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...

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)

“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)

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)

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)

The enhancement debate in neuroscience and biomedical ethics tends to focus on the augmentation of certain capacities or functions: memory, learning, attention, and the like. Typically, the point of contention is whether these augmentative enhancements should be considered permissible for individuals with no particular “medical” disadvantage along any of the dimensions of interest. Less frequently addressed in the literature, however, is the fact that sometimes the _diminishment_ of a capacity or function, under the right set of circumstances, could plausibly contribute (...) to an individual's overall well-being: more is not always better, and sometimes less is more. Such cases may be especially likely, we suggest, when trade-offs in our modern environment have shifted since the environment of evolutionary adaptation. In this article, we introduce the notion of “diminishment as enhancement” and go on to defend a _welfarist_ conception of enhancement. We show how this conception resolves a number of definitional ambiguities in the enhancement literature, and we suggest that it can provide a useful framework for thinking about the use of emerging neurotechnologies to promote human flourishing. (shrink)

In this chapter, we introduce the notion of “moral neuroenhancement,” offering a novel definition as well as spelling out three conditions under which we expect that such neuroenhancement would be most likely to be permissible (or even desirable). Furthermore, we draw a distinction between first-order moral capacities, which we suggest are less promising targets for neurointervention, and second-order moral capacities, which we suggest are more promising. We conclude by discussing concerns that moral neuroenhancement might restrict freedom or otherwise “misfire,” and (...) argue that these concerns are not as damning as they may seem at first. (shrink)

Our understanding of the neurochemical bases of human love and attachment, as well as of the genetic, epigenetic, hormonal, and experiential factors that conspire to shape an individual's sexual orientation, is increasing exponentially. This research raises the vexing possibility that we may one day be equipped to modify such variables directly, allowing for the creation of “high-tech” conversion therapies or other suspect interventions. In this article, we discuss the ethics surrounding such a possibility, and call for the development of legal (...) and procedural safeguards for protecting vulnerable children from the application of such technology. We also consider the more difficult case of voluntary, adult “conversion” and argue that in rare cases, such attempts might be permissible under strict conditions. (shrink)

"Neuroreductionism" is the tendency to reduce complex mental phenomena to brain states, confusing correlation for physical causation. In this paper, we illustrate the dangers of this popular neuro-fallacy, by looking at an example drawn from the media: a story about "hypoactive sexual desire disorder" in women. We discuss the role of folk dualism in perpetuating such a confusion, and draw some conclusions about the role of "brain scans" in our understanding of romantic love.

Over the past few years, we and our colleagues have been exploring the ethical implications of what we call “love drugs” and “anti-love drugs.” We use these terms informally to refer to “current, near-future, and more speculative distant-future technologies that would enhance or diminish, respectively, the romantic bond between couples engaged in a relationship”. In a recent “qualified defense” of our work, Andrew Andrew McGee suggests that, if we would only stop using the word “love” so expansively, our ethical proposals (...) might gain more traction. Specifically, he argues that “many of the putative instances of love” that we discuss in our papers “are not in fact... (shrink)

By nature we are all addicted to love... meaning we want it, seek it and have a hard time not thinking about it. We need attachment to survive and we instinctively seek connection, especially romantic connection. [But] there is nothing dysfunctional about wanting love.Throughout the ages, love has been rendered as an excruciating passion. Ovid was the first to proclaim: “I can’t live with or without you”—a locution made famous to modern ears by the Irish band U2. Contemporary film expresses (...) a similar sentiment: as Jake Gyllenhaal’s character famously says in Brokeback Mountain, “I wish I knew how to quit you.” And everyday speech, too, is rife with such expressions as “I need you” and “I’m addicted to you.”... (shrink)

The psychedelic psilocybin has shown promise both as treatment for psychiatric conditions and as a means of improving well-being in healthy individuals. In some jurisdictions (e.g., Oregon, USA), psilocybin use for both purposes is or will soon be allowed and yet, public attitudes toward this shift are understudied. We asked a nationally representative sample of 795 US Americans to evaluate the moral status of psilocybin use in an appropriately licensed setting for either treatment of a psychiatric condition or well-being enhancement. (...) Showing strong bipartisan support, participants rated the individual’s decision as morally positive in both contexts. These results can inform effective policy-making decisions around supervised psilocybin use, given robust public attitudes as elicited in the context of an innovative regulatory model. We did not explore attitudes to psilocybin use in unsupervised or non-licensed community or social settings. (shrink)

We thank Carrie Jenkins and Neil Levy for their thoughtful comments on our article about love and addiction. Although we do not have room for a comprehensive reply, we will touch on a few main issues.Jenkins points out, correctly in our view, that the word ‘addiction’ can trigger “connotations of reduced autonomy.” It may therefore be used, she argues, to “excuse” violent or otherwise harmful behaviors—disproportionately carried out by men—within the context of romantic relationships. Debates about love addiction, therefore, “are (...) best addressed with an eye to the more general issue of how we as a society apportion responsibility for things like date rape and intimate partner violence” (Jenkins... (shrink)

We argue that the fragility of contemporary marriages—and the corresponding high rates of divorce—can be explained (in large part) by a three-part mismatch: between our relationship values, our evolved psychobiological natures, and our modern social, physical, and technological environment. “Love drugs” could help address this mismatch by boosting our psychobiologies while keeping our values and our environment intact. While individual couples should be free to use pharmacological interventions to sustain and improve their romantic connection, we suggest that they may have (...) an obligation to do so as well, in certain cases. Specifically, we argue that couples with offspring may have a special responsibility to enhance their relationships for the sake of their children. We outline an evolutionarily informed research program for identifying promising biomedical enhancements of love and commitment. (shrink)

Pickering et al. argue that patients who refuse doctor-recommended treatments should in some cases be deemed incompetent to decide about their own medical care—in part because of their decis...

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)

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...

In their thoughtful article, Malm and Navin (2020) raise concerns about a potentially unjust generational welfare tradeoff between children and adults when it comes to chicken pox. We share their c...

The definition of soul in De Anima ii 1 is usually thought to be inadequate, since Aristotle ends the chapter by saying the account has been sketched in outline and begins ii 2 by explaining the proper way to define. I argue instead that this is Aristotle’s considered definition of soul. I do so by examining the transitional material between ii 1 and ii 2, explaining the meaning of ‘in outline’ and how the examples of proper definitions that show the (...) cause—squaring in De Anima and thunder from Posterior Analytics—correspond to the definition of soul given in ii 1. (shrink)

This commentary argues that, in contrast to the view of Professor Gonzalez, Aristotle’s account of final causation is not very helpful for addressing contemporary concerns. Aristotle presents it as a type of cause, but, when one considers Aristotle’s distinction between facts and explanations, a final cause is better viewed as simply a fact. It is true that organisms show an internal directedness towards an end, but one can still ask why this is the case. Because of its limitations, Aristotle’s account (...) of final causes is not a third ontological region between materialism and intelligent design, but its lack of explanation leaves it open to attack from either side. (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)

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.

This paper draws on a study of numeracy coordinators in primary schools in the UK in the second year of the implementation of the National Numeracy Strategy (NNS). It identifies them as working between three main tasks: embedding the Strategy, sustaining teacher collegiality and auditing accountability. We identify tensions in 'being a coordinator' in relation to these tasks, especially for discourse and identity. We assess the usefulness of the metaphor of 'brokering' in 'communities of practice' (Wenger, 1998) to theorise such (...) tensions. We conclude with some reservations about the metaphor, especially in the way the tensions are discursively performed in relation to the rate of change, complexity of notions of professional identity, and the problematic 'community' status of audit in the educational context. (shrink)

This paper draws on a study of numeracy coordinators in primary schools in the UK in the second year of the implementation of the National Numeracy Strategy. It identifies them as working between three main tasks: embedding the Strategy, sustaining teacher collegiality and auditing accountability. We identify tensions in 'being a coordinator' in relation to these tasks, especially for discourse and identity. We assess the usefulness of the metaphor of 'brokering' in 'communities of practice' to theorise such tensions. We conclude (...) with some reservations about the metaphor, especially in the way the tensions are discursively performed in relation to the rate of change, complexity of notions of professional identity, and the problematic 'community' status of audit in the educational context. (shrink)

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression to permanently prevent the development of secondary sex characteristics, as a way of affirming their gender identity. We argue that the aim of OPS is consistent with the proper goals of medicine to promote well-being, and therefore could ethically be offered to non-binary adults in principle; there are additional equity-based reasons to offer OPS to non-binary adults as a group; and the ethical defensibility (...) of facilitating individual requests for OPS from non-binary adults also depends on other relevant considerations, including the balance of potential benefits over harms for that specific patient, and whether the patient’s request is substantially autonomous. Although the broadly principlist ethical approach we take can be used to analyse other cases of non-binary adults requesting OPS apart from the case we evaluate, we highlight that the outcome will necessarily depend on the individual’s context and values. However, such clinical provision of OPS should ideally be within the context of a properly designed research study with long-term follow-up and open publication of results. (shrink)

We thank the commentators for their thoughtful responses to our article.1 Due to space constraints, we will confine our discussion to just three key issues. The first issue relates to the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This (...) conundrum thus relates both to what will be beneficial for that person and what constitutes respecting their autonomy, and clinicians must dwell on these questions when deciding what forms of medical intervention to offer. D’Angelo,2 Lemma3 and Wren4 highlight the importance of considering Phoenix as a ‘whole person in context’ 2 prior to initiating treatment or care. In this way, they advocate for a process of ‘therapeutic exploration’,4 which includes taking sufficient time to explore Phoenix’s personhood with them so as to support them in achieving an ‘authentic self-discovery’.2 We agree with these authors that identity development is a complex, life-long process that is influenced by biological, psychosocial and relational aspects, all of which may contribute to an individual’s desire to pursue gender-affirming interventions. To explore the various factors—both conscious and unconscious—that might be motivating Phoenix’s decision to pursue ongoing puberty suppression, D’Angelo,2 Lemma3 and Wren4 describe a comprehensive psychological approach to working with transgender and gender diverse individuals and propose questions to guide such discussions. Consistent with this approach, we stipulated that Phoenix had undergone regular psychological counselling and that the psychologist had judged that ‘Phoenix’s distress is significant and enduring…not a symptom …. (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)

In this reply to our commentators, we respond to ethical concerns raised about the potential use (or misuse) of personalized LLMs for academic idea and prose generation, including questions about c...

Recent research has relied on trolley-type sacrificial moral dilemmas to study utilitarian versus nonutili- tarian modes of moral decision-making. This research has generated important insights into people’s attitudes toward instrumental harm—that is, the sacrifice of an individual to save a greater number. But this approach also has serious limitations. Most notably, it ignores the positive, altruistic core of utilitarianism, which is characterized by impartial concern for the well-being of everyone, whether near or far. Here, we develop, refine, and validate a (...) new scale—the Oxford Utilitarianism Scale—to dissociate individual differences in the ‘negative’ (permissive attitude toward instrumental harm) and ‘positive’ (impartial concern for the greater good) dimensions of utilitarian thinking as manifested in the general population. We show that these are two independent dimensions of proto-utilitarian tendencies in the lay population, each exhibiting a distinct psychological profile. Empathic concern, identification with the whole of humanity, and concern for future generations were positively associated with impartial beneficence but negatively associated with instrumental harm; and although instrumental harm was associated with subclinical psychopathy, impartial beneficence was associated with higher religiosity. Importantly, although these two dimensions were independent in the lay population, they were closely associated in a sample of moral philosophers. Acknowledging this dissociation between the instrumental harm and impartial beneficence components of utilitarian thinking in ordinary people can clarify existing debates about the nature of moral psychology and its relation to moral philosophy as well as generate fruitful avenues for further research. (shrink)

How veridical is perception? Rather than representing objects as they actually exist in the world, might perception instead represent objects only in terms of the utility they offer to an observer? Previous work employed evolutionary modeling to show that under certain assumptions, natural selection favors such “strict‐interface” perceptual systems. This view has fueled considerable debate, but we think that discussions so far have failed to consider the implications of two critical aspects of perception. First, while existing models have explored single (...) utility functions, perception will often serve multiple largely independent goals. (Sometimes when looking at a stick you want to know how appropriate it would be as kindling for a campfire, and other times you want to know how appropriate it would be as a weapon for self‐defense.) Second, perception often operates in an inflexible, automatic manner—proving “impenetrable” to shifting higher‐level goals. (When your goal shifts from “burning” to “fighting,” your visual experience does not dramatically transform.) These two points have important implications for the veridicality of perception. In particular, as the need for flexible goals increases, inflexible perceptual systems must become more veridical. We support this position by providing evidence from evolutionary simulations that as the number of independent utility functions increases, the distinction between “interface” and “veridical” perceptual systems dissolves. Although natural selection evaluates perceptual systems only on their fitness, the most fit perceptual systems may nevertheless represent the world as it is. (shrink)

We propose to expand the conversation around moral enhancement from direct brain-altering methods to include technological means of modifying the environments and media through which agents can achieve moral improvement. Virtual Reality (VR) based enhancement would not bypass a person’s agency, much less their capacity for reasoned reflection. It would allow agents to critically engage with moral insights occasioned by a technologically mediated intervention. Users would gain access to a vivid ‘experience machine’ that allows for embodied presence and immersion in (...) a virtual world that meaningfully replicates relevant aspects of real life. We explore how VR can train empathy and foster moral growth in complex ways that would be inaccessible even for traditional moral education. Virtual Reality Perspective Taking is a unique medium for making empathy more reflective. (shrink)

Preface -- Key themes of discussions -- June 2, 1991 session -- June 5, 1991 session -- June 7, 1991 session -- Appendix A: Features of conscious interiority -- Appendix B: Glossary of names -- References -- About the author -- Index.

Authors have a lot of leeway with regard to what they can make true in their story. In general, if the author says that p is true in the fiction we’re reading, we believe that p is true in that fiction. And if we’re playing along with the fictional game, we imagine that, along with everything else in the story, p is true. But there are exceptions to these general principles. Many authors, most notably Kendall Walton and Tamar Szabó Gendler, (...) have discussed apparent counterexamples when p is “morally deviant”. Many other statements that are conceptually impossible also seem to be counterexamples. In this paper I do four things. I survey the range of counterexamples, or at least putative counterexamples, to the principles. Then I look to explanations of the counterexamples. I argue, following Gendler, that the explanation cannot simply be that morally deviant claims are impossible. I argue that the distinctive attitudes we have towards moral propositions cannot explain the counterexamples, since some of the examples don’t involve moral concepts. And I put forward a proposed explanation that turns on the role of ‘higher-level concepts’, concepts that if they are satisfied are satisfied in virtue of more fundamental facts about the world, in fiction, and in imagination. (shrink)

This book, the first comprehensive study in English of Heidegger's philosophy of art, starts in the mid-1930s with Heidegger's discussion of the Greek temple and his Hegelian declaration that a great artwork gathers together an entire culture in affirmative celebration of its foundational 'truth', and that, by this criterion, art in modernity is 'dead'. His subsequent work on Hölderlin, whom he later identified as the decisive influence on his mature philosophy, led him into a passionate engagement with the art of (...) Rilke, Ce;zanne, Klee and Zen Buddhism, liberating him not only from the overly restrictive conception of art of the mid-1930s but also from the disastrous politics of the period. Drawing on material hitherto unknown in the anglophone world, Young establishes a new account of Heidegger's philosophy of art and shows that his famous essay 'The Origin of the Work of Art' is its beginning, not its end. (shrink)

Arthur Schopenhauer was one of the greatest writers and German philosophers of the nineteenth century. His work influenced figures as diverse as Wagner, Freud and Nietzsche. Best known as a pessimist, he was one of the few philosophers read and admired by Wittgenstein. In this comprehensive introduction, Julian Young covers all the main aspects of Schopenhauer's philosophy. Beginning with an overview of Schopenhauer's life and work, he introduces the central aspects of his metaphysics fundamental to understanding his work as (...) a whole: his philosophical idealism and debt to the philosophy of Kant; his attempt to answer the question of what the world is; his account of science; and in particular his idea that 'will' is the essence of all things. Julian Young then introduces and assesses Schopenhauer's aesthetics, which occupy a central place in his philosophy. He carefully examines Schopenhauer's theories of the sublime, artistic genius and music, before assessing his ethics of compassion, his arguments for pessimism and his account of 'salvation'. In the final chapter, he considers Schopenhauer's legacy and his influence on the thought of Nietzsche and Wittgenstein, making this an ideal starting point for those coming to Schopenhauer for the first time. (shrink)