Fabrice Jotterand

The conceptualization of morality by some proponents of moral bioenhancement requires particular epistemological commitments and neuroessentialist assumptions. This chapter examines these assumptions and shows why such premises are problematic for the development of a sophisticated framework of morality at the intersection of neuroscience and moral philosophy and why these premises cannot support the possibility of moral enhancement. The author provides conceptual clarity on key concepts in the moral enhancement debate, including the distinction between psychopharmacology and neurotechnologies as means to cognitive enhancement, the meaning of moral enhancement, and the crucial distinction between moral capacity and moral content. Second, he critiques neuroessentialism, pointing to a danger to reduce human behavior to neurobiology and the potential to misconceptualize human moral psychology. Third, he expands his critique of neuroessentialism, particularly with regard to the concept of moral agency and offers a viable alternative based on social practices.

This chapter serves as an introduction to the volume, an international collection of essays that fill the gap in the growing literature in neuroethics dealing with cognitive neuroenhancement for healthy adults. It addresses issues of cognitive enhancement comprehensively in three important ways: (1) it examines the conceptual implications stemming from competing points of view about the nature and goals of enhancement; (2) it addresses the ethical, social, and legal implications of neuroenhancement from an international and global perspective including contributions from scholars in Africa, Asia, Australia, Europe, North America, and South America; and (3) it discusses and analyzes concrete legal issues and policy options tailored to specific contexts.

Artificial intelligence (AI)-based technologies are increasingly being utilized, tested, and integrated into conventional healthcare delivery. Technological opportunities, ranging from machine-learning-based data analysis tools to large language model-based virtual healthcare assistants, offer significant potential to enhance healthcare access and improve outcomes. Researchers have discussed potential benefits, including improved resource allocation, diagnostic accuracy, and patient outcomes from greater AI integration in healthcare, and also have voiced concerns around data privacy, algorithmic bias, and diffused accountability. This paper adds to the literature by proposing an ethical framework that allows for both describing and normatively evaluating AI-mediated healthcare delivery based on its potential impact on human-centered patient care. Drawing upon Pelligrino's notions of the patient–doctor relationship, we propose a framework with two axes, one related to spectrum of patient engagement and the other related to the clinician's role, through which to assess the use of AI in healthcare. Technologies and tools that have minimal to no interaction with patients and primarily assist physicians in making clinical decisions tend to have the least ethical challenges. On the other hand, those that are fully patient-facing and work in parallel with doctors or autonomously in therapeutic or decisional roles are the most controversial, as they risk making healthcare less human-centric. As we advance toward more pervasive integration of AI in healthcare, our framework can facilitate upfront design and downstream implementation-related decisions.

The increasing availability of brain data within and outside the biomedical field, combined with the application of artificial intelligence (AI) to brain data analysis, poses a challenge for ethics and governance. We identify distinctive ethical implications of brain data acquisition and processing, and outline a multi-level governance framework. This framework is aimed at maximizing the benefits of facilitated brain data collection and further processing for science and medicine whilst minimizing risks and preventing harmful use. The framework consists of four primary areas of regulatory intervention: binding regulation, ethics and soft law, responsible innovation, and human rights.

Philosophically, practical wisdom has been discussed within the context of virtue ethics as a deliberative process or one dependent on a constellation of other virtues. The context of virtue ethics provides additional relevant concepts to consider when defining and measuring practical wisdom. Broadening the psychological perspective to consider the practice of deliberation within decision-making or to examine the contributions of other virtues will advance the understanding of the nuances related to doing the right thing, at the right time, for the right reason toward a moral end. At the same time, with a more developed biological perspective, there can be advancements in the complexity and completeness of the biological model underlying the psychological processes of practical wisdom. Importantly, with a well-developed science of practical wisdom, one can foster behavioral changes in a professional agent conducive to making professionally wise choices. The aim of this collection of essays by experts in the field of practical wisdom is to bring together these multidisciplinary perspectives on the conceptualization of practical wisdom to guide a meaningful integration of concepts of competence and character with care into the education and support of medical professionals.

This paper argues that practical wisdom represents a useful framework for understanding the synthesis of the scientific, technical, and moral dimensions of medical practice and may, therefore, guide the meaningful integration of concepts of competence and character into the education and support of both the technical and moral agency of medical professionals. The authors show the importance of practical wisdom in three distinct domains: (1) in effective deliberation in clinical judgments; (2) in helping clinicians flourish by making wise decisions in light of the moral and emotional challenges they face in their practice; and (3) in helping physicians navigate between the rights of patients, the physician’s own moral good, and the objective good intrinsic to medicine. To promote the physician’s own moral good and the objective good intrinsic to medicine, the authors propose a philosophical position, the agential view, that preserves an essentialist view of medicine but emphasizes the necessity to develop a personal moral philosophy of clinical practice.

Neuroethics is an interdisciplinary field that arose in response to novel ethical challenges posed by advances in neuroscience. Historically, neuroethics has provided an opportunity to synergize different disciplines, notably proposing a two-way dialogue between an ‘ethics of neuroscience’ and a ‘neuroscience of ethics’. However, questions surface as to whether a ‘neuroscience of ethics’ is a useful and unified branch of research and whether it can actually inform or lead to theoretical insights and transferable practical knowledge to help resolve ethical questions. In this article, we examine why the neuroscience of ethics is a promising area of research and summarize what we have learned so far regarding its most promising goals and contributions. We then review some of the key methodological challenges which may have hindered the use of results generated thus far by the neuroscience of ethics. Strategies are suggested to address these challenges and improve the quality of research and increase neuroscience's usefulness for applied ethics and society at large. Finally, we reflect on potential outcomes of a neuroscience of ethics and discuss the different strategies that could be used to support knowledge transfer to help different stakeholders integrate knowledge from the neuroscience of ethics.

There is a growing literature in neuroethics dealing with the problem of cognitive neuroenhancement for healthy adults. However, discussions on this topic have tended to focus on abstract theoretical positions while concrete policy proposals and detailed models are scarce. Furthermore, discussions tend to rely solely on data from the US, while international perspectives are mostly neglected. Therefore, there is a need for a volume that deals with cognitive enhancement comprehensively in three important ways: a) with conceptual implications stemming from different points of view; b) with ethical, social and legal perspectives that would not be limited to one part of the world but reflect on the current situation in countries in Africa, Asia, Australia, Europe, North America and South America; and c) with discussions of concrete law and policy options. Contributors for the conceptual implications section will elaborate an important general issue (e.g. ethical acceptability of direct-to-consumer-marketing in case of cognitive enhancement drugs). Contributors for international perspectives section will provide a clear discussion on normative issues and cultural values, along with an analysis of empirical data on public attitudes on cognitive enhancement and/or prevalence (specific to the country in question). Contributors for law and policy section will offer a justification for the general policy type they argue for (1. prohibition, 2. discourage use, 3. laissez-faire, 4. encourage use, and 5. mandatory use) in the case of specific cognitive enhancement measure. Furthermore, they would evaluate the possible impact of a detailed regulatory model on consumption and demand, fairness in competitive settings and the social pressure to enhance.

Oral healthcare is attracting much attention after decades of neglect from policymakers. Recent studies have shown a strong association between oral and overall health, which can lead to serious health problems. Availability of oral healthcare services is an essential part of ensuring universal healthcare coverage. More importantly, current gaps in its accessibility by minority or marginalized population groups are crucial public health as well as ethical concerns. One notable effort to address this issue comes from Non-Governmental Organizations (NGOs), which offer oral healthcare services for non-insured refugees. However, the challenge remains that these care services are not comprehensive, which has implications for the refugees’ oral and general health. In this article, we discuss this complex issue in the German healthcare context by including ethical reflections. Therefore, the purpose of this article is to discuss the ethical challenges related to oral healthcare services provided by NGOs for refugees in Germany. First, we will introduce the general oral healthcare context worldwide and in Germany. Second, we will provide a general description of the oral healthcare services provided by NGOs for refugees in Germany, as well as an overview of existing gaps. This will provide us with the context for our third and most important task—discussing the ethical implications of the gaps. In doing so, and since the ethical implications can be several, we demarcate the scope of our analysis by focusing on the specific ethical issues of justice, harm, and autonomy. Finally, we offer some recommendations for how to move forward.

The coupled growth of population aging and international migration warrants attention on the methods and solutions available to adult children living overseas to provide distance caregiving for their aging parents. Despite living apart from their parents, the transnational informal care literature has indicated that first-generation immigrants remain committed to carry out their filial caregiving obligations in extensive and creative ways. With functions to remotely access health information enabled by emergency, wearable, motion, and video sensors, remote monitoring technologies (RMTs) may thus also allow these international migrants to be alerted in sudden changes and remain informed of their parent’s state of health. As technological solutions for caregiving, RMTs could allow independent living for older persons while any unusual deviations from normal health patterns are detected and appropriately supported. With a vignette of a distance care arrangement, we engage with concepts such as filial piety, in-absentia caregiving distress, and the social exchange theory, as well as the upholding of shifting cultural ideals to illustrate the complex dynamic of the satisfaction and quality of the informal caregiving relationship. This paper extends the traditional ethical issues in technology-aided caregiving, such as autonomy, privacy, and justice, to be considered within the context of distance care. We also posit newer ethical considerations such as consent in power imbalances, harm to caregivers, and stigma. These known and new ethical issues aim to encourage further ethically conscious design and use of RMTs to support distance care for older persons.

The debate over moral bioenhancement has incrementally intensified since 2008, when Persson and Savulescu, and Douglas wrote two separate articles on the reasons why enhancing human moral capabilities and sensitivity through technological means was ethically desirable. In this article, we offer a critique of how Persson and Savulescu theorize about the possibility of moral bioenhancement, including the problem of weakness of will, which they see as a motivational challenge. First, we offer a working definition of moral bioenhancement and underscore some of the challenges in determining whether moral bioenhancement, as conceptualized by Persson and Savulescu, falls into the category of enhancement or constitutes a type of therapeutic intervention. Second, we provide a critical analysis of the way Persson and Savulescu pathologize human behavior in relation to what they see as the main threat to the survival of the human species: weak moral motivation. Next, we critique the claim that the use of genetic manipulation and drug treatment will increase moral motivation. We argue that Persson and Savulescu mischaracterize the nature of human moral psychology because moral motivation includes affective and cognitive dimensions. The type of interventions they envision focus almost exclusively on the former. In the final two sections, we outline three main criticisms of moral bioenhancement and offer a more robust account of moral psychology and moral development than what Persson and Savulescu recommend, through the lens of Aristotle’s work on virtue ethics. Ultimately, we argue that what Persson and Savulescu, and Douglas consider as moral bioenhancement is a misnomer because they do not fully account for the complexity of moral agency.

The use of Intelligent Assistive Technology in dementia care opens the prospects of reducing the global burden of dementia and enabling novel opportunities to improve the lives of dementia patients. However, with current adoption rates being reportedly low, the potential of IATs might remain under-expressed as long as the reasons for suboptimal adoption remain unaddressed. Among these, ethical and social considerations are critical. This article reviews the spectrum of IATs for dementia and investigates the prevalence of ethical considerations in the design of current IATs. Our screening shows that a significant portion of current IATs is designed in the absence of explicit ethical considerations. These results suggest that the lack of ethical consideration might be a codeterminant of current structural limitations in the translation of IATs from designing labs to bedside. Based on these data, we call for a coordinated effort to proactively incorporate ethical considerations early in the design and development of new products.

The rise of neurotechnologies, especially in combination with artificial intelligence (AI)-based methods for brain data analytics, has given rise to concerns around the protection of mental privacy, mental integrity and cognitive liberty – often framed as “neurorights” in ethical, legal, and policy discussions. Several states are now looking at including neurorights into their constitutional legal frameworks, and international institutions and organizations, such as UNESCO and the Council of Europe, are taking an active interest in developing international policy and governance guidelines on this issue. However, in many discussions of neurorights the philosophical assumptions, ethical frames of reference and legal interpretation are either not made explicit or conflict with each other. The aim of this multidisciplinary work is to provide conceptual, ethical, and legal foundations that allow for facilitating a common minimalist conceptual understanding of mental privacy, mental integrity, and cognitive liberty to facilitate scholarly, legal, and policy discussions.

In this article, we develop a non-rights-based argument based on beneficence (i.e., the welfare of individuals and communities) and justice as the disposition to act justly to promote equity in health care resource allocation. To this end, we structured our analysis according to the following main sections. The first section examines the work of Amartya Sen and his equality of capabilities approach and outlines a framework of health care as a fundamental human need. In the subsequent section, we provide a definition of health equity based on the moral imperative to guarantee that every individual ought to have the freedom to pursue health goals and well-being. In the later part of the article, we outline a non-right approach to health care based on three pillars: (1) human flourishing, (2) justice as a disposition not a process, and (3) solidarity.

This article examines the potential implications of the implementation of artificial intelligence in health care for both its delivery and the medical profession. To this end, the first section explores the basic features of AI and the yet theoretical concept of autonomous AI followed by an overview of current and developing AI applications. Against this background, the second section discusses the transforming roles of physicians and changes in the patient–physician relationship that could be a consequence of gradual expansion of AI in health care. Subsequently, an examination of the responsibilities physicians should assume in this process is explored. The third section describes conceivable practical and ethical challenges that implementation of a single all-encompassing AI healthcare system would pose. The fourth section presents arguments for regulation of AI in health care to ensure that these applications do not violate basic ethical principles and that human control of AI will be preserved in the future. In the final section, fundamental components of a moral framework from which such regulation may be derived are brought forward, and some possible strategies for building a moral framework are discussed.

While the implementation of digital technology in psychiatry appears promising, there is an urgent need to address the implications of the absence of ethical design in the early development of such technologies. Some authors have noted the gap between technology development and ethical analysis and have called for an upstream examination of the ethical issues raised by digital technologies. In this paper, we address this suggestion, particularly in relation to digital healthcare technologies for patients with schizophrenia spectrum disorders. The introduction of digital technologies in psychiatry offers a broad spectrum of diagnostic and treatment options tailored to the health needs and goals of patients’ care. These technologies include wearable devices, smartphone applications for high-immersive virtual realities, smart homes, telepsychiatry and messaging systems for patients in rural areas. The availability of these technologies could increase access to mental health services and improve the diagnostics of mental disorders.Additional Instruction AbstractIn this descriptive review, we systematize ethical concerns about digital technologies for mental health with a particular focus on individuals suffering from schizophrenia. There are many unsolved dilemmas and conflicts of interest in the implementation of these technologies, such as (1) the lack of evidence on efficacy and impact on self-perception; (2) the lack of clear standards for the safety of their daily implementation; (3) unclear roles of technology and a shift in the responsibilities of all parties; (4) no guarantee of data confidentiality; and (5) the lack of a user-centered design that meets the particular needs of patients with schizophrenia. mHealth can improve care in psychiatry and make mental healthcare services more efficient and personalized while destigmatizing mental health disorders. To ensure that these technologies will benefit people with mental health disorders, we need to heighten sensitivity to ethical issues among mental healthcare specialists, health policy makers, software developers, patients themselves and their proxies. Additionally, we need to develop frameworks for furthering sustainable development in the digital technologies industry and for the responsible usage of such technologies for patients with schizophrenia in the clinical setting. We suggest that digital technology in psychiatry, particularly for schizophrenia and other serious mental health disorders, should be integrated into treatment with professional supervision rather than as a self-treatment tool.

The benefits of Artificial Intelligence (AI) in medicine are unquestionable and it is unlikely that the pace of its development will slow down. From better diagnosis, prognosis, and prevention to more precise surgical procedures, AI has the potential to offer unique opportunities to enhance patient care and improve clinical practice overall. However, at this stage of AI technology development it is unclear whether it will de-humanize or re-humanize medicine. Will AI allow clinicians to spend less time on administrative tasks and technology related procedures and more time being present in person to attend to the needs of their patients? Or will AI dramatically increase the presence of smart technology in the clinical context to a point of undermining the humane dimension of the patient–physician relationship? In this brief commentary, we argue that technological solutions should be only integrated into clinical medicine if they fulfill the following three conditions: (1) they serve human ends; (2) they respect personal identity; and (3) they promote human interaction. These three conditions form the moral imperative of humanity.

It is not the purpose of this article to evaluate the techno-scientific claims of the transhumanists. Instead, I question seriously the nature of the ethics and morals they claim can, or soon will, be manipulated artificially. I argue that while the possibility to manipulate human behavior via emotional processes exists, the question still remains concerning the content of morality. In other words, neural moral enhancement does not capture the fullness of human moral psychology, which includes moral capacity and moral content. In this article, I revisit the debate between Hume and Kant concerning the role of emotions and reason in moral philosophy. I do so with reference to the work of philosopher Alasdair McIntyre. His moral philosophy has long stood as an essential text in virtue ethics, which constitutes the basis for my critique of the promise to engineer virtues (what I call “neural moral enhancement”). First, I outline three specific shifts that occurred in the history of Western moral philosophy in order to contextualize current debates on the nature of morality/moral agency. Second, I summarize MacIntyre's critique of contemporary moral philosophy and show its relevance to an assessment of neural moral enhancement. Finally I argue that moral neuroenhancement is a one-dimensional conceptualization of moral agency that does not reflect the fullness of human moral psychology. It envisions a world in which individual moral capacities will be enhanced and controlled but says nothing about the nature of the morality.

The aim of this thesis is to examine the concept of virtue ethics in Stanley Hauerwas's understanding of virtue and delineate how that contributes to his ethical reasoning and his comprehension of medical ethics. The first chapter focuses on the shift that occurred in moral theory under the stance of the Enlightenment that eroded the traditional idea of morality as the formation of the self, allowing space for new concepts that dismissed the importance of the agent in the ethical task of seeking the good. In the second chapter, the three main ideas that make up Hauerwas' ethical theory are examined with a particular attention to the importance of agency in moral life. The third chapter describes how Hauerwas' medical ethics, informed by his moral theory based on character, vision, and narrative, is relevant to medical ethics. Hauerwas argues that because medicine is a form of human activity with internal goods and standards of excellence intrinsic to its practice, it requires taking into account the notion of agency in the healing relationship. Finally, in the last chapter the specific religious discourse of Hauerwas' ethics is discussed in relation to secular medical ethics. In other words, this thesis raises the question of whether the reduction of medical ethics to a set of principles, as it is mostly the case today, represents a suitable picture of the reality of moral life in medicine.