a substantial number of clinical trials using iPSC-derived products are deemed successful. This analysis should benefit others worldwide as they consider their own public funding policies. (shrink)

High moral standards and adherence to a moral code have long been strong tenets of the profession of medicine, even though there have been occasional lapses that have led to renewed calls for a revitalization of moral integrity in medicine. Certainly, a moral component has generally been held to be an important aspect of the concept of a physician.

Mr. Bernard was a homeless man, aged 58. His medical history revealed alcohol abuse, seizure disorder, and two suicide attempts. Brought to the emergency room at a local hospital after being found “semi-comatose,” his respiratory distress led to his being intubated and placed on a ventilator. The healthcare team suspected the patient ingested antifreeze. Transferred from that hospital to the intensive care unit of the university hospital, his diagnosis was “high osmolar gap with high-anion gap metabolic acidosis, most likely secondary (...) to ethylene glycol ingestion and renal insufficiency.”. (shrink)

In September 1994, theNew York Timescarried a front page article declaring healthcare reform dead in Congress. The obituary on healthcare followed a Congressional decision not to pursue the issue further in 1994. Although Congress and the President will likely revisit healthcare reform during 1995, the choices may be between various incremental steps, rather than substantive changes to bring about universal coverage.

ABSTRACT: Social robots are increasingly being deployed to address social isolation and loneliness, particularly among older adults. Clips on social media attest that individuals availing themselves of this option are pleased with their robot companions. Yet, some people find the use of social robots to meet fundamental human emotional needs disturbing. This article clarifies and critically evaluates this response. It sets forth a framework for loneliness, which characterizes one kind of loneliness as involving an affective experience of lacking human relations (...) that provide certain social goods. Next, the article discusses social robots and critically reviews the literature on the ethics of using them in light of this loneliness characterization. Third, we present a normative argument connecting the philosophical critique of loneliness-as-absence with the design and deployment of social robots. Finally, we draw out the implications of our analysis for public health and for interrogating the aims of commercial companies who make social robots. (shrink)

In the January edition of the Journal of Medical Ethics, Fujita and Tabuchi responded that we misunderstood the ‘facts’ in our previous article. Our article’s method was twofold. First, it appealed to normative analysis and publicly accessible materials, and second, it targeted a policy-making approach to public funding. We specifically did not focus on the Center for iPS Cell Research and Application or induced pluripotent stem stock projects. The Authors raised five criticisms, including transparency of our interpretation of public funding (...) policy. We reply to these criticisms by clarifying facts, and demonstrating new data, and asking the Authors what qualifies as a ‘good fact’ in medical ethics. We note that in some cases, it might be possible to examine to what extent facts are ‘true’, while in other cases, ‘facts’ are laden with ‘values’, which cannot be confirmed or falsified with observation alone. The level of ‘good’ implicit in a fact is a challenging issue that goes well beyond science and makes metaethical assumptions about the relationships between facts and values more broadly. (shrink)

Is it time to ditch the concept of “person” from practical fields, like bioethics? Blumenthal-Barby (2024) answers in the affirmative. They urge leaving personhood out of practical debates at the f...

Previously, we introduced a capability approach to assess the responsible use of brain-computer interface. In this commentary, we say more about the ethical basis of our capability view and respond to three objections. The first objection holds that by stressing that capability lists are provisional and subject to change, we threaten the persistence of human dignity, which is tied to capabilities. The second objection states that we conflate capabilities and abilities. The third objection claims that the goal of using neuroenhancements (...) should be preserving capabilities, not altering them. (shrink)

In 1963 the American journalist Betty Friedan published her book The Feminine Mystique, in which she identified, on the basis of an analysis of women's magazines and surveys of women, a paradox in the self- awareness of American women: in striving to achieve the ideal of femininity, they devote themselves zealously to serving the family, and at the same time they feel they are "different" human beings from men, who have access to the world at large. Friedan compared the situation (...) of the housewife with the situation of a prisoner in a concentration camp. In both, a person is deprived of self-identity, of self-respect, and of manifesting one's individuality and is isolated from the large world of ideas and events. Friedan's general conclusion was that the ideal of "femininity" that guides women is not a natural bent of their natures but an inhumane stereotype that is imposed by advertising, business, and government because it is useful to society. (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)

Should the nation provide expensive care and scarce organs to convicted felons? We distinguish between two fields of justice: Medical Justice and Societal Justice. Although there is general acceptance within the medical profession that physicians may distribute limited treatments based solely on potential medical benefits without regard to nonmedical factors, that does not mean that society cannot impose limits based on societal factors. If a society considers the convicted felon to be a full member, then that person would be entitled (...) to at least a decent minimum level of care — which might include access to scarce life-saving organs. However, if criminals forfeit their entitlement to the same level of medical care afforded to all members of society, they still would be entitled to a kind of rudimentary decent minimum granted to all persons on simple humanitarian grounds. Almost certainly this entitlement would not include access to organ transplants. (shrink)

It is now a default obligation to provide cardiopulmonary resuscitation (CPR), in the absence of knowledge of a patient’s or surrogate’s wishes to the contrary. We submit that it is time to reevaluate this position. Attempting CPR should be subject to the same scrutiny demanded of other medical interventions that involve balancing a great benefit against grievous harms.

Volume 20, Issue 7, July 2020, Page 136-138.

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)

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)

This paper spotlights ways in which sexual capacities relate to central human capabilities, such as the ability to generate a personally meaningful story of one’s life; be physically, mentally and emotionally healthy; experience bodily integrity; affiliate and bond with others; feel and express a range of human emotions; and choose a plan of life. It sets forth a dignity-based argument for affording older people access to sex robots as part of reasonable efforts to support their central human capabilities at a (...) floor level. The argument develops stepwise: (1) first, I dispel ageism and negative stereotypes about later-life sexuality, showing their deep historical roots in medicine and science; (2) second, I set forth a positive argument, grounded in capability accounts of justice, for deploying sex robots for older people with disabilities; (3) finally, after responding to objections, I conclude that sex robots are a reasonable way to support later-life sexuality for persons with disabilities. While often depicted as a product for younger, able-bodied people, this paper is a bid for reimagining sex robots as a product for older, disabled people. (shrink)