Increasingly, medical records are being stored in computer databases that allow for efficiencies in providing treatment and in the processing of clinical and financial services. Computerization of medical records has also diminished patient privacy and, in particular, has increased the potential for misuse, especially in the form of nonconsensual secondary use of personally identifiable records. Organizations that store and use medical records have had to establish security measures, prompted partially by an inconsistent patchwork of legal standards that vary from state (...) to state. There is widespread appreciation among policy makers regarding the need for legal reform. The Health Information and Portability Accountability Act of 1996 mandated that the Administration develop regulations regarding the control of medical records. The Administration has offered regulations from the Department of Health and Human Services. Survey data reveal what healthcare professionals who have access to sensitive medical records believe are the greatest threats to patients' privacy. The overlap between Administration proposals and the responses of healthcare professionals is striking. (shrink)

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need (...) to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

Rosalind Hursthouse has written an excellent book, in which she develops a neo-Aristotelian virtue ethics that she sees as avoiding some of the major criticisms leveled against virtue ethics in general, and against Aristotle's brand of virtue ethics in particular.

In 2009, Greenpeace launched an aggressive campaign against Nestlé, accusing the organization of driving rainforest deforestation through its palm oil suppliers. The objective was to damage the brand image of Nestlé and, thereby, force the organization to make its supply chain more sustainable. Prominent cases such as these have led to the prevailing view that sustainable supply chain management is primarily reactive and propelled by external pressures. This research, in contrast, assumes that SSCM can contribute positively to the reputation of (...) an organization as a “good citizen” and, thereby, counter the impression that external stakeholder pressure is the only driver of SSCM. The study draws on Resource Dependence Theory in analyzing the three competing models of the potential stakeholder, SSCM and the corporate sustainability performance relationship. A dataset of 1,621 organizations allows the statistical comparison of these three models. Findings suggest that stakeholder pressure and SSCM both contribute to an organization’s sustainability performance. Thus, supply chain managers will perceive benefits from SSCM other than merely the reduction of risk from reputational damage through stakeholder activism. (shrink)

Rosalind Hursthouse has written an excellent book, in which she develops a neo-Aristotelian virtue ethics that she sees as avoiding some of the major criticisms leveled against virtue ethics in general, and against Aristotle's brand of virtue ethics in particular.

In lieu of an abstract, here is a brief excerpt of the content:diacritics 33.2 (2005) 71-97 [Access article in PDF] The Subject of Religion Lacan and the Ten Commandments Kenneth Reinhard Julia Reinhard Lupton Despite Freud's Nietzschean unmasking of religion as ideology, psychoanalysis has frequently been attacked as itself a religion, a cabal of analyst-priests dedicated to the worship of a dead master. Such critics "do not believe in Freud" in much the same way as atheists "do not believe (...) in God," and their rejections of psychoanalysis in the name of the secular partake in the very structure of religious thought they claim to repudiate. In Seminar XXI: Les non-dupes errent, Lacan comments on the blindness of the atheistic insight concerning religion: "I know that you're not believers, right? But that doesn't mean that you aren't all the more conned... because even if you are not believers, you still believe in that aspiration [for the love of God]. I won't say that you suppose it; rather, it supposes you" [Dec. 18, 1973; our trans.]. In Lacan's analysis, it is not that secular intellectuals suffer from unexamined religious "suppositions" or assumptions, to be swept away through a little ideology-critique or time on the couch. The case is rather, in Lacan's strong formulation, that religious discourse supposes us—supports and underwrites our very structures of being, subjectivity, and social interaction. That is, the secular subject is produced by the religious discourses that precede and continue to speak through it; the challenge for the contemporary critic is not to silence or debunk those discourses, but rather to bring the modern subject to assume responsibility for their enunciation.Throughout the decades of his seminar, Lacan addressed the monotheistic foundations of Western subjectivity as a set of discursive ruptures or cuts which continue to scar and brand the modern subject beyond their secular abrogation. Distinguishing between Freud "the individual with his atheistic profession of faith" and "the Freud who was the first to acknowledge the value and relevance of [the] myth... we call the death of God" [S VII 192–93], Lacan insists that Freud regarded monotheism as an epochal divide that irrevocably altered all that came before and after it: "On the left of this [monotheistic] message, there are some things that are henceforth outdated, obsolete; they no longer hold beyond the manifestation of the message. On the right, things are quite different" [172]. What, in Lacan's analysis, is the difference that monotheism has made, both during its periods of dominance and after? The laws, narratives, and symbols of monotheism continue to undergird key fantasies of personhood, nationhood, and neighborhood in the modernity that purports to have supplanted them. In Lacan's formulation, monotheism "supposes" the subject of these fantasies, precipitating it from out of the expanse of signifiers and in relation to a sublime object of both unbearable enjoyment and social obligation. Moreover, it is the scandal and the gift of monotheism that it not only creates moments of traumatic singularity, but also thinks the singular as trauma, rending the fabric of an animistic nature which would unite every polarity of being in the fullness of a sexual relation. Unlike the gods of Greek philosophy, the monotheistic God is not part of the nature he creates. In its decisive thinking of singularity, monotheism elicits and eludes all rapprochement with philosophical conceptions of the One, whether in the guise of Hellenized Judaism, Pauline theology, or Arab Aristotelianism. Lacan extends the monotheistic project of thinking singularity [End Page 71] by insisting that "there is something of One" [il y a de l'Un]—not the self-identical One of Greek logic, mathematics, and cosmology, but the One of a violent rupture that creates subjects and their worlds around a void, an un that un-does the primacy it speaks.If, from the Lacanian vantage, the singular invention of the God shared by the People of the Book forever separates religion from philosophy, we would also insist that religion is not simply a subset of "culture," understood as the symbolic practices that unify a people... (shrink)

Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. We (...) also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the “war on drugs.”. (shrink)

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of (...) ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making. In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices. (shrink)

In September 2015 a well-publicised Campaign Against Sex Robots (CASR) was launched. Modelled on the longer-standing Campaign to Stop Killer Robots, the CASR opposes the development of sex robots on the grounds that the technology is being developed with a particular model of female-male relations (the prostitute-john model) in mind, and that this will prove harmful in various ways. In this chapter, we consider carefully the merits of campaigning against such a technology. We make three main arguments. First, we argue (...) that the particular claims advanced by the CASR are unpersuasive, partly due to a lack of clarity about the campaign’s aims and partly due to substantive defects in the main ethical objections put forward by campaign’s founder(s). Second, broadening our inquiry beyond the arguments proferred by the campaign itself, we argue that it would be very difficult to endorse a general campaign against sex robots unless one embraced a highly conservative attitude towards the ethics of sex, which is likely to be unpalatable to those who are active in the campaign. In making this argument we draw upon lessons from the campaign against killer robots. Finally, we conclude by suggesting that although a generalised campaign against sex robots is unwarranted, there are legitimate concerns that one can raise about the development of sex robots. (shrink)

A core challenge for contemporary bioethics is how to address the tension between respecting an individual’s autonomy and promoting their wellbeing when these ideals seem to come into conflict (Not...

As a result of the world-wide COVID-19 epidemic, an internal tension in the goals of medicine has come to the forefront of public debate. Medical professionals are continuously faced with a tug of...

Julia Annas offers a new account of virtue and happiness as central ethical ideas. She argues that exercising a virtue involves practical reasoning of the kind we find in someone exercising an everyday practical skill, such as farming, building, or playing the piano. This helps us to see virtue as part of an agent's happiness or flourishing.

Past research has found that the value of a person's activities can affect observers' judgments about whether that person is experiencing certain emotions (e.g., people consider morally good agents happier than morally bad agents). One proposed explanation for this effect is that emotion attributions are influenced by judgments about fittingness (whether the emotion is merited). Another hypothesis is that emotion attributions are influenced by judgments about the agent's true self (whether the emotion reflects how the agent feels “deep down”). We (...) tested these hypotheses in six studies. After finding that people think a wide range of emotions can be fitting and reflect a person's true self (Study 1), we tested the predictions of these two hypotheses for attributions of happiness, love, sadness, and hatred. We manipulated the emotions' fittingness (Studies 2a-b and 4) and whether the emotions reflected an agent's true self (Studies 3 and 5), measuring emotion attributions as well as fittingness judgments and true self judgments. The fittingness manipulation only impacted emotion attributions in the cases where it also impacted true self judgments, whereas the true self manipulation impacted emotion attribution in all cases, including those where it did not impact fittingness judgments. These results cast serious doubt on the fittingness hypothesis and offer some support for the true self hypothesis, which could be developed further in future work. -/- . (shrink)

Evidence suggests that psychedelics bring about their therapeutic outcomes in part through the subjective or qualitative effects they engender and how the individual interprets the resulting experiences. However, psychedelics are contraindicated for individuals who have been diagnosed with certain mental illnesses, on the grounds that these subjective effects may be disturbing or otherwise counter-therapeutic. Substantial resources are therefore currently being devoted to creating psychedelic substances that produce many of the same biological changes as psychedelics, but without their characteristic subjective effects. (...) In this article, we consider ethical issues arising from the prospect of such potential “nonsubjective” psychedelics. We are broadly supportive of efforts to produce such substances for both scientific and clinical reasons. However, we argue that such nonsubjective psychedelics should be reserved for those special cases in which the subjective effects of psychedelics are specifically contraindicated, whereas classic psychedelics that affect subjective experience should be considered the default and standard of care. After reviewing evidence regarding the subjective effects of psychedelics, we raise a number of ethical concerns around the prospect of withholding such typically positive, meaningful, and therapeutic experiences from most patients. (shrink)

Large language models (LLMs) such as ChatGPT or Google’s Bard have shown significant performance on a variety of text-based tasks, such as summarization, translation, and even the generation of new...

The concept of medical necessity is often used to explain or justify certain decisions—for example, which treatments should be allowed under certain conditions—as though it had an obvious, agreed-upon meaning as well as an inherent normative force. In introducing this special issue of Clinical Ethics on medical necessity, we argue that the term, as used in various discourses, generally lacks a definition that is clear, non-circular, conceptually plausible, and fit for purpose. We propose that future work on this concept should (...) address three main questions: what medical necessity is (i.e., what makes something medically necessary, as opposed to something else); what the concept does (what ‘work’ is it doing when invoked in different settings); and what should follow, normatively, from the fact that something is indeed medically necessary (on some plausible conception). (shrink)

This interpretive introduction provides unique insight into Plato's Republic. Stressing Plato's desire to stimulate philosophical thinking in his readers, Julia Annas here demonstrates the coherence of his main moral argument on the nature of justice, and expounds related concepts of education, human motivation, knowledge and understanding. In a clear systematic fashion, this book shows that modern moral philosophy still has much to learn from Plato's attempt to move the focus from questions of what acts the just person ought to (...) perform to the more profound questions of what sort of person the just person ought to be. (shrink)

The growth of self-tracking and personal surveillance has given rise to the Quantified Self movement. Members of this movement seek to enhance their personal well-being, productivity, and self-actualization through the tracking and gamification of personal data. The technologies that make this possible can also track and gamify aspects of our interpersonal, romantic relationships. Several authors have begun to challenge the ethical and normative implications of this development. In this article, we build upon this work to provide a detailed ethical analysis (...) of the Quantified Relationship. We identify eight core objections to the QR and subject them to critical scrutiny. We argue that although critics raise legitimate concerns, there are ways in which tracking technologies can be used to support and facilitate good relationships. We thus adopt a stance of cautious openness toward this technology and advocate the development of a research agenda for the positive use of QR technologies. (shrink)

Davis called for “extreme caution” in the use of non-invasive brain stimulation to treat neurological disorders in children, due to gaps in scientific knowledge. We are sympathetic to his position. However, we must also address the ethical implications of applying this technology to minors. Compensatory trade-offs associated with NIBS present a challenge to its use in children, insofar as these trade-offs have the effect of limiting the child’s future options. The distinction between treatment and enhancement has some normative force here. (...) As the intervention moves away from being a treatment toward being an enhancement—and thus toward a more uncertain weighing of the benefits, risks, and costs—considerations of the child’s best interests diminish, and the need to protect the child’s autonomy looms larger. NIBS for enhancement involving trade-offs should therefore be delayed, if possible, until the child reaches a state of maturity and can make an informed, personal decision. NIBS for treatment, by contrast, is permissible insofar as it can be shown to be at least as safe and effective as currently approved treatments, which are themselves justified on a best interests standard. (shrink)

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive (...) ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments. (shrink)

Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state—something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue that developments (...) from the human enhancement debate can help clarify or resolve some of the conceptual and ethical entanglements arising from the apparent conflict between seeking medicine while not necessarily suffering from a pathology or disorder. Specifically, we focus on the welfarist account of human enhancement and argue it can provide a useful conceptual framework for thinking about some of the more contentious disagreements about access to transgender healthcare services. (shrink)

This paper investigates the norm of presupposition, as one pervasive type of indirect speech act. It argues against the view that sees presuppositions as an indirect counterpart of the direct speech act of assertion and proposes instead that they are much more similar to the direct speech act of assumption. More concretely, it suggests that the norm that governs presuppositions is not an epistemic or doxastic attitude such as knowledge, justified belief, or mere belief; it's a practical attitude, most plausibly (...) the attitude of rational acceptance. This view has important ramifications well beyond debates in philosophy of language and linguistics. It affects not only our view of which speech act sequences are fine and which are off; it bears on whether presuppositions can function as testimony, whether they can be lies, and whether they are ontologically committal, thus addressing central topics in epistemology, ethics, and metaphysics. (shrink)

This paper discusses the inefficacy problem that arises in contexts of “collective harm.‘ These are contexts in which by acting in a certain sort of way, people collectively cause harm, or fail to prevent it, but no individual act of the relevant sort seems to itself make a difference. The inefficacy problem is that if acting in the relevant way won’t make a difference, it’s unclear why it would be wrong. Each individual can argue, “things will be just as bad (...) whether or not I act in this way, so there’s no point in doing otherwise.‘ The goal of this paper is to give an overview of some of the main responses available to the problem and to highlight central issues that arise for each type of response. In the final section, I explain what I take to be the most promising strategy and discuss the form that this strategy should take. (shrink)

This volume launches a new series of contemporary conversations about scientific classification. Most philosophical conversations about kinds have focused centrally or solely on natural kinds, that is, kinds whose existence is not dependent on the scientific process of synthesis. This volume refocuses conversations about classification on unnatural, or synthetic, kinds via extensive study of three paradigm cases of unnatural kinds: nanomaterials, stem cells, and synthetic biology.

Sentences containing predicates of personal taste exhibit two striking features: whether they are true seems to lie in the eye of the beholder and whether they are true can be—and often is—subject to disagreement. In the last decade, there has been a lively debate about how to account for these two features. In this paper, I shall argue for two claims: first, I shall show that even the most promising approaches so far offered by proponents of so-called indexical contextualism fail (...) to account for the disagreement feature. They might be able to account for some disagreement data, but they have trouble accounting for two kinds of disagreement data that caused the estrangement from indexical contextualism and the migration to relativism in the first place: the denial and the retraction data. Second, I shall show that we still do not have to abandon indexical contextualism, because what I shall call the superiority approach—a new pragmatically extended version of indexical contextualism—can very well account for the data. (shrink)

Julia Markovits develops a desire-based, internalist account of what normative reasons are--an account which is compatible with the idea that moral reasons can apply to all of us, regardless of our desires. She builds on Kant's formula of humanity to defend universal moral reasons, and addresses the age-old question of why we should be moral.

In this book, Julia Ching offers a survey of over 4,000 years of Chinese civilization through an examination of the relationship between kingship and mysticism. She investigates the sage-king myth and ideal, arguing that institutions of kingship were bound up with cultivation of trance states and communication with spirits. Over time, the sage-king myth became a model for the actual ruler. As a paradigm, it was also appropriated by private individuals who strove for wisdom without becoming kings. As the (...) Confucian tradition interacted with the Taoist and the Buddhist, the religious character of spiritual and mystical cultivation became more pronounced. But the sage-king idea continued, promoting expectations of benevolent despotism rather than democratization in Chinese civilization. (shrink)

Many people follow Grice in thinking that all conversational implicatures are cancellable. And often enough, they use this insight as a test for conversational implicatures. If you want to find out whether something is a conversational implicature, the test has it, you should ask yourself whether the thing in question is cancellable; if you find that it is not cancellable, you can infer that it is not a conversational implicature. If you find that it is cancellable, you can infer that (...) it might well be a conversational implicature and that you should now do further testing. Various philosophers and linguists have questioned the test however. Some have held that Grice's cancellability claim is subject to counterexamples and that the test is not reliable. Others have argued that even though Grice's claim can be defended against the examples in question, the test is not as informative as people have hoped. This article provides an overview of the recent discussion on the cancellability test and suggests a way forward. (shrink)

In our recent article, together with more than 60 of our colleagues, we outlined a proposal for drug policy reform consisting of four specific yet interrelated strategies: (1) de jure decriminalization of all psychoactive substances currently deemed illicit for personal use or possession (so-called “recreational” drugs), accompanied by harm reduction policies and initiatives akin to the Portugal model; (2) expunging criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs (and releasing those serving (...) time for these offenses), while delivering retroactive ameliorative relief; (3) the ultimate legalization and careful regulation of currently illicit drugs; and (4) the delivery of a new “Marshall Plan” focused on community-building initiatives, expanded harm reduction programs, and social and health care support efforts (Earp et al. 2021). We were gratified to see so many thoughtful commentaries on our proposal, and we respond to them in part in this reply. (shrink)

This essay examines the thought that our right actions have moral worth only if we perform them for the right reasons. It argues against the view, often ascribed to Kant, that morally worthy actions must be performed because they are right and argues that Kantians and others ought instead to accept the view that morally worthy actions are those performed for the reasons why they are right. In other words, morally worthy actions are those for which the reasons why they (...) were performed (the reasons motivating them) and the reasons why they morally ought to have been performed (the reasons morally justifying them) coincide. The essay calls this the Coincident Reasons Thesis and argues that it provides plausible necessary and sufficient conditions for morally worthy action, defending the claim against proposed counterexamples. It ends by showing that the plausibility of the thesis, which it argues is largely independent of any particular ethical standpoint, gives us some reason to doubt a class of ethical theories that includes utilitarianism. (shrink)

There are many cases in which people collectively cause some morally significant outcome (such as a harmful or beneficial outcome) but no individual act seems to make a difference. The problem in such cases is that it seems each person can argue, ‘it makes no difference whether or not I do X, so I have no reason to do it.’ The challenge is to say where this argument goes wrong. My approach begins from the observation that underlying the problem and (...) motivating the typical responses to it is a standard, intuitive assumption. The assumption is that if an act will not make a difference with respect to an outcome, then it cannot play a sig- nificant, non-superfluous role in bringing that outcome about. In other words, helping to bring about an outcome requires making a difference. I argue that the key to solving the problem is to reject this assumption. I develop an account of what it is to help to bring about an outcome, where this does not require making a difference, and I use this explain our reasons for action in the problem cases. This account also yields an error theory that explains why the standard assumption is so tempting, even though it is mistaken. (shrink)

“Love hurts”—as the saying goes—and a certain amount of pain and difficulty in intimate relationships is unavoidable. Sometimes it may even be beneficial, since adversity can lead to personal growth, self-discovery, and a range of other components of a life well-lived. But other times, love can be downright dangerous. It may bind a spouse to her domestic abuser, draw an unscrupulous adult toward sexual involvement with a child, put someone under the insidious spell of a cult leader, and even inspire (...) jealousy-fueled homicide. How might these perilous devotions be diminished? The ancients thought that treatments such as phlebotomy, exercise, or bloodletting could “cure” an individual of love. But modern neuroscience and emerging developments in psychopharmacology open up a range of possible interventions that might actually work. These developments raise profound moral questions about the potential uses—and misuses—of such anti-love biotechnology. In this article, we describe a number of prospective love-diminishing interventions, and offer a preliminary ethical framework for dealing with them responsibly should they arise. (shrink)

Outlines of Scepticism, by the Greek philosopher Sextus Empiricus, is a work of major importance for the history of Greek philosophy. It is the fullest extant account of ancient scepticism, and it is also one of our most copious sources of information about the other Hellenistic philosophies. Its first part contains an elaborate exposition of the Pyrrhonian variety of scepticism; its second and third parts are critical and destructive, arguing against 'dogmatism' in logic, epistemology, science and ethics - an approach (...) that revolutionized the study of philosophy when Sextus' works were rediscovered and published in the sixteenth century. This volume presents the accurate and readable translation which was first published in 1994, together with a substantial new historical and philosophical introduction by Jonathan Barnes. (shrink)

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...) a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient’s (former) autonomy since it draws on the ‘wrong’ kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently ‘fine-tuned’ on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient’s preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient’s own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies. (shrink)

Generative AI programs can produce high-quality written and visual content that may be used for good or ill. We argue that a credit–blame asymmetry arises for assigning responsibility for these outputs and discuss urgent ethical and policy implications focused on large-scale language models.

People disagree frequently, about both objective and subjective matters. But while at least one party must be wrong in a disagreement about objective matters, it seems that both parties can be right when it comes to subjective ones: it seems that there can be faultless disagreements. But how is this possible? How can people disagree with one another if they are both right? And why should they? In recent years, a number of philosophers and linguists have argued that we must (...) become relativists about truth to understand faultless disagreements. This book shows that we can dispense with relativism. It combines a more standard semantics with a novel pragmatic theory to develop a superior approach. The book discusses both classic and recent literature in philosophy and linguistics. It provides a general introduction to the debate about the semantics and pragmatics of perspectival expressions, as well as an original contribution to the contemporary discussion. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either good (...) or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

The emerging field of synthetic biology aims to engineer novel biological entities. The envisioned future bio-based economy builds largely on “cell factories”: organisms that have been metabolically engineered to sustainably produce substances for human ends. In this paper, we argue that synthetic biology’s goal of creating efficient production vessels for industrial applications implies a set of ontological assumptions according to which living organisms are machines. Traditionally, a machine is understood as a technological, isolated and controllable production unit consisting of parts. (...) But modified organisms, or hybrids, require us to think beyond the machine paradigm and its associated dichotomies between artificial and natural, organisms and artefacts. We ask: How may we conceptualise hybrids beyond limiting ontological categories? Our main claim is that the hybrids created by synthetic biology should be considered not as machines but as metabolic systems. We shall show how the philosophical account of metabolism can inform an ontology of hybrids that moves beyond what we call the “machine ontology”, considering that metabolism enables thinking beyond the dominant dichotomies and allows us to understand and design lifeforms in a bio-based economy. Thus, the aim of this paper is twofold: first, to develop the philosophical ontology of hybrids, and second, to move synthetic biology beyond the problematically limiting view of hybrids. (shrink)

Some expressions, such as ‘generous’ and ‘stingy’, are used not only to describe the world around us. They are also used to evaluate the things to which they are applied. In this paper, I suggest a novel account of how this evaluation is conveyed—the conventional triggering view. It partly agrees and partly disagrees with both the standard semantic view and its popular pragmatic contender. Like the former and unlike the latter, my view has it that the evaluation is conveyed due (...) to the conventional meaning of the sentences in question. Unlike the former and much like the latter, my view suggests that the evaluation is a secondary rather than a primary content. (shrink)

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person after (...) becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

Consequentialism is the view that the rightness or wrongness of actions depend solely on their consequences. It is one of the most influential, and controversial, of all ethical theories. In this book, Julia Driver introduces and critically assesses consequentialism in all its forms. After a brief historical introduction to the problem, Driver examines utilitarianism, and the arguments of its most famous exponents, John Stuart Mill and Jeremy Bentham, and explains the fundamental questions underlying utilitarian theory: what value is to (...) be specified and how it is to be maximized. Driver also discusses indirect forms of consequentialism, the important theories of motive consequentialism and virtue consequentialism, and explains why the distinction between subjective and objective consequentialism is so important. Including helpful features such as a glossary, chapter summaries, and annotated further reading at the end of each chapter, Consequentialism is ideal for students seeking an authoritative and clearly explained survey of this important problem. (shrink)