Jan-Christoph Heilinger

The increased presence of medical AI in clinical use raises the ethical question which standard of explainability is required for an acceptable and responsible implementation of AI-based applications in medical contexts. In this paper, we elaborate on the emerging debate surrounding the standards of explainability for medical AI. For this, we first distinguish several goods explainability is usually considered to contribute to the use of AI in general, and medical AI in specific. Second, we propose to understand the value of explainability relative to other available norms of explainable decision-making. Third, in pointing out that we usually accept heuristics and uses of bounded rationality for medical decision-making by physicians, we argue that the explainability of medical decisions should not be measured against an idealized diagnostic process, but according to practical considerations. We conclude, fourth, to resolve the issue of explainability-standards by relocating the issue to the AI’s certifiability and interpretability.

This paper explores the role and resolution of disagreements between physicians and their diagnostic AI-based decision support systems. With an ever-growing number of applications for these independently operating diagnostic tools, it becomes less and less clear what a physician ought to do in case their diagnosis is in faultless conflict with the results of the DSS. The consequences of such uncertainty can ultimately lead to effects detrimental to the intended purpose of such machines, e.g. by shifting the burden of proof towards a physician. Thus, we require normative clarity for integrating these machines without affecting established, trusted, and relied upon workflows. In reconstructing different causes of conflicts between physicians and their AI-based tools—inspired by the approach of “meaningful human control” over autonomous systems and the challenges to resolve them—we will delineate normative conditions for “meaningful disagreements”. These incorporate the potential of DSS to take on more tasks and outline how the moral responsibility of a physician can be preserved in an increasingly automated clinical work environment.

The world we live in is unjust. Preventable deprivation and suffering shape the lives of many people, while others enjoy advantages and privileges aplenty. Cosmopolitan responsibility addresses the moral responsibilities of privileged individuals to take action in the face of global structural injustice. Individuals are called upon to complement institutional efforts to respond to global challenges, such as climate change, unfair global trade, or world poverty. Committed to an ideal of relational equality among all human beings, the book discusses the impact of individual action, the challenge of special obligations, and the possibility of moral overdemandingness in order to lay the ground for an action-guiding ethos of cosmopolitan responsibility. This thought-provoking book will be of interest to any reflective reader concerned about justice and responsibilities in a globalised world. Jan-Christoph Heilinger is a moral and political philosopher. He teaches at Ludwig-Maximilians-Universität, Munich, Germany, and at Ecole normale supérieure, Port-au-Prince, Haiti.

This volume brings together a range of practical and theoretical perspectives on responsibility in the context of refugee and migrant integration. Addressing one of the major challenges of our time, a diverse group of authors shares insights from history, philosophy, psychology, cultural studies, and from personal experience. The book expands our understanding of the complex challenges and opportunities that are associated with migration and integration, and highlights the important role that individuals can and should play in the process.

Advances in biotechnology have enabled interventions in the human organism that promise to increase physical and intellectual perform over the 'normal' or 'natural' boundary, as well as make possible targeted changes in human experience. The author investigates ethical debates surrounding these issues with a particular focus on arguments that employ a normative concept of a person in order to establish that particular interventions are permissible or impermissible. He develops an integrated model that 'maps' of the concept of a human being, thereby bringing the normative elements of the concept to the fore. Nevertheless, with a view to issues of risk and justice, the author argues that anthropological arguments are only one elements of a comprehensive ethics of enhancement.

Whatever ethical stance one takes in the debate regarding the ethics of human enhancement, one or more reference points are required to assess its morality. Some have suggested looking at the bioethical notions of safety, justice, and/or autonomy to find such reference points. Others, arguing that those notions are limited with respect to assessing the morality of human enhancement, have turned to human nature, human authenticity, or human dignity as reference points, thereby introducing some perfectionist assumptions into the debate. In this article, we ask which perfectionist assumptions should be used in this debate. After a critique of views that are problematic, we take a positive approach, suggesting some perfectionist elements that can lend guidance to the practice of human enhancement, based on the work of Martha Nussbaum's Capability Approach. We suggest that the central capabilities can be used to define the human aspect of human enhancement and thereby allow a moral evaluation of enhancement interventions. These central capabilities can be maximized harmoniously to postulate what an ideal human would look like. Ultimately, the aim of this article is twofold. First, it seeks to make explicit the perfectionist assumptions found in the debate and eliminate those that are problematic. Second, the paper clarifies an element that is often neglected in the debate about human enhancement, the view of the ideal human towards which human enhancement should strive. Here, we suggest that some central capabilities that are essential for an ideal human being can be maximized harmoniously and can therefore serve as possible reference points to guide human enhancement.

Asgary and Smith (2013) identify an important challenge: the difficult position of physicians caught between the obligation to treat every human being with the same professional rigor, and their feelings of responsibility toward the state and its judicial decisions on asylum requests. The authors show that in some cases this conflict leads to a tendency to "sacrifice their medical responsibilities". The authors' core demand is that health care workers should be independent of the state and judiciary systems, and thus prioritize the interests of the patient. We agree entirely with the authors, that well-performed documenting is the only ethically justifiable option and should not be influenced by a feeling of responsibility for contributing to judicial decisions. However, the authors also address the more general, and ethically more challenging, issue of the responsibility of health care workers and the state toward asylum seekers and ask, how much health care provision is appropriate?

The paper discusses the role of anthropological arguments in contemporary ethics as exemplified in the current debate about biotechnological human enhancement interventions. Anthropological arguments refer to a normative conception of what it means to be a human being and are highly contested in contemporary moral philosophy. Most often they are promoted to constrain the ethically acceptable use of enhancement technologies. I argue that anthropological arguments can play a fundamental and important role in assessing the moral qualities of enhancement interventions, but only if their normative justification and their specific content are properly determined. I offer an account how to do so, based on the contractualist and pragmatist ideal that all those who are affected by a decision of normative relevance should be included in what I call a “quasi-democratic deliberative process”. However, given that they stand in need of wide agreement, anthropological arguments resulting from such a process will be be rather minimal in content. In the exemplary debate about human enhancements they hence turn out to be widely – though not fully – permissive and unable to justify a restrictive stance towards enhancement interventions.

Is it necessary to have an ideal of perfection in mind to identify and evaluate true biotechnological human “enhancements”, or can one do without? To answer this question we suggest employing the distinction between ideal and non-ideal theory, found in the debate in political philosophy about theories of justice: the distinctive views about whether one needs an idea of a perfectly just society or not when it comes to assessing the current situation and recommending steps to increase justice. In this paper we argue that evaluating human enhancements from a non-ideal perspective has some serious shortcomings, which can be avoided when endorsing an ideal approach. Our argument starts from a definition of human enhancement as improvement, which can be understood in two ways. The first approach is backward-looking and assesses improvements with regard to a status quo ante. The second, a forward-looking approach, evaluates improvements with regard to their proximity to a goal or according to an ideal. After outlining the limitations of an exclusively backward-looking view, we answer possible objections against a forward-looking view. Ultimately, we argue that the human enhancement debate would lack some important moral insights if a forward-looking view of improvement is not taken into consideration.

Both, bioconservatives and bioliberals, should seek a discussion about ideas of human perfection, making explicit their underlying assumptions about what makes for a good human life. This is relevant, because these basic, and often implicit ideas, inform and influence judgements and choices about human enhancement interventions. Both neglect, and polemical but inconsistent use of the complex ideas of perfection are leading to confusion within the ethical debate about human enhancement interventions, that can be avoided by tackling the notion of perfection directly. In the recent debates, bioconservatives have prominently argued against the ‘pursuit of perfection’ by biotechnological means. In the first part of this paper, we show that—paradoxically—bioconservatives themselves explicitly embrace specific conceptions of human perfection and perfectionist assumptions about the good human life in order to argue against the use of enhancement technologies. Yet, we argue that the bioconservative position contains an untenable ambiguity between criticising and endorsing ideas of human perfection. Hence, they stand in need of clarifying their stance on human perfection. In the second part of the paper, we ask whether bioliberals in fact (implicitly) advocate a particular conception of perfection, or whether they are right in holding that they do not, and that discussing perfection is obsolete anyway. We show that bioliberals also rely on a specific idea of human perfection, based on the idea of autonomy. Hence, their denial of the relevance of perfection in the debate is unconvincing and has to be revised