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Rethinking our Assumptions about Moral Status
Recent technological developments and potential technological developments of the near future require us to try to think clearly about what it is to have moral status and about when and why we should attribute moral status to beings and entities. What should we say about the moral status of human non-human chimeras, human brain organoids, artificial intelligence, cyborgs, post-humans, and human minds that have been uploaded into a computer, or onto the internet? In this introductory chapter we survey some key assumptions ordinarily made about moral status that may require rethinking. These include the assumptions that all humans who are not severely cognitively impaired have equal moral status, that possession of the sophisticated cognitive capacities typical of human adults is necessary for full moral status, that only humans can have full moral status, and that there can be no beings with higher moral status than ordinary adult humans. We also need to consider how we should treat beings and entities when we find ourselves uncertain about their moral status.
Rethinking Moral Status
Common-sense morality implicitly assumes that reasonably clear distinctions can be drawn between the ‘full’ moral status usually attributed to ordinary adult humans, the partial moral status attributed to non-human animals, and the absence of moral status, usually ascribed to machines and other artefacts. These assumptions were always subject to challenge; but they now come under renewed pressure because there are beings we are now able to create, and beings we may soon be able to create, which blur traditional distinctions between humans, non-human animals, and non-biological beings. Examples are human non-human chimeras, cyborgs, human brain organoids, post-humans, human minds that have been uploaded into computers and onto the internet, and artificial intelligence. It is far from clear what moral status we should attribute to any of these beings. While commonsensical views of moral status have always been questioned, the latest technological developments recast many of the questions and raise additional objections. There are a number of ways we could respond, such as revising our ordinary suppositions about the prerequisites for full moral status. We might also reject the assumption that there is a sharp distinction between full and partial moral status. The present volume provides a forum for philosophical reflection about the usual presuppositions and intuitions about moral status, especially in light of the aforementioned recent and emerging technological advances.
Early experiences of the End of Life Choice Act 2019 amongst assisted dying practitioners in Aotearoa New Zealand.
BACKGROUND: The global trend of legalising assisted dying (AD) has reshaped end-of-life care practices, and Aotearoa New Zealand's adoption of the End of Life Choice Act (the Act) in 2019 represents a significant shift. Limited empirical research on AD in New Zealand after the enactment of the Act underscores the need for investigation. Conducting research in the early stages of AD implementation is crucial to building a strong knowledge base and laying the foundation for future research. This would ensure equitable and suitable service provision for the service users. AIM: This research captured the experiences of health practitioners directly involved in providing AD under New Zealand's End of Life Choice Act 2019. DESIGN: Using the "memorable case" approach, 22 participants reflected on the process of assessing, treating, and delivering AD services in the first 12 months of implementing the new AD law. RESULTS: Thematic analysis identified four major themes underlying the experiences of assisted dying practitioners/providers (ADPs). The themes focused on three aspects of ADPs' experience: KNOWING: prior personal experience (personal beliefs, clinical background, and AD training) and reflective experiences of DOING assessments, service delivery, and patient/family experiences and BEING an ADP (personal, professional, emotional, and social impacts). Additionally, the themes highlighted the overarching influence of health system infrastructure, challenges, and resources that shaped ADPs' overall experience. CONCLUSION: These findings contribute to new knowledge by uncovering gaps in understanding, competency, service implementation, and the emotional impact on ADPs. The findings could inform the development of an educational, supportive, and culturally safe program, including resources for workforce development.
Addressing the gap in health data management skills: an online self-guided course for researchers and health professionals.
BACKGROUND: The healthcare sector is rapidly evolving with the rise of digital technology and data-driven decision-making. However, traditional medical education has yet to fully integrate training on managing health-related information, resulting in a significant skills gap among medical and research professionals. This gap is pronounced in low- and middle-income countries (LMICs), where data privacy concerns and inadequate infrastructure hinder efforts to utilise and share health data. AIMS: To address this gap, we developed an online, modular course aimed at providing foundational skills on capturing, storing and sharing health data. METHODS: The course was developed using the ADDIE(Analyze, Design, Develop, Implement, Evaluate) instructional design model. A needs assessment workshop involving 25 global health proffesionals identified key training gaps which informed the curriculum's development. A multidisciplinary team from six institutions developed the modules. The course was piloted in a face-to-face setting with 37 participants and later adapted for online delivery via the Global Health Network platform. We evaluated the course using Level 1 of Kirkpatrick's model for training evaluation. RESULTS: Six foundational modules were developed: Introduction to Data Management, Data Quality, Data Repositories, Ethics of Data Sharing, Data Governance, and Costing for Data Management. Between December 2020 and April 2024, 6,384 individuals from 90 countries completed the course. Of these, 32% were from Africa, 15% from Asia, 16% from South/Central America and the Caribbean, and 24% from Europe. Summative evaluations, based on voluntary post-module surveys, demonstrated high relevance to participants' learning needs (96.6%) and strong intentions to apply the skills gained (88.3%). Key motivators for enrollment included the course's free access, relevance to professional or academic needs, and trust in the organizations and authors behind the content. CONCLUSIONS: The high enrolment and broad geographical reach demonstrates the potential of online training as a cost-effective tool to equip health practitioners and researchers with data literacy skills. Future evaluations will assess its impact on participants' knowledge, behavior, and data-sharing and reuse practices.
Where There's Hope, There's Life 1 : On the Importance of Hope in Health Care.
It is widely supposed that it is important to ensure that patients undergoing medical procedures hope that their treatments will be successful. But why is hope so important, if indeed it is? After examining the answers currently on offer in the literature, we identify a hitherto unrecognized reason for supposing that it is important that patients possess hope for a successful treatment, which draws on prospect theory, Kahneman and Tversky's hugely influential descriptive theory about decision-making in situations of risk and uncertainty. We also consider some concerns about patient consent and the potential manipulation of patients that are raised by our account.
When conspiracy theorists win
‘Generalists’ hold that conspiracy theories, as a class, have epistemic defects. Well confirmed theories that invoke conspiracies, such as the theory that the Nixon administration conspired to orchestrate the break in at the Democratic National Committee offices in the Watergate complex, on 17 June 1972,–the ‘Watergate theory’–raise a problem for generalists as it’s hard to understand how such theories can have epistemic defects. The Watergate theory is often not considered a mere conspiracy theory, because it enjoys ‘official theory’ status and in folk usage that means it is not a conspiracy theory. However, most people concede that the Watergate theory was a conspiracy theory before obtaining official status. So, appealing to folk usage does not make the problem go away. Recently however, several generalist scholars including, Cassam, Mandik, Thalman and Butter, have argued that theories invoking conspiracies that enjoy official status were never conspiracy theories. I’ll consider their reasoning and show where they go wrong. I’ll work with the examples of the Watergate theory and the ‘false flag’ theory of the Mountain Meadows massacre of 1857, which has it that this massacre of over 100 people was led by white Utahn Mormons disguised as Native Americans.
The sanctity of life as a sacred value.
The doctrine of the sanctity of life has traditionally been characterised as a Judeo-Christian doctrine that has it that bodily human life is an intrinsic good and that it is always impermissible to kill an innocent human. Abortion and euthanasia are often assumed to violate the doctrine. The doctrine is usually understood as being derived from religious dogma and, as such, not amenable to debate. I show that this characterisation of the doctrine is problematic in a number of ways, and I go on to rethink the doctrine. In doing so I follow in the footsteps of Ronald Dworkin, who offered a characterisation of the doctrine in his 1993 Life's Dominion, drawing on a conceptualisation of sacredness that is radically different from standard ones and not dependent on religious dogma. I'll argue that although Dworkin's efforts have much to recommend, his conceptualisation of sacredness is inadequate. Dworkin attempted to reconceptualise sacredness 'from the armchair'. Here I explain how sacred values are thought of in anthropology and psychology and argue that the sanctity of human life should be understood in the same way. I'll explain how doing so allows us to resolve a number of conceptual problems that bedevil standard characterisations of the doctrine of the sanctity of life. I'll also consider the possibility of a compromise over the sanctity of human life, and as a consequence, compromise over the permissibility of abortion and euthanasia. I'll argue that such compromise is possible, albeit difficult to achieve.
Is There a New Conspiracism?
The authors of a much discussed recent book A Lot of People are Saying: The New Conspiracism and the Assault on Democracy, Russell Muirhead and Nancy L. Rosenblum argue that ‘a new conspiracism’ has emerged recently. Their examples include Donald Trump’s allegations that elections have been rigged, ‘Birther’ accusations about Barack Obama, ‘QAnon’ and ‘Pizzagate’. They characterize these as ‘conspiracism without the theory’. They argue that the new conspiracism is validated by repetition, disregards experts, and is satisfied with the conclusion that allegations are ‘true enough’. Here I argue that there is no new conspiracism. Muirhead and Rosenblum have misconstrued their chief examples of new conspiracism and mischaracterized classic conspiracism. The non-existence of a new conspiracism matters. If those studying contemporary conspiracism suppose that many of the objects of their study are theory-free then they are liable to fail to examine the theories that actually are driving contemporary conspiracism. Also, if they suppose that they are confronting an entirely new phenomenon then they are in danger of failing to learn lessons from the rich history of conspiracy theorizing.
Non-accommodationism and conscientious objection in healthcare: a response to Robinson.
Michael Robinson takes issue with an 'argument from voluntariness' made by several opponents of current practices for managing conscientious objection (CO) in healthcare, including Cantor, Stahl and Emanuel, and Schuklenk, whom he characterises as 'non-accommodationists'. Here I argue that while Robinson is right to oppose the argument from voluntariness, he misunderstands current arrangements for managing CO in healthcare, and he misses the force of the non-accommodationist case against those arrangements. I also argue that despite what he says, Robinson is as much a proponent of reform of the management of CO in healthcare as are his non-accommodationist opponents. Additionally, I raise a concern about Robinson's preferred approach to managing CO in healthcare.
Huckleberry Finn's Conscience: Reckoning with the Evasion.
Huck Finn's struggles with his conscience, as depicted in Mark Twain's famous novel The Adventures of Huckleberry Finn (AHF) (1884), have been much discussed by philosophers; and various philosophical lessons have been extracted from Twain's depiction of those struggles. Two of these philosophers stand out, in terms of influence: Jonathan Bennett and Nomy Arpaly. Here I argue that the lessons that Bennett and Arpaly draw are not supported by a careful reading of AHF. This becomes particularly apparent when we consider the final part of the book, commonly referred to, by literary scholars, as 'the evasion'. During the evasion Huck behaves in ways that are extremely difficult to reconcile with the interpretations of AHF offered by Bennett and Arpaly. I extract a different philosophical lesson from AHF than either Bennett or Arpaly, which makes sense of the presence of the evasion in AHF. This lesson concerns the importance of conscious moral deliberation for moral guidance and for overcoming wrongful moral assumptions. I rely on an interpretation of AHF that is influential in literary scholarship. On it the evasion is understood as an allegory about US race relations during the 20-year period from the end of the US Civil War to the publication of AHF.