Recent articles published in this journal have highlighted the shortcomings of individualistic approaches to health promotion, and the potential contributions of relational analyses of autonomy to public health ethics. I argue that the latter helps to elucidate the former, by showing that an inadequate analysis of autonomy leads to misassignment of both forward-looking and backward-looking responsibility for health outcomes. Health promotion programmes predicated on such inadequate analyses are then ineffective, because they assign responsibility to agents whose social environment inhibits their (...) ability to act on such responsibilities; inequitable, because the social barriers to autonomous agency display a socio-economic gradient; and stigmatizing, because they license blaming of individuals for their own poor health without taking into account how reasonable it is to hold these individuals responsible, given the social barriers to autonomy they face. I further sketch how incorporating a relational understanding of autonomy could help to produce health promotion programmes that do not succumb to these difficulties, while avoiding coercive paternalism, exploring potential applications in ecological approaches to health promotion. (shrink)

The paper offers a solution to the problem of specifying computational systems that behave in accordance with a given set of ethical principles. The proposed solution is based on the concepts of ethical requirements and ethical protocols. A new conceptual tool, called the Control Closure of an operation, is defined and used to translate ethical principles into ethical requirements and protocols. The concept of Generalised Informational Privacy (GIP) is used as a paradigmatic example of an ethical principle. GIP is defined (...) in such a way as to (i) discriminate specific cases in which an individual’s GIP can be infringed without accessing the individual’s data; (ii) separate unauthorised accesses to data that do not respect the right to GIP from access that do; and (iii) distinguish different degrees of GIP. Finally a camera phone is used to illustrate the proposed solution. (shrink)

Patient choice, we might think, is the popular version of the ideas of informed consent and the principle of respect for autonomy and intimately connected to the politics of liberal individualism. There are various accounts to be given for why patient choice, in all its forms, has dominated thinking in bioethics and popular culture. All of them, I suggest, will make reference to the decline of paternalism. The bad old days of ‘doctor knows best’ are gone and were replaced by (...) the primacy of patient choice and informed consent.The response to the dominance of the principle of patient choice has been slow in building but it has come in a number of ways. Two sets of papers in this issue of the Journal of Medical Ethics show just how far this response has come and the degree to which the pendulum is swinging back in the other direction. Neil Levy's Feature article, ‘Forced to be free? Increasing patient autonomy by constraining it’, argues that we should go to greater lengths to correct patients' mistaken decisions . In the ‘Author meets critics’ section, Sarah Conly's book, Against Autonomy: Justifying Coercive Paternalism is the focus of comment . Both authors draw on a similar range of empirical evidence to undermine the sanctity of patient and individual choice. An array of commentators draw on these target pieces to give a clear picture of the ways in which the popular view can justifiably be undermined.Levy's paper focuses on the process of informed consent in clinical contexts. He argues that, while this process is crucially important, it systematically fails because of well-documented frailties of human reason. The evidence of these frailties comes from cognitive and social psychology, on biases and heuristics. The key question is how …. (shrink)

And in this book the distinguished scholar Amartya Sen offers a powerful critique of the theory of social justice that, in its grip on social and political ...

The emerging international biomedical law tends to recognise the right not to know one’s genetic status. However, the basis and conditions for the exercise of this right remain unclear in domestic laws. In addition to this, such a right has been criticised at the theoretical level as being in contradiction with patient’s autonomy, with doctors’ duty to inform patients, and with solidarity with family members. This happens especially when non-disclosure poses a risk of serious harm to the patient’s relatives who, (...) without that vital information, could be deprived of preventive or therapeutic measures. This paper argues, firstly, that individuals may have a legitimate interest in not knowing their genetic make up to avoid serious psychological consequences; secondly, that this interest, far from being contrary to autonomy, may constitute an enhancement of autonomy; thirdly, that the right not to know cannot be presumed, but must be “activated” by the individual’s explicit choice, and fourthly, that this is not an absolute right, in the sense that it may be restricted when disclosure to the patient is necessary in order to avoid a risk of serious harm to third persons. (shrink)

: The standard bioethics account is that respecting patient autonomy means ensuring patients make their own decisions. In fact, respecting patient autonomy often has more to do with the overall shape and meaning of patients' health care regimes, and sometimes, at least, patients will very reasonably defer to medical authority.

The standard bioethics account is that respecting patient autonomy means ensuring that patients make their own decisions, and that requires that they give informed consent. In fact, respecting autonomy often has more to do with the overall shape and meaning of their health care regimes. Ideally, patients will sometimes take control of their health care but sometimes defer to medical authority. The physician's task is, in part, to inculcate patients into the appropriate good health care regimes.

Toleration is one of the fundamental principles that inform the design of a democratic and liberal society. Unfortunately, its adoption seems inconsistent with the adoption of paternalistically benevolent policies, which represent a valuable mechanism to improve individuals’ well-being. In this paper, I refer to this tension as the dilemma of toleration. The dilemma is not new. It arises when an agent A would like to be tolerant and respectful towards another agent B’s choices but, at the same time, A is (...) altruistically concerned that a particular course of action would harm, or at least not improve, B’s well-being, so A would also like to be helpful and seeks to ensure that B does not pursue such course of action, for B’s sake and even against B’s consent. In the article, I clarify the specific nature of the dilemma and show that several forms of paternalism, including those based on ethics by design and structural nudging, may not be suitable to resolve it. I then argue that one form of paternalism, based on pro-ethical design, can be compatible with toleration and hence with the respect for B’s choices, by operating only at the informational and not at the structural level of a choice architecture. This provides a successful resolution of the dilemma, showing that tolerant paternalism is not an oxymoron but a viable approach to the design of a democratic and liberal society. (shrink)

The phenomenon of distributed knowledge is well-known in epistemic logic. In this paper, a similar phenomenon in ethics, somewhat neglected so far, is investigated, namely distributed morality. The article explains the nature of distributed morality, as a feature of moral agency, and explores the implications of its occurrence in advanced information societies. In the course of the analysis, the concept of infraethics is introduced, in order to refer to the ensemble of moral enablers, which, although morally neutral per se, can (...) significantly facilitate or hinder both positive and negative moral behaviours. (shrink)

A socio-cognitive approach to trust can help us envisage a notion of networked trust for multi-agent systems (MAS) based on different interacting agents. In this framework, the issue is to evaluate whether or not a socio-cognitive analysis of trust can apply to the interactions between human and autonomous agents. Two main arguments support two alternative hypothesis; one suggests that only reliance applies to artificial agents, because predictability of agents’ digital interaction is viewed as an absolute value and human relation is (...) judged to be a necessary requirement for trust. The other suggests that trust may apply to autonomous agents because predictability of agents’ interaction is viewed only as a relative value since the digital normativity that grows out of the communication process between interacting agents in MAS has always deal with some unpredictable outcomes (_reduction of uncertainty_). Furthermore, human touch is not judged to be a necessary requirement for trust. In this perspective, a diverse notion of trust is elaborated, as trust is no longer conceived only as a relation between interacting agents but, rather, as a relation between cognitive states of control and lack of control (_double bind_). (shrink)

In our information societies, tasks and decisions are increasingly outsourced to automated systems, machines, and artificial agents that mediate human relationships, by taking decisions and acting on the basis of algorithms. This raises a critical issue: how are algorithmic procedures and applications to be appraised and governed? This question needs to be investigated, if one wishes to avoid the traps of ICTs ending up in isolating humans behind their screens and digital delegates, or harnessing them in a passive role, by (...) curtailing their freedom and autonomy. (shrink)

This article presents the first thematic review of the literature on the ethical issues concerning digital well-being. The term ‘digital well-being’ is used to refer to the impact of digital technologies on what it means to live a life that is good for a human being. The review explores the existing literature on the ethics of digital well-being, with the goal of mapping the current debate and identifying open questions for future research. The review identifies major issues related to several (...) key social domains: healthcare, education, governance and social development, and media and entertainment. It also highlights three broader themes: positive computing, personalised human–computer interaction, and autonomy and self-determination. The review argues that three themes will be central to ongoing discussions and research by showing how they can be used to identify open questions related to the ethics of digital well-being. (shrink)

We explore the question of whether machines can infer information about our psychological traits or mental states by observing samples of our behaviour gathered from our online activities. Ongoing technical advances across a range of research communities indicate that machines are now able to access this information, but the extent to which this is possible and the consequent implications have not been well explored. We begin by highlighting the urgency of asking this question, and then explore its conceptual underpinnings, in (...) order to help emphasise the relevant issues. To answer the question, we review a large number of empirical studies, in which samples of behaviour are used to automatically infer a range of psychological constructs, including affect and emotions, aptitudes and skills, attitudes and orientations (e.g. values and sexual orientation), personality, and disorders and conditions (e.g. depression and addiction). We also present a general perspective that can bring these disparate studies together and allow us to think clearly about their philosophical and ethical implications, such as issues related to consent, privacy, and the use of persuasive technologies for controlling human behaviour. (shrink)

The ever-increasing application of algorithms to decision-making in a range of social contexts has prompted demands for algorithmic accountability. Accountable decision-makers must provide their decision-subjects with justifications for their automated system’s outputs, but what kinds of broader principles should we expect such justifications to appeal to? Drawing from political philosophy, I present an account of algorithmic accountability in terms of the democratic ideal of ‘public reason’. I argue that situating demands for algorithmic accountability within this justificatory framework enables us to (...) better articulate their purpose and assess the adequacy of efforts toward them. (shrink)

This article argues that existing approaches to programming ethical AI fail to resolve a serious moral-semantic trilemma, generating interpretations of ethical requirements that are either too semantically strict, too semantically flexible, or overly unpredictable. This paper then illustrates the trilemma utilizing a recently proposed ‘general ethical dilemma analyzer,’ GenEth. Finally, it uses empirical evidence to argue that human beings resolve the semantic trilemma using general cognitive and motivational processes involving ‘mental time-travel,’ whereby we simulate different possible pasts and futures. I (...) demonstrate how mental time-travel psychology leads us to resolve the semantic trilemma through a six-step process of interpersonal negotiation and renegotiation, and then conclude by showing how comparative advantages in processing power would plausibly cause AI to use similar processes to solve the semantic trilemma more reliably than we do, leading AI to make better moral-semantic choices than humans do by our very own lights. (shrink)

This book helps us understand the true meaning of the concept and how it can be used to understand our world.

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

In many Western jurisdictions, the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own health care decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This last question has to do with what is commonly called “decisional capacity,” a central concept in health care law (...) and ethics, and increasingly an independent topic of philosophical inquiry. (shrink)

Recent work on interpretability in machine learning and AI has focused on the building of simplified models that approximate the true criteria used to make decisions. These models are a useful pedagogical device for teaching trained professionals how to predict what decisions will be made by the complex system, and most importantly how the system might break. However, when considering any such model it’s important to remember Box’s maxim that "All models are wrong but some are useful." We focus on (...) the distinction between these models and explanations in philosophy and sociology. These models can be understood as a "do it yourself kit" for explanations, allowing a practitioner to directly answer "what if questions" or generate contrastive explanations without external assistance. Although a valuable ability, giving these models as explanations appears more difficult than necessary, and other forms of explanation may not have the same trade-offs. We contrast the different schools of thought on what makes an explanation, and suggest that machine learning might benefit from viewing the problem more broadly. (shrink)

The concept of distributed moral responsibility (DMR) has a long history. When it is understood as being entirely reducible to the sum of (some) human, individual and already morally loaded actions, then the allocation of DMR, and hence of praise and reward or blame and punishment, may be pragmatically difficult, but not conceptually problematic. However, in distributed environments, it is increasingly possible that a network of agents, some human, some artificial (e.g. a program) and some hybrid (e.g. a group of (...) people working as a team thanks to a software platform), may cause distributed moral actions (DMAs). These are morally good or evil (i.e. morally loaded) actions caused by local interactions that are in themselves neither good nor evil (morally neutral). In this article, I analyse DMRs that are due to DMAs, and argue in favour of the allocation, by default and overridably, of full moral responsibility (faultless responsibility) to all the nodes/agents in the network causally relevant for bringing about the DMA in question, independently of intentionality. The mechanism proposed is inspired by, and adapts, three concepts: back propagation from network theory, strict liability from jurisprudence and common knowledge from epistemic logic. (shrink)