Anantharaman Muralidharan

This paper argues that one problem that besets black-box AI is that it lacks algorithmic justifiability. We argue that the norm of shared decision making in medical care presupposes that treatment decisions ought to be justifiable to the patient. Medical decisions are justifiable to the patient only if they are compatible with the patient’s values and preferences and the patient is able to see that this is so. Patient-directed justifiability is threatened by black-box AIs because the lack of rationale provided for the decision makes it difficult for patients to ascertain whether there is adequate fit between the decision and the patient’s values. This paper argues that achieving algorithmic transparency does not help patients bridge the gap between their medical decisions and values. We introduce a hypothetical model we call Justifiable AI to illustrate this argument. Justifiable AI aims at modelling normative and evaluative considerations in an explicit way so as to provide a stepping stone for patient and physician to jointly decide on a course of treatment. If our argument succeeds, we should prefer these justifiable models over alternatives if the former are available and aim to develop said models if not.

Ageing populations are increasing across the world. Many countries are exploring new ways to provide care for the elderly in hospitals, community care and family household settings. Scientific progress in robotics, artificial intelligence integrated systems and increasingly sophisticated software engineering have contributed to innovative developments in care robots in the Asia Pacific regions, Europe and the US. Whilst the use of care robots is not widespread, research is already occurring to integrate wider use of care robots in the elderly population towards improving their quality of life. Developments in care robots for the elderly are valuable yet they give rise to special concerns as they affect peoples’ health and safety. This chapter identifies key ethical and legal issues arising from the use of care robots in the ageing population. Ethical aspects such as deception and trust from care robots are highlighted, which implicate governance concerns ranging from balancing innovations and ensuring user safety to determining the appropriate levels of regulatory oversight and support for developers and market strategies. An examination of these issues provides some guidance for law makers and policy developers in these areas of concern in establishing applicable regulatory direction, responses and governance framework.

On the standard version of political liberalism, the exercise of political power is legitimate only if it is justifiable to all reasonable persons. Correspondingly, reasonable disagreement about the moral doctrines underlying a law makes that law not justifiable to all reasonable persons. In this paper, I argue that political liberals are committed to understanding reasonable disagreement as being rational, rather than praiseworthy disagreement between morally reasonable person because other conceptions of reasonableness commit them to an incoherent triad of claims.

Ethics committees like Institutional Review Boards and Research Ethics Committees are typically empowered to approve or reject proposed studies, typically conditional on certain conditions or revisions being met. While some have argued this power should be primarily a function of applying clear, codified requirements, most institutions and legal regimes allow discretion for IRBs to ethically evaluate studies, such as to ensure a favourable risk-benefit ratio, fair subject selection, adequate informed consent, and so forth. As a result, ethics committees typically make moral demands on researchers: require them to act in a way the committee considers ethically right or appropriate. This paper argues that moral demands are legitimate only if publicly justifiable; and as a result, committee decisions are subject to a public justification requirement. Ethics committees can permissibly request for more information, changes to the research protocol or that the research is delayed or even stopped only if these demands are publicly justifiable. This latter claim is in turn justified on the basis that moral demands to φ are permissible only if we are in a position to know that the addressee ought to φ and that we are in a position to know a proposition only if it is publicly justifiable. This argument suggests that ethics committees must consciously and explicitly appeal to public reasons in their decision-making. In cases where public reasons cannot be offered, committees would not be permitted to reject a given study or make approval conditional on an amendment.

The development of some COVID-19 vaccines by private companies like Moderna and Sanofi-GSK has been substantially funded by various governments. While the Sanofi CEO has previously suggested that countries that fund this development ought to be given some priority, this suggestion has not been taken seriously in the literature. Considerations of nationalism, sustainability, need, and equitability have been more extensively discussed with respect to whether and how much a country is entitled to advance purchase orders of the vaccine under conditions of absolute scarcity. Yet, little attention has been paid to whether prior investment into developing a vaccine entitles a country to some priority with respect to these orders. Moreover, while not a majority view, some survey results show that a significant minority of the populace does endorse some view like this. This article argues that the minority have a point: recognizing funder countries some priority is justified by the weak Lockean claim (WLC). According to the WLC, the fact that someone has contributed to the development of something gives them some entitlement to the resultant product. This article will defend the WLC, and address objections to the argument, including those pertaining to questions of historical injustice and medical need. This argument does not imply an unconstrained entitlement. Rather, contribution to development is one morally relevant factor that must be tempered by and weighed against potentially more substantial claims to priority based on need, equity, and other considerations.

The development of some COVID-19 vaccines by private companies like Moderna and Sanofi-GSK has been substantially funded by various governments. While the Sanofi CEO has previously suggested that countries that fund this development ought to be given some priority, this suggestion has not been taken seriously in the literature. Considerations of nationalism, sustainability, need, and equitability have been more extensively discussed with respect to whether and how much a country is entitled to advance purchase orders of the vaccine under conditions of absolute scarcity. Yet, little attention has been paid to whether prior investment into developing a vaccine entitles a country to some priority with respect to these orders. Moreover, while not a majority view, some survey results show that a significant minority of the populace does endorse some view like this. This article argues that the minority have a point: recognizing funder countries some priority is justified by the weak Lockean claim (WLC). According to the WLC, the fact that someone has contributed to the development of something gives them some entitlement to the resultant product. This article will defend the WLC, and address objections to the argument, including those pertaining to questions of historical injustice and medical need. This argument does not imply an unconstrained entitlement. Rather, contribution to development is one morally relevant factor that must be tempered by and weighed against potentially more substantial claims to priority based on need, equity, and other considerations.

Recently, self-fulfilling cases, that is, ones in which an agent's believing a proposition guarantees its truth, have been offered as counterexamples to uniqueness. According to uniqueness, at most one doxastic attitude is epistemically rational given the evidence. I argue that self-fulfilling cases are not counterexamples to uniqueness because belief-formation is not governed by epistemic rationality in such cases. Specifically, this is because epistemic rationality is not just about forming true beliefs, but about tracking mind-independent truths. In support of the latter claim, I offer three arguments, namely that self-fulfilling and non-self-fulfilling cases differ in their phenomenology, in the norms that guide belief formation, and in the way they relate to the evidence.

The supposed fact of reasonable disagreement plays a crucial role in standard accounts of political liberalism. The standard account posits reasonable disagreement as arising primarily from the supposed fact that, in at least some circumstances, people can permissibly respond in different ways to the same evidence. That is to say, the standard account presupposes permissivism: It is possible that more than one doxastic attitude towards a proposition is rationally permissible, given a body of evidence. In this thesis, I shall show that the standard account is mistaken in presupposing permissivism by arguing for Uniqueness: Given a total body of evidence at most one doxastic attitude is rationally permissible. I shall argue for this by first rehearsing White’s two objections to permissivism and showing that, at the very least, they show that an intrapersonal version of Uniqueness is true. That is to say, at most one doxastic attitude is justified for a given agent given a total body of evidence. I shall then present different accounts of permissivism consistent with intrapersonal uniqueness and show that none of these accounts are successful. If my argument is successful, the standard account of political liberalism may have to be revised.

Demands for improved access to innovative therapies have prompted a discourse that claims patients have rights to access treatments that may be of benefit, even if evidence that demonstrates safety and efficacy is lacking. This rights-based discourse is grounded in accounts of autonomy and assertions claiming that the state ought to not interfere with the free choices of patients and clinical decision-making. In this essay, we scrutinise these arguments to defend the ethical and legal permissibility of interference in contexts where the uncertainty of benefit and potential for harm creates vulnerabilities that undermine patient capacity for self-determination. In support of this argument, we draw on two theoretical approaches to explore the limits of autonomy in innovative contexts and analyse the legal bases of the rights-based discourse. We then apply this analysis to the case example of stem cell transplantation as an innovative treatment for multiple sclerosis.

The Uniqueness Thesis (U), according to Richard Feldman and Roger White, says that for a given set of evidence E and a proposition P, only one doxastic attitude about P is rational given E. Luis Rosa has recently provided two counterexamples against U which are supposed to show that even if there is a sense in which choosing between two doxastic attitudes is arbitrary, both options are equally and maximally rational. Both counterexamples work by exploiting the idea that ‘ought implies can’ and trying to spell out situations in which some inferences are beyond the capabilities of some reasoners. I argue that on a descriptive account of doxastic rationality, questions of whether ‘epistemic ought implies can’ can be bracketed and that at least one of the inferential moves that Rosa describes in his cases is irrational. I further argue that a descriptive account of doxastic rationality is the appropriate notion of rationality that is to be considered when evaluating U. If my argument for a descriptive account of rationality is successful, then we have reason to revise our use of the term rationality to fit this descriptive understanding.