Guy Kahane

BackgroundWhether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.MethodOne hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a series of ethical principles and three personality tests.ResultsMore supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity (r = −0.272, P < 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS (Z = −6.056, P < 0.001), MCS (Z = −6.746, P < 0.001) and LIS (Z = −6.681, P < 0.001).ConclusionLay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient’s explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions

Recent studies using functional magnetic resonance imaging of patients in a vegetative state have raised the possibility that such patients retain some degree of consciousness. In this paper, the ethical implications of such findings are outlined, in particular in relation to decisions about withdrawing life-sustaining treatment. It is sometimes assumed that if there is evidence of consciousness, treatment should not be withdrawn. But, paradoxically, the discovery of consciousness in very severely brain-damaged patients may provide more reason to let them die. Although functional neuroimaging is likely to play an increasing role in the assessment of patients in a vegetative state, caution is needed in the interpretation of neuroimaging findings

Background: Increasing use of genetic technologies in clinical and research settings increases the potential for misattributed paternity to be identified. Yet existing guidance from the President's Commission for the Study of Ethical Problems in Biomedical and Behavioral Research and the Institute of Medicine (among others) offers contradictory advice. Genetic health professionals are thus likely to vary in their practice when misattributed paternity is identified, and empirical investigation into the disclosure of misattributed paternity is scarce. Given the relevance of this ethical dilemma and its significance to users of genetic services, this study aimed to investigate the attitudes of lay people with regard to the disclosure of misattributed paternity. Methods: An online questionnaire was hosted and advertised through Amazon's Mechanical Turk to 200 United States residents aged 18 years or older. Respondents were asked to rate (via a Likert scale) the ethical permissibility of possible actions a clinician may carry out when misattributed paternity is identified. Data analysis consisted of preliminary descriptive analysis, chi-squared analysis, and Wilcoxon signed-rank tests. Results: There was no clear majority support for many of the options surveyed across different contexts, with only six out of ten scenarios displaying some general consensus. Men were more likely to support scenarios where the father is informed of paternity. Importantly, participants' views varied according to whether the desires of the father were previously expressed, suggesting that perceptions of the permissibility of a clinician's action will depend on the interests of all parties affected. Conclusions: This sample of the general public showed attitudes that were, at least to some degree, at variance with some professional guidelines. We give arguments for why at least some of these attitudes might be justified. We argue that case-specific judgments should be made and outline some of the relevant ethical considerations. While general guidelines ought to be considered, context-specific moral judgments cannot be avoided.

In this paper, we investigate how data about public preferences may be used to inform policy around the use of controversial novel technologies, using public preferences about autonomous vehicles (AVs) as a case study. We first summarize the recent ‘Moral Machine’ study, which generated preference data from millions of people regarding how they think AVs should respond to emergency situations. We argue that while such preferences cannot be used to directly inform policy, they should not be disregarded. We defend an approach that we call ‘Collective Reflective Equilibrium in Practice’ (CREP). In CREP, data on public attitudes function as an input into a deliberative process that looks for coherence between attitudes, behaviours and competing ethical principles. We argue that in cases of reasonable moral disagreement, data on public attitudes should play a much greater role in shaping policies than in areas of ethical consensus. We apply CREP to some of the global preferences about AVs uncovered by the Moral Machines study. We intend this discussion both as a substantive contribution to the debate about the programming of ethical AVs, and as an illustration of how CREP works. We argue that CREP provides a principled way of using some public preferences as an input for policy, while justifiably disregarding others.

The universe that surrounds us is vast, and we are so very small. When we reflect on the vastness of the universe, our humdrum cosmic location, and the inevitable future demise of humanity, our lives can seem utterly insignificant. Many philosophers assume that such worries about our significance reflect a banal metaethical confusion. They dismiss the very idea of cosmic significance. This, I argue, is a mistake. Worries about cosmic insignificance do not express metaethical worries about objectivity or nihilism, and we can make good sense of the idea of cosmic significance and its absence. It is also possible to explain why the vastness of the universe can make us feel insignificant. This impression does turn out to be mistaken, but not for the reasons typically assumed. In fact, we might be of immense cosmic significance-though we cannot, at this point, tell whether this is the case.

Anti-theists argue that the world, or our lives, would be overall worse if God exists because God’s existence imposes distinctive downsides. Many hold, however, that anti-theism is incoherent if we assume that God would not permit gratuitous evil to occur. This is because that would entail that any alleged downsides of God’s existence would be permitted only if they are necessary to bring about a greater good or to prevent an even greater evil. I will argue that this emerging consensus is mistaken: the argument from the principle of non-gratuitous evil to the falsity of anti-theism is invalid because it trades on an ambiguity. Appealing directly to God’s perfect goodness fails for similar reasons. Anti-theism can therefore only be rejected via substantive axiological debate.

The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey findings, both because of the acknowledged limitations of survey methodology, and because survey conclusions cannot, in themselves, yield answers about what the right threshold should be for providing or withholding treatment.2 In this brief response, we are going to address head-on the important ethical question raised within our survey – when life is worth living for an infant. We follow-up on the suggestion of two commentators that the presence or absence of “relational potential” might be ethically important to report in studies of the outcome of severely impaired infants,3 and to whether parental requests for treatment should be supported.4 The notion of “relational potential” was introduced by John Arras in a 1984 commentary.5 Arras was responding to the Baby Doe Regulations and a …

Current and future possibilities for enhancing human physical ability, cognition, mood, and lifespan raise the ethical question of whether we should enhance normal human capacities in these ways. This chapter offers such an account of enhancement. It begins by reviewing a number of suggested accounts of enhancement, and points to their shortcomings. The chapter then identifies two key senses of “enhancement”: functional enhancement, the enhancement of some capacity or power (e.g. vision, intelligence, health) and human enhancement, the enhancement of a human being's life. The latter notion is the notion of enhancement most relevant to ethical debate. The chapter argues that it is best understood in welfarist terms. It illustrates this welfarist approach to enhancement by applying it to the case of cognitive enhancement. Unlike the sociological pragmatic and functional approaches, the welfarist account is inherently normative. It ties enhancement to the value of well‐being.

This chapter is concerned with objections to theism that revolve around prudential considerations. The prospects of prudential arguments that aim to show that God doesn't exist seem to me dim. But I consider whether prudential considerations can give us pragmatic reasons for not believing that God exists. I also consider how prudential considerations can figure in debunking arguments against theist belief. I then turn to the question of whether we should want God to exist. In answering this question, I consider a further kind of prudential argument – an argument that moves from claims about what would follow from God's existence or nonexistence, to prudential conclusions. In particular, I consider axiological arguments purporting to show that God's existence would make our lives worse. I end by briefly considering questions relating to nihilism, meaning, and significance.

Some lives are more meaningful than others. Some lives are more important than others. What is the relationship between meaning in life and importance? Because both can be described as relating to significance, the two are often conflated. But these are rather different concepts and the meaningful and the important can easily come apart. They do, however, interact in important ways. When importance also meets the conditions for meaningfulness, it amplifies it, and importance on a large scale is a key, and perhaps the only, source of superlative meaningfulness. When contrasted with the quest for meaning, the desire for importance can seem shallow and egocentric. But the desire to make an important contribution reflects a legitimate existential concern. And, in their best form, both the desire for importance, and that for meaningfulness, similarly combine outward-looking and self-regarding aspects.

The demands of morality can seem straightforward. Be kind to others. Do not lie. Do not murder. But moral life is not so simple. We are often confronted with difficult situations in which someone is going to get hurt no matter what we do, in which we cannot meet all of our obligations, in which loyalties come into conflict, in which we cannot help everyone who needs it, or in which we must compromise on important values. It is natural to describe such situations as moral dilemmas. This chapter is about the psychology of how we represent, process, and make decisions about what to do when moral life is difficult in this way. Our first aim is to provide some conceptual clarity on what exactly turns a choice situation into a moral dilemma. Here, we propose a normative account of moral dilemmas in terms of moral appropriate feelings of conflict in response to strongly conflicting reasons. Our second aim is to critically survey existing psychological work, providing an overview of some important findings, while raising questions for future research.

Philosophers have long been involved in the pursuit of a goal shared by researchers in psychiatry and the cognitive sciences: understanding the relationship between the functioning of the human mind and human well-being or suffering. For this reason there is a very large area of overlap between philosophical and psychiatric research. The overlap is particularly significant in the domain of practical ethics, which is concerned with understanding the moral dimension of policies and actions in the real world. This chapter reviews two distinct domains in which psychiatry and practical ethics overlap. First, issues in practical ethics arise out of new advances in psychopharmacology, including clinical and non-clinical use of new antidepressants drugs, the clinical use of placebo medications, and psychiatric drugs which enhance human cognition; these issues are frequently grouped under the banner of "neuroethics." Second, the understanding of fundamental questions in moral philosophy is being driven forward by evidence from psychology and psychiatry. Evidence from autism and the personality disorders is shedding light on the nature of moral motivation, while evidence from addiction and compulsion is generating progress in understanding moral responsibility. Finally, some areas are highlighted in which the science of psychiatry may benefit from the application of existing work in moral philosophy and practical ethics.