Andrew J. Barnhart

ChatGPT Health, an artificial intelligence feature launched by OpenAI in January 2026, integrates personal medical records and consumer health data into a large language model–based chatbot. It positions itself as a digital health tool to help users navigate a fragmented US health care system marked by inaccessible insurance, medical deserts, and workforce shortages. We argue that, rather than closing these gaps, ChatGPT Health risks widening what we call the solidarity gap in health care. By appearing to address unmet needs, it may obscure and entrench the structural conditions that produce health care disparities. We identify specific risks to patient safety, such as the legitimization of dangerous self-rationing and self-medication behaviors, inaccurate triage of clinical emergencies, erosion of effective health communication, and the reinforcement of confirmation and anchoring bias. These risks are particularly acute for individuals facing structural barriers to care. To prevent ChatGPT Health and similar large language model–based health tools from deepening inequities, we propose solidarity-based policy interventions such as upstream reforms that rebuild the institutional foundations of access and health equity and downstream safeguards that embed artificial intelligence tools within accountable, equitable health care infrastructures as complements to rather than substitutes for human care.

People with disabilities are systematically excluded from randomized controlled trials (RCTs). Recent evidence indicates that a substantial proportion of trials contain explicit disability-related exclusion criteria, while nearly half use implicit criteria (e.g., broad comorbidity bans or investigator discretion) that effectively screen out participants with disabilities. Crucially, the vast majority of these explicit exclusions could be overcome through reasonable design adaptations. This article argues that such exclusion reflects not only methodological oversight but also ableist assumptions embedded in research design, regulatory frameworks, and the concept of clinical equipoise. Drawing on Elizabeth Barnes’s mere-difference view, which holds that disability represents value-neutral variation in human embodiment rather than an inherent deficit in well-being, we develop three principal contributions. First, we advance an original critique of mere-difference grounded in power relations and standpoint epistemology, arguing that value-neutrality claims require an explicit anti-ableist commitment to avoid obscuring structural injustice. Second, we present a comparative analysis of clinical trial regulations across 10 countries and regions (the United States, the European Union, the United Kingdom, Canada, Japan, Singapore, China, Kenya, Nigeria, and Brazil), demonstrating that unlike gender, age, and race/ethnicity, disability is not subject to mandatory inclusion reporting or exclusion justification requirements. Third, we show how the mere-difference view, appropriately modified, can reshape clinical equipoise by expanding the relevant expert community to include disabled voices and by establishing genuine uncertainty where the standard view forecloses it. We conclude that clinical trial protocols should require explicit justification for disability-based exclusions and that global harmonization efforts, particularly the ICH E6(R3) guidelines, should incorporate explicit language on disability inclusion.

Unresponsive Wakefulness Syndrome (UWS), a condition characterized by wakefulness without awareness, presents significant medical and moral uncertainties, particularly in end-of-life decision-making. Digital Brain Twins (DBTs), virtual replicas of patients’ brains driven by advanced artificial intelligence, offer the potential to alleviate medical uncertainties by providing precise diagnoses, prognoses, and experimental platforms for treatment testing. This paper provides a theoretical contribution by examining the potential ethical impact of these technologies in the context of UWS. We argue that, while DBTs promise greater diagnostic accuracy, personalized predictions of recovery, and non-invasive tools for exploring therapeutic interventions, they do not necessarily resolve the moral uncertainties faced by proxy decision-makers. Decisions about withdrawing or continuing life-sustaining treatment are fundamentally moral and value-laden, often extending beyond empirical evidence provided by DBTs. Factors such as cognitive biases, emotional distress, and subjective interpretations of best interest further complicate these decisions. While DBTs represent a breakthrough in precision medicine, their role in navigating the ethical complexities of UWS is limited, emphasizing the need for integrated approaches that combine technological innovation with ethical and psychological support for proxies.

In precision medicine, digital twins—virtual models of patients created using personalized data and advanced machine learning—are potentially changing healthcare by predicting health outcomes and guiding medical decisions. However, their use raises complex ethical questions, particularly concerning their relationship to human dignity. Patients often regard dignity as central to their healthcare experience, and failing to incorporate this principle into the design and application of digital twins risks undermining personal autonomy, misusing sensitive data, eroding patient–provider trust, and creating broader ethical challenges. This paper argues that digital twins are not mere data sets or predictive tools, but symbolic extensions of the dignity of the individuals they represent. Using David Kirchhoffer's multidimensional framework of human dignity, this study examines how digital twins engage with both absolute (inherent) and contingent (socially constructed) dimensions of dignity. The analysis begins by exploring the multidimensional concept of human dignity, followed by a discussion of how digital twins embody these dimensions, illustrated through examples such as digital brain twins, posthumous digital representations, and disability contexts. Finally, the paper addresses the ethical implications of these findings, emphasizing the moral responsibilities of researchers, developers, and clinicians to treat digital twins as representations of patient dignity, thereby ensuring these technologies advance healthcare without compromising the fundamental respect owed to every individual.

Ethical deliberations are unfolding for potentially controversial organoid‐entities such as brain organoids and embryoids. Much of the ethical deliberation centers on the questionable moral status of such organoid‐entities. However, while such work is important and appropriate, ethical deliberations may become too exclusively rooted in moral status and potentially overshadow other relevant moral dilemmas. The ethical discussion on organoid models can benefit from insights brought forth by both Judith Jarvis Thomson and Don Marquis in how they attempted to advance the abortion debate. To discuss other abortion ethical issues more fully, both Thomson and Marquis assumed differing moral status positions of the conceptus and followed lines of reasoning based on these moral status assumptions. We suggest a similar approach with controversial organoid‐entities like brain organoids and embryoids. To avoid overshadowing or overlooking other relevant ethical issues, ethicists ought to first assume an organoid‐entity moral status position (such as a high moral status or no moral status) and explore any possible arguments that may result from such a position. While we ought not to copy the content of Thomson and Marquis' arguments exactly for organoid‐entities, it is worthwhile to translate their arguments' overarching structures. This paper explores the relevant insights of Thomson and Marquis, how they can be translated into the organoid ethics debate, and what possible lines of inquiry may be worth exploring based on particular moral status assumptions.

Cerebral organoid models in-of-themselves are considered as an alternative to research animal models. But their developmental and biological limitations currently inhibit the probability that organoids can fully replace animal models. Furthermore, these organoid limitations have, somewhat ironically, brought researchers back to the animal model via xenotransplantation, thus creating hybrids and chimeras. In addition to attempting to study and overcome cerebral organoid limitations, transplanting cerebral organoids into animal models brings an opportunity to observe behavioral changes in the animal itself. Traditional animal ethics frameworks, such as the well-known three Rs (reduce, refine, and replace), have previously addressed chimeras and xenotransplantation of tissue. But these frameworks have yet to completely assess the neural-chimeric possibilities. And while the three Rs framework was a historical landmark in animal ethics, there are identifiable gaps in the framework that require attention. The authors propose to utilize an expanded three Rs framework initially developed by David DeGrazia and Tom L. Beauchamp, known as the Six Principles (6Ps). This framework aims to expand upon the three Rs, fill in the gaps, and be a practical means for assessing animal ethical issues like that of neural-chimeras and cerebral organoid xenotransplantation. The scope of this 6Ps application will focus on two separate but recent studies, which were published in 2019 and 2020. First, they consider a study wherein cerebral organoids were grown from donors with Down syndrome and from neurotypical donors. After these organoids were grown and studied, they were then surgically implanted into mouse models to observe the physiological effects and any behavioral change in the chimera. Second, they consider a separate study wherein neurotypical human embryonic stem cell-derived cerebral organoids were grown and transplanted into mouse and macaque models. The aim was to observe if such a transplantation method would contribute to therapies for brain injury or stroke. The authors place both studies under the lens of the 6Ps framework, assess the relevant contexts of each case, and provide relevant normative conclusions. In this way, they demonstrate how the 6Ps could be applied in future cases of neural-chimeras and cerebral organoid xenotransplantation.

ObjectiveTo present the ethical issues, moral arguments, and reasons found in the ethical literature on organoid models.DesignIn this systematic review of reasons in ethical literature, we selected sources based on predefined criteria: The publication mentions moral reasons or arguments directly relating to the creation and/or use of organoid models in biomedical research; These moral reasons and arguments are significantly addressed, not as mere passing mentions, or comprise a large portion of the body of work; The publication is peer-reviewed and published in an academic article, book, national-level report, working paper, or Ph.D. thesis; The publications collected are in English.AnalysisEach article was read in-depth for identifiable moral reasons, arguments, and concerns. These were then inductively classified and synthesized to create broader categories of reasons, and eventually an overarching conceptual scheme was created.ResultsA total of twenty-three sources were included and analyzed out of an initial 266 collected sources. Five themes of ethical issues and arguments were found: Animal Experimentation; Clinical Applications and Experiments; Commercialization and Consent; Organoid Ontology and Moral Status; and Research Ethics and Research Integrity. These themes are then further broken down into sub-themes and topics. Given the extensive nature of the topics found, we will focus on describing the topics that comprised of more in-depth reasons and arguments rather than few, passing mentions or concerns.ConclusionsThe ethics of organoids requires further deliberation in multiple areas, as much of the discussions are not presented as in-depth arguments. Such sentiments are also echoed throughout the organoid ethics literature.

Human brain organoids (HBOs) are three-dimensional structures derived from human pluripotent stem cells that model aspects of fetal brain development. As HBO models grow more complex, ethical concerns arise, particularly around the potential for consciousness. Defining and detecting consciousness in HBOs remains unresolved, with existing theories offering conflicting predictions. This systematic review examines how consciousness is conceptualized in the ethical and philosophical literature concerning HBOs. We selected peer-reviewed publications written in English from 2013 onward that directly address consciousness regarding HBOs. After screening 51 sources, 24 were analysed in themes: Consciousness Terminology, Biological Limitations, Theories of Consciousness, Detecting Consciousness, Comparisons with Conscious Entities, and Special Entities. Uncertainty about consciousness in general complicates the conversation around HBOs. Clear communication is essential to avoid misconceptions, and future research may benefit from focusing on organoid intelligence as a more tractable concept.