In a recent paper in Nature1 entitled The Moral Machine Experiment, Edmond Awad, et al. make a number of breathtakingly reckless assumptions, both about the decisionmaking capacities of current so-called “autonomous vehicles” and about the nature of morality and the law. Accepting their bizarre premise that the holy grail is to find out how to obtain cognizance of public morality and then program driverless vehicles accordingly, the following are the four steps to the Moral Machinists argument:

1. 1) Find out what “public morality” will prefer to see happen.

2. 2) On the basis of this discovery, claim both popular acceptance of the preferences and persuade would-be owners and manufacturers that the vehicles are programmed with the best solutions to any survival dilemmas they might face.

3. 3) Citizen agreement thus characterized is then presumed to deliver moral license for the chosen preferences.

4. 4) This yields “permission” to program vehicles to spare or condemn those outside the vehicles when their deaths will preserve vehicle and occupants.

This paper argues that the Moral Machine Experiment fails dramatically on all four counts.

This paper aims to explore the role assistive technologies (ATs) might play in helping people with autism spectrum disorder (ASD) and a concomitant responsibility deficit become more morally responsible. Toward this goal, the authors discuss the philosophical concept of responsibility, with a reliance on Nicole Vincent’s taxonomy of responsibility concepts. They then outline the ways in which ASD complicates ascriptions of responsibility, particularly responsibility understood as a capacity. Further, they explore the ways in which ATs might improve a person’s capacity so that responsibility can be properly ascribed to them. After demonstrating that although assistive technologies are likely to be able to enhance a person’s capacity in such a way so that responsibility can be ascribed to them, the authors assert that these technologies will have a number of additional effects on the other aspects of the concept of responsibility.

A middle-aged woman had a massive stroke and would be dead within hours. The husband was in the ER waiting room. I took him aside and explained the grim prognosis. He paused, his expression blank, his lips searching for something to say. Finally, he blurted out, “I think I’ll go home and take a shower.”

Is it possible to trace the contours of a bioethical reflection on nutrition? The present study tries to do so, relying on the metaphorical and symbolic value that food often takes. Indeed, eating does not mean just getting sufficient nutrition, because through the offer and exchange of food, people recognize and welcome each other. In this sense we are all, in some way, cannibals, because in eating, we eat the other, even if the introjection of the other is only symbolic and not literal, as in the case of actual cannibals. Eating habits are also very rooted in various cultures and sometimes resist migratory flows to a greater extent than language and religion do. Consequently, the disgust for, or the refusal of, other people’s food may be an indicator of a more general rejection of the diversity of other people. The conclusion reached by this study is that eating is taking care of the self and of the other and, therefore, as Jacques Derrida observes, it is necessary to “eat well” and also “eat the good.”

Starting from two paintings by Salvador Dalì (The Enigma of William Tell and Autumnal Cannibalism), the article explores Sigmund Freud and Carl Gustav Jung’s idea of erotic cannibalism. The fear of being eaten is an archetype of the collective unconscious, as fairy tales clearly reveal. Following Jacques Derrida’s reflections, the author suggests that the fear of being eaten is not limited to anthropophagic cultures, because there is a sort of symbolic cannibalism which has to do with the capacity for annihilation. The petrifying gaze of Medusa, described by Jean Paul Sartre, is a good example of this symbolic cannibalism. On the opposite side of the spectrum, compared to the petrifying gaze, we find the recognizing look of a mother toward her child. For the child, the mother embodies the good subject, which is reassuring and nonthreatening (the fairy who stands in contrast to the devouring ogre in fairy tales). Sara Ruddick explicitly refers to this motherhood model in her book Maternal Thinking, where she lays out the methodology for the ethics of care. The maternal, or recognizing gaze, as the opposite of Medusa’s gaze portrayed by Sartre, is well described in a compelling text by the Italian novelist Luigi Pirandello. At the same time, it plays an important role in Georg Wilhelm Friedrich Hegel’s The Phenomenology of the Spirit. Finally, the article returns to Salvador Dalì, showing how in his life, the artist experienced the Other’s gaze in both forms: the objectifying one, represented by the artist’s father (portrayed in The Enigma of William Tell), and the recognizing one, embodied by his partner Gala (portrayed in Autumnal Cannibalism).

Patients with amyotrophic lateral sclerosis (ALS) face many difficult, timing-sensitive decisions over the course of their illness, weighing present versus future harms and benefits. Supplemented by interviews with people with ALS, we argue for a relational approach to understanding these decisions and their effects on identity. We highlight two critical aspects of the patient–caregiver relationship: (1) the extent to which each may rely on the other leaves their wellbeing intimately intertwined and (2) patients often require others to help with the imaginative task of considering possible futures for each therapeutic option. We show why family involvement in decisionmaking practices can be so critical, and shed light on the ways intimate others help preserve and protect people’s identities amidst the destabilizing uncertainty illness and treatment can bring.

This paper challenges the long-standing and widely accepted view that medical ethics is nothing more than common morality applied to clinical matters. It argues against Tom Beauchamp and James Childress’s four principles; Bernard Gert, K. Danner Clouser and Charles Culver’s ten rules; and Albert Jonsen, Mark Siegler, and William Winslade’s four topics approaches to medical ethics. First, a negative argument shows that common morality does not provide an account of medical ethics and then a positive argument demonstrates why the medical profession requires its own distinctive ethics. The paper also provides a way to distinguish roles and professions and an account of the distinctive duties of medical ethics. It concludes by emphasizing ways in which the uncommon morality approach to medical ethics is markedly different from the common morality approach.

To what extent, if any, should minors have a say about whether they participate in research that offers them no prospect of direct benefit? This article addresses this question as it pertains to minors who cannot understand enough about what their participation would involve to make an autonomous choice, but can comprehend enough to have and express opinions about participating. The first aim is to defend David Wendler and Seema Shah’s claim that minors who meet this description should not be offered a choice about whether they participate. The second aim is to show, contra Wendler and Shah, that the principle of nonmaleficence requires more with respect to giving these minors a say than merely respecting their dissent. Additionally, it requires that investigators obtain affirmation of their non-dissent. This addresses intuitive concerns about denying children a choice, while steering clear of the problems that arise with allowing them one.

What purpose can be served by empirically unsubstantiated speculation in ethics? In answering that question, we need to distinguish between the major branches of ethics. In foundational moral philosophy, the use of speculative examples is warranted to the extent that ethical principles and theories are assumed to be applicable even under the extreme circumstances referred to in these examples. Such an assumption is in need of justification, and it cannot just be taken for granted. In applied ethics, the use of unrealistic scenarios is more difficult to justify. It can be positively harmful if it diverts our attention from more urgent issues. Neuroethics is one of the areas of applied ethics where speculative scenarios have taken up much of the attention that could instead have been devoted to problems that are relevant for the treatment and care of patients. Speculative ethics has often been defended with mere possibility arguments that may at first hand seem difficult to refute. It is shown with examples how such claims can be defeated with a combination of science and argumentation analysis.

Advance directives entail a refusal expressed by a still-healthy patient. Three consequences stem from that fact: (a) advance refusal is unspecific, since it is impossible to predict what the patient’s conditions and the risk-benefit ratio may be in the foreseeable future; (b) those decisions cannot be as well informed as those formulated while the disease is in progress; (c) while both current consent and refusal can be revoked as the disease unfolds, until the treatment starts out, advance directives become effective when the patient becomes incapable or unconscious; such decisions can therefore not be revoked at any stage of the disease. Therefore, advance directives are binding for doctors only at the stage of advance treatment planning, i.e., only if they refer to an illness already in progress.

The 1992 Convention on Biological Diversity (CBD) and its 2010 Nagoya Protocol brought about a breakthrough in global policy making. They combined a concern for the environment with a commitment to resolving longstanding human injustices regarding access to, and use of biological resources. In particular, the traditional knowledge of indigenous communities was no longer going to be exploited without fair benefit sharing. Yet, for 25 years after the adoption of the CBD, there were no major benefit sharing agreements that led to significant funding streams for indigenous communities. This changed with the signing of the Rooibos Benefit Sharing Agreement in South Africa, described in this paper. As the authors report, the Rooibos Agreement is a superlative in two respects. It is the biggest benefit sharing agreement between industry and indigenous peoples to date. It is also the first industry-wide agreement to be formed in accordance with biodiversity legislation. This article is a co-production between traditional knowledge holders, the lawyer who represented their interests, the Co-Chair of the Nagoya Protocol negotiations, and an ethicist who analyzed the major challenges of this historic agreement. With no precedent in the benefit sharing world, the agreement stands as a concrete example of the ‘art of the possible.’ Although the rooibos case is unique in a number of aspects, the experience offers many transferable insights, including: patience; incrementalism; honesty; trust; genuine dialogue; strong legal support; a shared recognition that a fair, win-win deal is possible; government leadership; and unity amongst indigenous peoples. Such ingredients of success can apply well beyond southern Africa.

In our paper, we argue for three necessary conditions for morally permissible animal research: (1) an assertion (or expectation) of sufficient net benefit, (2) a worthwhile-life condition, and (3) a no-unnecessary-harm/qualified-basic-needs condition.1 We argue that these conditions are necessary, without taking a position on whether they are jointly sufficient. In their excellent commentary on our paper, Matthias Eggel, Carolyn Neuhaus, and Herwig Grimm (hereafter, the authors) argue for a friendly amendment to one of our three conditions.2 In particular, they argue for replacing the first condition—expectation of sufficient net benefit (ESNB)—with an expectation of knowledge production (EKP).3 In this reply, we will explain why we are open to this proposed amendment, but not yet convinced.

In “Medical Ethics: Common or Uncommon Morality,”1 Rosamond Rhodes defends a specialist view of medical ethics, specifically the ethics of physicians. Rhodes’s account is specifically about the ethics of medical professionals, rooted in what these professionals do. It would seem to follow that other healthcare professions might be subject to ethical standards that differ from those applicable to physicians, rooted in what these other professions do, but I leave this point aside for purposes of this commentary. Rhodes’s view includes both a negative and a positive thesis. The negative thesis is that precepts in medical ethics—understood as the ethics of physicians—cannot be derived from principles of common morality. The positive thesis is two-fold: that precepts in medical ethics must be derived from an account of the special nature of what physicians do, and that this account is to be understood through an overlapping consensus of rational and reasonable medical professionals. While I agree emphatically with, and have learned a great deal from, Rhodes’s defense of the negative thesis, I disagree with both claims in Rhodes’s positive thesis, for reasons I will now explain after a brief observation about the negative thesis.

In this essay, the author reflects on his development as a physician by recounting two patient narratives of patients he cared for as a third year medical student. In the process of telling these stories of sickness, the author also provides a window on medical practice in the 1980’s in an academic medicine center and how practices have changed. Decades before what has been dubbed “narrative medicine,” the author learned the power of words to shape relationships and promote professional formation.

This article considers recent ethical topics relating to medical AI. After a general discussion of recent medical AI innovations, and a more analytic look at related ethical issues such as data privacy, physician dependency on poorly understood AI helpware, bias in data used to create algorithms post-GDPR, and changes to the patient–physician relationship, the article examines the issue of so-called robot doctors. Whereas the so-called democratization of healthcare due to health wearables and increased access to medical information might suggest a positive shift in the patient-physician relationship, the physician’s ‘need to care’ might be irreplaceable, and robot healthcare workers (‘robot carers’) might be seen as contributing to dehumanized healthcare practices.

This article describes the development, implementation, and evaluation of a complex methotrexate ethics case used in teaching a Pharmacy Law and Ethics course. Qualitative analysis of student reflective writings provided useful insight into the students’ experience and comfort level with the final ethics case in the course. These data demonstrate a greater student appreciation of different perspectives, the potential for conflict in communicating about such cases, and the importance of patient autonomy. Faculty lessons learned are also described, facilitating adoption of this methotrexate ethics case by other healthcare profession educators.

In her thorough and thoughtful contribution to the Cambridge Quarterly of Healthcare Ethics titled “Medical Ethics: Common or Uncommon Morality” Rosamond Rhodes argues that contrary to American mainstream bioethics, medical ethics is not, and should not be, based on common morality, but rather, that the medical profession requires its own distinctive morality.1 She goes on to list sixteen duties that, according to her, form the core of medical ethics proper.