Jon Rueda

La pandemia de la COVID-19 ha recordado la importancia de prevenir y planificarse ante eventos altamente desastrosos para la salud comunitaria. Varios fenómenos emergentes suponen amenazas prospectivas para la Salud Pública. Sin embargo, el carácter mayormente futuro de problemas como la resistencia antibiótica, el impacto del cambio climático en la salud o la bioingeniería de patógenos genera dificultades de análisis. ¿Cuáles son los desafíos éticos y epistemológicos que suscitan los problemas futuros para la Salud Pública? ¿Cómo deben abordarse los problemas morales de escenarios futuros, potencialmente catastróficos? En este artículo se defiende la necesidad de adoptar enfoques éticos anticipativos desde la ética de la Salud Pública. En primer lugar, se argumentará que el abordaje de estos problemas futuros requiere reflexionar sobre el futuro como problema ético y epistémico. En segundo lugar, se analizarán las características de la incipiente ética anticipatoria en los ámbitos de la ética de la tecnología y la bioética. En tercer lugar, se defenderá la aplicación de metodologías de previsión y anticipación en debates sobre la ética de la Salud Pública. Finalmente, se ofrecerán algunas reflexiones para fortalecer los análisis normativos anticipativos a fin de prevenir y atajar de antemano los efectos adversos de las futuras crisis sanitarias.

Altruism and solidarity are concepts that are closely related to organ donation for transplantation. On the one hand, they are typically used for encouraging people to donate. On the other hand, they also underpin the regulations in force in each country to different extents. They are often used indistinctly and equivocally, despite the different ethical implications of each concept. This paper aims to clarify to what extent we can speak of altruism and solidarity in the predominant models of organ donation. It also raises the ethical question of whether these categories are adequate as a basis for such models, bearing in mind that organs are a scarce resource and that a shortage of them may mean that fewer lives are saved or improved.

The cumulative impact of enhancement technologies may alter the human species in the very long-term future. In this article, I will start showing how radical genetic enhancements may accelerate the conversion into a novel species. I will also clarify the concepts of ‘biological species’, ‘transhuman’ and ‘posthuman’. Then, I will summarize some ethical arguments for creating a transhuman or posthuman species with a substantially higher level of well-being than the human one. In particular, I will present what I shall call the Principle of the Best Interests of Posthumanity, which states that the enhancement of the human and transhuman species must be directed towards the creation of a posthuman existence that is substantially more valuable than its predecessors. I suggest that human extinction may be considered, within that principle, as one of the best interests of posthumanity. Finally, I will develop three objections that make that principle unattractive and that show that pursuing a full-blown programme of posthuman evolution is ethically flawed.

Digital COVID certificates are a novel public health policy to tackle the COVID-19 pandemic. These immunity certificates aim to incentivize vaccination and to deny international travel or access to essential spaces to those who are unable to prove that they are not infectious. In this article, we start by describing immunity certificates and highlighting their differences from vaccination certificates. Then, we focus on the ethical, legal, and social issues involved in their use, namely autonomy and consent, data protection, equity, and international mobility from a global fairness perspective. The main conclusion of our analysis is that digital COVID certificates are only acceptable if they meet certain conditions: that they should not process personal data beyond what is strictly necessary for the aimed goals, that equal access to them should be guaranteed, and that they should not restrict people’s autonomy to access places where contagion is unlikely. We conclude that, if such conditions are guaranteed, digital COVID certificates could contribute to mitigating some of the most severe socioeconomic consequences of the pandemic.

To analyze which ethically relevant biases have been identified by academic literature in artificial intelligence algorithms developed either for patient risk prediction and triage, or for contact tracing to deal with the COVID-19 pandemic. Additionally, to specifically investigate whether the role of social determinants of health have been considered in these AI developments or not. We conducted a scoping review of the literature, which covered publications from March 2020 to April 2021. ​Studies mentioning biases on AI algorithms developed for contact tracing and medical triage or risk prediction regarding COVID-19 were included. From 1054 identified articles, 20 studies were finally included. We propose a typology of biases identified in the literature based on bias, limitations and other ethical issues in both areas of analysis. Results on health disparities and SDOH were classified into five categories: racial disparities, biased data, socio-economic disparities, unequal accessibility and workforce, and information communication. SDOH needs to be considered in the clinical context, where they still seem underestimated. Epidemiological conditions depend on geographic location, so the use of local data in studies to develop international solutions may increase some biases. Gender bias was not specifically addressed in the articles included. The main biases are related to data collection and management. Ethical problems related to privacy, consent, and lack of regulation have been identified in contact tracing while some bias-related health inequalities have been highlighted. There is a need for further research focusing on SDOH and these specific AI apps.

The trolley problem is one of the liveliest research frameworks in experimental ethics. In the last decade, social neuroscience and experimental moral psychology have gone beyond the studies with mere text-based hypothetical moral dilemmas. In this article, I present the rationale behind testing the actual behaviour in more realistic scenarios through Virtual Reality and summarize the body of evidence raised by the experiments with virtual trolley scenarios. Then, I approach the argument of Ramirez and LaBarge (2020), who claim that the virtual simulation of the Footbridge version of the trolley dilemma is an unethical research practice, and I raise some objections to it. Finally, I provide some reflections about the means and ends of trolley-like scenarios and other sacrificial dilemmas in experimental ethics.

Emerging reprogenetic technologies may radically change how humans reproduce in the not-so-distant future. One foreseeable consequence of disruptive innovations in the procreative domain is an increase in the reproductive autonomy of intended parents. Regarding the prospective parental liberty of enhancing non-health–related traits of the offspring, one controversy has particularly dominated the literature. Does parents' choice of genetically enhancing the traits of their descendants compromise children's future personal autonomy? In this article, I will analyse the main arguments which posit that reprogenetic enhancement could be at odds with the child's future autonomy. I will argue that these objections are ill-founded. Moreover, I will present other arguments that show that reprogenetic technologies can enhance the autonomy of future children. Autonomy enhancement is a plausible and pro tanto desirable application of emerging reprogenetic technologies.

Erick J. Ramirez, Miles Elliott and Per‑Erik Milam (2021) have recently claimed that using Virtual Reality (VR) as an educational nudge to promote empathy is unethical. These authors argue that the influence exerted on the participant through virtual simulation is based on the deception of making them believe that they are someone else when this is impossible. This makes the use of VR for empathy enhancement a manipulative strategy in itself. In this article, we show that Ramirez et al.’s ethical rejection of empathy enhancement through VR is based on confusion. First, we show that this misunderstanding stems from the conception of empathy-enhancing simulations solely as failed attempts at “being someone else,” along with ignoring the crucial difference between the psychological perspective-taking processes of imagine-other and imagine-self. Then, having overcome that misconception, we argue that the ethical misgivings about the use of VR to promote empathy should disappear and that these projects have greater potential for behavioural change than purely sympathy-focused interventions.

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future.

The neuroscience of ethics is allegedly having a double impact. First, it is transforming the view of human morality through the discovery of the neurobiological underpinnings that influence moral behavior. Secondly, some neuroscientific findings are radically challenging traditional views on normative ethics. Both claims have some truth but are also overstated. In this article, the author shows that they can be understood together, although with different caveats, under the label of ‘neurofoundationalism’. Whereas the neuroscientific picture of human morality is undoubtedly valuable if we avoid neuroessentialistic portraits, the empirical disruption of normative ethics seems less plausible. The neuroscience of morality, however, is providing relevant evidence that any empirically-informed ethical theory needs to critically consider. Although neuroethics is not going to bridge the is-ought divide, it may establish certain facts that require us to rethink the way we achieve our ethical aspirations.

Interview with Philip Brey in which he clarifies and exemplifies the concept of ‘socially disruptive technology’, offering a series of key aspects for its present and future analysis from the disciplinary perspective of technology ethics. Philip Brey is Professor of Philosophy of Technology at the Department of Philosophy at the University of Twente. He has been a keynote speaker of the International Workshop on Controversies and Polarization on Disruptive Technologies, that took place virtually and in Granada, on October 5th and 6th 2020. His key-talk was titled “Disruptive Technologies: Social, Moral and Ontological Consequences”.

The history of humankind is full of examples that indicate a constant desire to make human beings more moral. Nowadays, technological breakthroughs might have a significant impact on our moral character and abilities. This is the case of Virtual Reality (VR) technologies. The aim of this paper is to consider the ethical aspects of the use of VR in enhancing empathy. First, we will offer an introduction to VR, explaining its fundamental features, devices and concepts. Then, we will approach the characterization of VR as an “empathy machine,” showing why this medium has aroused so much interest and why, nevertheless, we do not believe it is the ideal way to enhance empathy. As an alternative, we will consider fostering empathy-related abilities through virtual embodiment in avatars. In the conclusion, however, we will, we will examine some of the serious concerns related to the ethical relevance of empathy and will defend the philosophical case for a reason-guided empathy, also suggesting specific guidelines for possible future developments of empathy enhancement projects through VR embodied experiences.

La pandemia de la COVID-19 ha levantado sospechas de edadismo y gerontofobia en diversas prácticas de racionamiento sanitario. La edad es un criterio de triaje controvertido. En este artículo se esclarece la relevancia ética de la edad dentro de los sistemas de triaje, analizando particularmente su rol dentro de los principios de equidad y de eficiencia. La equidad requiere dar más oportunidades a aquellos que han cumplido menos ciclos vitales. La eficiencia tiene en cuenta la edad de manera subrepticia al tratar de maximizar los beneficios a corto plazo (salvar vidas) y a largo plazo (salvar años de vida). Finalmente, la edad no debe ser la última ratio de las decisiones de triaje, aunque es una variable a tener en cuenta debido a su presencia implícita en principios fundamentales de priorización. The COVID-19 pandemic has raised suspicions of ageism and gerontophobia in various health rationing practices. Age is a controversial triage criterion. This article clarifies the ethical relevance of age within triage systems, particularly its role within the principles of fairness and efficiency. Fairness requires giving more opportunities to those who have completed fewer life cycles. Efficiency takes age into account surreptitiously when trying to maximize short-term (saving lives) and long-term (saving years of life) benefits. Finally, age should not be the final rationale in triage decisions, although it is a variable to be taken into account because of its implicit presence in fundamental principles of prioritization.

Tanto el transhumanismo como el posthumanismo filosófico han prestado una atención especial a la corporalidad humana en relación al avance tecnológico. En el presente artículo, se comienza señalando cómo ambos movimientos difieren significativamente respecto a la herencia del humanismo. Posteriormente, se aborda la noción transhumanista de la ‘libertad morfológica’ de la mano de More, Sandberg y Bostrom. A continuación, se presentan casos paradigmáticos de modificaciones corporales mediante implantes cibernéticos. En último lugar, se problematizan las cuestiones de la identidad, la corporalidad y el desencuentro entre ambas corrientes respecto al ‘volcado de la mente’. Transhumanism and philosophical posthumanism have paid special attention to human corporeality in relation to technological breakthroughs. This article begins by pointing out how the two movements differ significantly about the inheritance of humanism. Subsequently, the transhumanist notion of ‘morphological freedom’ is addressed from the proposals of More, Sandberg, and Bostrom. Then, paradigmatic cases of body modifications through cybernetic implants are considered. Finally, the issues of identity, corporeality, and the disagreement between the two currents regarding ‘mind uploading’ are problematized.

Tackling climate change is one of the most demanding challenges of humanity in the 21st century. Still, the efforts to mitigate the current environmental crisis do not seem enough to deal with the increased existential risks for the human and other species. Persson and Savulescu have proposed that our evolutionarily forged moral psychology is one of the impediments to facing as enormous a problem as global warming. They suggested that if we want to address properly some of the most pressing problems that cause catastrophic harm to our existence, we should enhance our moral behavior by biomedical means. The objective of this paper is, precisely, to reflect on whether a Moral Bio-Enhancement (henceforth MBE) program would be a viable option to confront the climate emergency. To meet this goal, I will propose the Ultimate Mostropic (hereafter UM) thought experiment, a hypothetical situation where we have already discovered the UM, an available, safe (without any deleterious secondary effects), extremely cheap and effective pill to enhance our cognitive, affective and motivational abilities related to morality. After briefly presenting the main argument of Persson and Savulescu regarding MBE and climate change, I will point out some of the difficulties that make MBE a daunting but exciting philosophical and scientific debate. In order to overcome these complications, I will describe the UM thought experiment, which involves two scenarios of the MBE program: (a) the state-driven, compulsory and universal enterprise, and (b) the initiative of voluntary individuals. I will show that the shortcomings of MBE programs through the UM in both scenarios make Persson and Savulescu’s proposal a not appealing pathway to mitigate climate change. In the final section, I will suggest that an inaccurate attribution of responsibilities underlies their proposal and that the collective inaction problem should be redirected primarily through a reinforcement of the political nature of the solutions.

Biomedical innovations are making possible the enhancement of human capabilities. There are two philosophical stances on the role that medicine should play in this respect. On the one hand, naturalism rejects every medical intervention that goes beyond preventing and treating disease. On the other hand, welfarism advocates enhancements that foster subjective well-being. We will show that both positions have considerable shortcomings. Consequently, we will introduce a third characterization in which therapies and enhancements can be reconciled with the legitimate objectives of medicine inasmuch as they improve the capabilities that enable the freedom to pursue personal well-being.

Transhumanism is a challenging movement that invites us to rethink what defines humanity, including what we value and regret the most about our existence. Vulnerability is a key concept that require thorough philosophical scrutiny concerning transhumanist proposals. Vulnerability can refer to a universal condition of human life or, rather, to the specific exposure to certain harms due to particular situations. Even if we are all vulnerable in the first sense, there are also different sources and levels of vulnerability depending on concrete social circumstances. Recently, Michael Hauskeller argued about a fundamental incompatibility between transhumanism and vulnerability. He understands vulnerability as an existential category, linked to woundability and mortality. This idea is akin to ontological vulnerability, but it does not notice some important features of social vulnerability. On the other side, transhumanism is a complex and non-homogeneous movement. Here we distinguish between a strong and a weak version of transhumanism. We will propose that the salience of vulnerability is only diminished in the radical one, while a moderate version can reconcile vulnerability with human enhancement. Thus, vulnerability, a concept that has recently gained much importance as an anthropological category in contemporary ethics, is not necessarily at odds with any transhumanist project.

In their recent article, Brown et al analyse several ethical aspects around immunity passports and put forward some recommendations for implementing them. Although they offer a comprehensive perspective, they overlook two essential aspects. First, while the authors consider the possibility that immunological passports may appear to discriminate against those who do not possess them, the opposite viewpoint of immune people is underdeveloped. We argue that if a person has been tested positive for and recovered from COVID-19, becoming immune to it, she cannot be considered a hazard to public health and, therefore, the curtailment of her fundamental rights (eg, the right to freedom of movement) is not legitimate. Second, they omit that vaccine distribution will create similar problems related to immunity-based licenses. Vaccine certificates will de facto generate a sort of immunity passport. In the next phases of the pandemic, different immunity statuses will be at stake, because the need to identify who can spread COVID-19 is unavoidable. If a person does not pose a threat to public health because she cannot spread the infection, then her right to freedom of movement should be respected, regardless of how she acquired that immunity.