Brian D. Earp

In this paper, we argue for the adoption of algorithmic bioethics, which uses algorithms, in the form of decision trees, to articulate, understand, apply, and evaluate bioethical arguments. Algorithms bring many benefits to the study of bioethics: they clearly, precisely, and transparently articulate the decision procedure and facts relevant to an ethical decision; furthermore, they can be used to systematically discover, map out, and compare different ethical decision procedures concerning a practical issue. We then also outline and tackle potential limitations of algorithmic bioethics, and explore future directions for using decision trees in bioethics. Throughout, we illustrate our points using a case study of ethical decision trees, created with the help of large language models, about conscientious objection in medicine.

Background Determining when medical treatment is futile is conceptually, empirically, and ethically disputed. This creates challenges for patients, families, doctors, healthcare, and legal systems. Amid such disputes, there is still a practical need to resolve futility questions in individual cases. Can artificial intelligence (AI) be ethically and effectively used to help with such decisions? Methods We adopted a critical narrative review method. We first surveyed existing scholarship on the ethics of medical futility to identify the main positions in ongoing futility debates. We then surveyed existing or potential medical AI devices to identify whether such tools might be used to help address these debates or their practical upshots. Finally, we philosophically analysed whether such tools ought to be used, identifying and weighing reasons using analytic argument, applying relevant ethical concepts, and philosophical principles, such as respect for autonomy, beneficence, non-maleficence, and justice. Results We found that there are some key challenges or risks in using AI for such purposes, for example, using AI may exacerbate the problem of self-fulfilling prophecies in futility determination by absorbing predicted outcomes as data. Nevertheless, under certain conditions, medical AI could ethically be used to prevent or help resolve futility disputes in healthcare decision-making. Conclusions AI could ethically contribute to preventing or resolving futility disputes depending on how AI is integrated and regulated in end-of-life care.

Digital duplicates (DDs), or artificial intelligence (AI) simulations of individual minds, are AI models designed to emulate real people. Depending on how they are trained, DDs can reproduce aspects or signs of a person’s psychology, values and communication style, enabling interaction with digital approximations of living, recently deceased or historical individuals. Proposed uses include education, advocacy, grief support, medical decision-­ making and the continuation of creative or personal projects. While potentially valuable, these applications also pose ethical risks such as privacy loss, misrepresentation, manipulation and the erosion of authentic human relationships. This paper argues that DDs should be treated as context-­ specific tools rather than general-­ purpose technologies. We outline a two-­ tier ethical framework grounded in considerations of harm and proportionality, supported by the values of information permission, transparency, authenticity and appropriate access. The framework unites diverse moral concerns under a single framework while allowing their relative weight to vary across domains such as medicine, education, memorialisation and entertainment. By situating ethical evaluation within a harm-­ reduction approach that is sensitive to context, we offer a practical basis for the responsible development and governance of human-emulating AI systems.

Large language models (LLMs) are becoming routine as tools for drafting, editing, and revising scholarly manuscripts, raising difficult questions about how much transparency is needed to assess research integrity, authorship claims, and accountability. In response, some authors have proposed that researchers who use LLMs in manuscript preparation should be required to submit the prompts they used, together with the generated outputs, as supplemental material. We support detailed disclosure when it is needed to assess the scientific validity or reproducibility of a study, for example where LLMs are used in data analysis, coding, literature synthesis, or the production of figures. We argue, however, against Mandatory Full Inclusion (MFI) of prompts and outputs for ordinary writing assistance. Such a policy would, we suggest, be difficult to enforce, easy for dishonest users to evade, burdensome for careful users to follow, and poorly suited to the capacities of editors and peer reviewers. It would also risk discouraging beneficial uses of LLMs, penalizing careful multi-model consultation, distorting how researchers interact with AI systems, and disadvantaging scholars who already face undue or unnecessary barriers in academic publishing, including scholars at under-resourced institutions. More generally, an MFI policy would impose a level of surveillance on AI-assisted writing that has no clear analog in ordinary human collaboration. We propose instead a proportionate prompt-and-output disclosure framework: targeted disclosure where reproducibility or validity requires it; voluntary documentation where authors wish to demonstrate their contribution; and continued reliance on authorship attestation, contributor statements, and misconduct procedures where warranted. This approach better aligns transparency with the risks posed by LLM use in scholarly writing, while also minimizing surveillance-related harms and inefficiencies.

Past research has found that the value of a person's activities can affect observers' judgments about whether that person is experiencing certain emotions (e.g., people consider morally good agents happier than morally bad agents). One proposed explanation for this effect is that emotion attributions are influenced by judgments about fittingness (whether the emotion is merited). Another hypothesis is that emotion attributions are influenced by judgments about the agent's true self (whether the emotion reflects how the agent feels “deep down”). We tested these hypotheses in six studies. After finding that people think a wide range of emotions can be fitting and reflect a person's true self (Study 1), we tested the predictions of these two hypotheses for attributions of happiness, love, sadness, and hatred. We manipulated the emotions' fittingness (Studies 2a-b and 4) and whether the emotions reflected an agent's true self (Studies 3 and 5), measuring emotion attributions as well as fittingness judgments and true self judgments. The fittingness manipulation only impacted emotion attributions in the cases where it also impacted true self judgments, whereas the true self manipulation impacted emotion attribution in all cases, including those where it did not impact fittingness judgments. These results cast serious doubt on the fittingness hypothesis and offer some support for the true self hypothesis, which could be developed further in future work.

Adolescents sometimes express firm views about high-stakes medical decisions that conflict with those of their caregivers or clinicians, raising difficult questions about how much weight their wishes should carry. A recurring concern is whether such decisions will later be regretted, although the normative significance of future potential regret remains hotly debated. Recent work in adult bioethics has proposed using artificial intelligence–based Personalized Patient Preference Predictors (P4s) to estimate what current treatment incapacitated adults would have chosen based on their known or inferred preferences when last autonomous. This paper explores whether, and with what ethical significance, a parallel ‘Paediatric Personalized Patient Preference Predictor’ (P5) could be applied to children and young people. We analyse how predicted future preferences might bear on questions of substituted judgment or proxy consent, best-interests assessments, resistance to treatment, and adolescents’ own deliberation. We distinguish different groups of paediatric patients based on current and future decision-making capacity, and identify both where a P5 might have greatest promise and where it is least defensible. We identify challenges for a P5 including that of self-reinforcing or self-negating preferences as well as of deciding which future preferences are relevant to current decisions. We argue that, in paediatrics, predicted future preferences cannot ground substituted judgment in the adult sense, but may nonetheless play a supportive role in best-interests reasoning and shared decision-making, subject to significant epistemic and ethical constraints.

The article advances the idea of "digital life models" to assist with difficult personal decisions, including those that can change an individual in profound ways. We propose that if personalized AI simulations can model how an individual's life might unfold under different conditions, this could help the individual better understand the likelihoods and expected subjective value of these possible outcomes. It remains to be seen whether these digital life models are technically feasible, given fundamental challenges in modeling psychological complexity, person-environment interactions, and value change. Ethical concerns include data privacy, cultural bias, and the risk of improperly shaping user decisions. Acknowledging these limitations, we argue that digital life models, if successfully developed, could in principle enhance rational and authentic decision-making in the face of potentially transformative change.

There is a philosophical debate about whether the use of biomedical enhancements to promote or sustain love in romantic relationships is compatible with the desirability of such love. We argue that enhancements are problematic in this respect only if they substantially replace the causal role of the beloved's identity in generating the lover's disposition to care. When enhancements remove psychological impediments to seeing the beloved ‘as they really are’ without introducing new (significant or overriding) inauthentic causes of love, they do not reduce the value of the love between the lover and the beloved. In this article, we discuss three conditions for love to be an intrinsically valuable good and the causal role of the beloved's identity for each of them. We show that the fundamental desirability of love understood in terms of these three conditions does not depend on whether enhancements are used, but on whether the identity of the beloved continues to play the right causal role. Enhancements can help us preserve valuable relationships and support the causes of love that are already in place. Finally, even if relatively less desirable than unenhanced love, enhanced love can still remain valuable and desirable in absolute terms.

Medical ethics often turns on categories. A patient is disabled, a person is a parent, an entity is an embryo, a participant is vulnerable. These descriptions can identify features of a case that have ethical or legal significance. They can also carry assumptions that have not been fully argued for: for example, about moral status, decision-making authority or susceptibility to harm.1 This risk is greatest in marginal or difficult cases, where new clinical, legal or scientific contexts stretch familiar categories beyond the settings in which they first developed their practical force. Philosophers have long observed that categories do more than sort things. Ian Hacking argued that classifications of people can interact with those classified: they can affect how people are treated, how institutions respond to them and how people understand themselves and others.2 A category such as ‘vulnerable participant’, ‘disabled person’ or ‘parent’ can therefore help to create (aspects of) the social reality it may only appear to describe. Categories often used in medical ethics can trigger protections, duties, permissions, restrictions and expectations. This gives them practical value but also makes their use ethically significant and potentially contestable. They may often require close evaluation. Several papers in this issue invite readers to apply this kind of scrutiny. Before using a category to inform a decision, three questions are worth asking. Which facts does the category pick out? Which decision, recommendation, policy or (other) normative conclusion is it being used to support? And what moral premise connects those facts to that decision or conclusion? A category may be apt for one purpose and misleading for another. Problems arise when the application of a category is taken to settle questions that the ethical reasoning has not yet addressed. Our first example concerns the category of disability as applied within the …

Background Toomey et al (2024) found that US participants were more likely to follow a medical treatment preference—expressed after substantial cognitive decline—of a third person rather than their own future self. This correlated with a greater tendency to see the third person as still their true self. We hypothesised that the greater epistemic access one has to one’s own true self as opposed to others might drive this difference. Methods A codebook designed to capture different kinds of evidence and reasoning was developed, and participants’ explanations for their treatment decisions in Toomey et al’s study were coded and qualitatively analysed. Results In first-person cases, participants were more likely to explain their treatment decision with reference to perceived direct access to their own true self. In contrast, in third-person cases, participants more often relied on proxies or heuristics, such as the presumption that an expressed preference is an authentic one or that preferences expressed with greater cognition tend to better reflect the true self. Conclusions These findings support the hypothesis that differential epistemic access to the true self in first- and third-person cases may drive different medical treatment decisions. Participants may be trying to follow the patient’s ‘true’ or ‘authentic’ preference in all cases, but relying on different kinds of evidence in so doing.

This editorial discusses a proposed policy on artificial intelligence (AI) use that we may adopt in the coming months, depending on feedback from our community of authors and reviewers and ongoing developments at our publisher, BMJ Group. We propose that all manuscripts submitted to the Journal of Medical Ethics ( JME ) and JME Practical Bioethics ( JMEPB ) must include a dedicated Generative AI Use Declaration section in the manuscript itself, placed before the reference list. This requirement would apply to all submissions, regardless of whether generative AI—as defined in Box 1—was used. Authors would affirm that no generative AI tools were used (Option A); affirm that none were used to substantively influence the content of the manuscript beyond AI-assisted ‘copy editing’i of human-written text (Option B); or affirm that generative AI tools were used, stating which ones were used as well as how and for what purposes they were used (Option C). See Box 2 for details. Box 1 ### A definition of generative artificial intelligence (generative AI) to aid interpretation of this policy: the ‘ JME ’ definition By ‘generative AI’, we mean computer-based systems that produce new content, or substantially transform or substantially revise existing content such as text, code or images, in response to user prompts or other inputs. These systems produce outputs by learning from and recombining patterns in training data through predictive extrapolation. They include but are not limited to large language models. For the purposes of this policy, they do not include deterministic tools such as calculators, conventional statistical software, reference managers or rule-based spelling or grammar checkers. All references to ‘AI’ in this policy refer to generative AI in the sense described here. Box 2 ### Proposal for a required Generative Artificial Intelligence (AI) Use Declaration for submissions to Journal of Medical Ethics ( JME )-family journals If our proposed policy is implemented, we would ask all authors to include the following section, headed ‘Generative AI Use Declaration’, immediately before the reference list. Authors would be asked to model their declaration on the option that most accurately describes their …

The pursuit of artificial consciousness requires conceptual clarity to navigate its theoretical and empirical challenges. This paper introduces a composite, multilevel, and multidimensional model of consciousness as a heuristic framework to guide research in this field. Consciousness is treated as a complex phenomenon, with distinct constituents and dimensions that can be operationalized for study and for evaluating their replication. We argue that this model provides a balanced approach to artificial consciousness research by avoiding binary thinking (e.g., conscious vs. non-conscious) and offering a structured basis for testable hypotheses. To illustrate its utility, we focus on "awareness" as a case study, demonstrating how specific dimensions of consciousness can be pragmatically analyzed and targeted for potential artificial instantiation. By breaking down the conceptual intricacies of consciousness and aligning them with practical research goals, this paper lays the groundwork for a robust strategy to advance the scientific and technical understanding of artificial consciousness.

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals to “health benefits” as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences. For example, it may create a “loophole” through which certain forms of female genital cutting—or female genital “mutilation” as it is defined by the World Health Organization—could potentially be legitimized. Moreover, by comparing current dominant Western attitudes toward female genital “mutilation” and so-called intersex genital “normalization” surgeries (i.e. surgeries on children with certain differences of sex development), we show that the concept of health invoked in each case is inconsistent and culturally biased. It is time for Western healthcare organizations—including the American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and World Health Organization—to adopt a more consistent concept of health and a unified ethical stance when it comes to child genital cutting practices.

The stakes in medicine are high. Crucial decisions, often involving matters of life and death, have to be made quickly. However, medicine is practised under great uncertainty. Clinicians sometimes lack the evidence required to diagnose or treat patients with confidence; patients struggle to know when to seek care; and policymakers must design rules or plan interventions using incomplete data. When faced with a decision problem, it is often unclear what the right course of action is or how to respond when something goes wrong. But given the stakes, delaying action is often not an option. Artificial intelligence (AI) is transforming our epistemic and moral landscapes. With access to vast datasets and the computational power required to analyse them, AI detects patterns that clinicians would miss, quantifies policy trade-offs that were previously invisible and generates increasingly fine-grained predictions. However, better evidence does not necessarily mean the resolution of moral uncertainty. With more information at our disposal, we may have to make more morally significant choices than ever before. We must also assign responsibility in contexts where decision-making is distributed across both humans and AI agents, even though the latter may at times operate in ways entirely opaque to us. This special e-issue of the Journal of Medical Ethics brings together nine articles that address AI’s transformation of uncertainty in medicine. This collection is unified by a central insight: AI may broaden our access to information and offer new, optimised solutions to longstanding problems, but its use introduces new complications to already challenging moral quandaries. Indeed, with AI in the loop, how to choose or act permissibly and how to distribute moral responsibility in a complex system have become more difficult to determine. The articles here take one of two approaches to these issues. The first is to show how AI expands …

Human brain organoids (HBOs) are three-dimensional structures derived from human stem cells that model aspects of brain development and function, offering potentially unprecedented opportunities for studying neurological disorders and for developing treatments. This consensus paper presents recommendations from the Asia Pacific Neuroethics Working Group, developed through interdisciplinary collaboration among scientists, bioethicists, philosophers, and legal scholars who convened in Singapore in November 2024. We provide a comprehensive analysis of the ethical, legal, and sociocultural dimensions of HBO research, addressing both current realities and future possibilities. The paper examines key ethical considerations, including the potential moral status of HBOs, particularly regarding sentience and consciousness, while identifying and dispelling common misconceptions and “ethical red herrings” arising from sensationalized portrayals. We analyze consent frameworks for cell donation, privacy concerns, dual-use risks, and questions of distributive justice. Legal challenges are explored, including the categorical ambiguity of HBOs within existing regulatory frameworks, intellectual property issues, and cross-border inconsistencies in standards. Sociocultural perspectives emphasize the importance of public understanding, cross-cultural engagement, and empirical research on diverse community attitudes toward HBO research. In our recommendations, we advocate for evidence-based ethical discussions, anticipatory frameworks addressing potential future developments, contextualized analysis comparing HBOs to related experimental models, robust informed consent processes, proportionate responses to consciousness concerns, development of adaptive regulatory frameworks, responsible science communication to manage public expectations, and sustained interdisciplinary collaboration. We emphasize a balanced approach that promotes scientific innovation while maintaining rigorous ethical oversight, recognizing HBOs’ significant potential for advancing neuroscience and medicine. This represents the first comprehensive ethical framework for HBO research from the Asia Pacific region, helping to establish foundational principles for responsible development of this rapidly advancing field.

The World Congress of Bioethics held in Qatar in 2024 (WCB 2024) sparked controversy around the role of religion in bioethics, highlighting the need for critical discussions. During the congress, there was a strong push for incorporating religious values into bioethical discourse, raising questions about the validity and implications of such an approach. This paper examines the influence of religious thought on bioethical discussions, and the ongoing debate over the role of religious perspectives in this field. Here, we explore Jecker and colleagues’ pluriversal framework, which was proposed at WCB 2024, espousing a bioethical discourse grounded in civility, respect for law, justice, non-domination, and toleration. While the framework aims to embrace the world's cultural and religious diversity, here, we suggest that it struggles with significant ethical inconsistencies, poses challenges for pluralistic dialogue, and may be hard to reconcile with human rights. Through an analysis of Jecker's principles and their application, we discuss the difficulty of integrating conflicting religious views with ethical values and with widely accepted human rights frameworks. We then proceed to examine how and why religions might exert undue influence on bioethics, and we argue for a different future for bioethics.

Psychedelics are increasingly being studied and used in clinical and therapeutic contexts, prompting renewed ethical and regulatory debate. Claims of psychedelic exceptionalism—whether “negative,” portraying psychedelics as uniquely risky and thus requiring stricter oversight, or “positive,” portraying them as uniquely beneficial and thus exempt from ordinary ethical rules—have become common. In a recent article, we argued that while psychedelics may involve distinctive constellations of features, these do not justify fundamentally new ethical standards. In response, Daniel Villiger and, separately, Edward Jacobs, agreed that psychedelics should not be exempt from existing ethical standards (what Villiger calls Type A ethical exceptionalism) but suggested that their distinctive qualities may still warrant unique applications of those standards (Type B ethical exceptionalism). For example, Villiger argues that psychedelics possess certain features that do not, in his view, exist anywhere else in medicine, including the unpredictability and emotional intensity of the psychedelic experience, alongside a temporary lowering of psychological defences, leading to heightened suggestibility and sensitivity to context. He argues that such allegedly unique features call for exceptional policies around how existing ethical standards are to be applied—Type B exceptionalism. In this essay, we argue that the features Villiger identifies are only ethically significant insofar as they raise concerns about (inter alia) autonomy and vulnerability. But these concerns arise also in other medical settings. As such, policies addressing these issues would apply more broadly to other medical interventions raising similar concerns. Villiger thus fails to establish a genuine case for psychedelic ethical exceptionalism, even of the more modest, Type B variety.

The challenge of making healthcare decisions for incapacitated patients continues to confront stakeholders worldwide. Annette Rid and David Wendler proposed a Patient Preference Predictor (P3) that uses population-level data to infer an incapacitated patient’s likely treatment choices, with the aim of aligning care with the values and preferences they held when last autonomous. Some objectors claimed this would fail to respect patients’ (former) autonomy because the basis for prediction would not be specific to the individual (e.g., based on data reflecting their own specific reasons for preferring one course of action over another). In response, we proposed a ‘Personalised Patient Preference Predictor’ (P4) that would harness the predictive capacities of personalised large language models (LLMs) fine-tuned on individual-level data of various kinds. The envisioned P4, if realized, would be akin to a ‘digital psychological twin’ or AI simulation of the patient that would encode their unique preferences and values to enable an individualised prediction of their likely treatment preferences. The P4, in turn, has been criticised on various grounds: philosophical, practical, and ethical. Here, we comprehensively evaluate the concerns of our critics based on all known published critiques as of the time of writing. While acknowledging the weight of some of these concerns, we argue that they do not entail that a P4 should not be developed. Rather, the concerns point to areas where thoughtful design choices, responsible regulation, and further philosophical reflection are needed to steer the proposal in a positive direction.

> Future people count. There could be a lot of them. We can make their lives better. > > -- William MacAskill, What We Owe The Future > > [Longtermism is] quite possibly the most dangerous secular belief system in the world today. > > -- Émile P. Torres, Against Longtermism Philosophers,1 2 psychologists,3 4 politicians5 and even some tech billionaires6 have sounded the alarm about artificial intelligence (AI) and the dangers it may pose to the long-term future of humanity. Some believe it poses an existential risk (X-Risk)7 to our species, potentially causing our extinction or bringing about the collapse of human civilisation as we know it. The above quote from philosopher Will MacAskill captures the key tenets of ‘longtermism’, an ethical standpoint that places the onus on current generations to prevent AI-related—and other—X-Risks for the sake of people living in the future.1 2 Developing from an adjacent social movement commonly associated with utilitarian philosophy, ‘effective altruism’, longtermism has amassed following of its own. Its supporters argue that preventing X-Risks is at least as morally significant as addressing current challenges like global poverty. However, critics are concerned that such a distant-future focus will sideline efforts to tackle the many pressing moral issues facing humanity now.8 9 Indeed, according to ‘strong’ longtermism,10 future needs arguably should take precedence over present ones. In essence, the claim is that there is greater expected utility to allocating available resources to prevent human extinction in the future than there is to focusing on present lives, since doing so stands to benefit the incalculably large number of people in later generations who will far outweigh existing populations.1 Taken to the extreme, this view suggests it would be morally permissible, or even required, to actively neglect, harm or destroy large swathes of humanity as …

When used clinically, psychedelics may appear unusual or even unique when compared to more familiar or long-standing medical interventions, prompting some to suggest that the ethical issues raised may likewise be exceptional. If that is correct, then perhaps psychedelics should be treated differently from other medical substances: for example, by being subjected to different ethical or evidentiary standards. Alternatively, it may be that psychedelics have more in common with various existing medical interventions than first meets the eye. We argue in favor of the latter position, drawing on parallels from earlier debates around genetic exceptionalism in bioethics. We suggest there are risks to adopting a stance of “psychedelic ethical exceptionalism,” and propose that consistent ethical rules and evidentiary standards should be applied across all relevant areas of clinical medicine. Importantly, this does not preclude the possibility that changes to existing standards should be made; but if so, this should not be justified by appealing to the alleged uniqueness of psychedelics.

A prominent critique of cognitive or athletic enhancement claims that certain performance‐improving drugs or technologies may ‘cheapen’ resulting achievements. Considerably less attention has been paid to the impact of enhancement on the value of moral achievements. Would the use of moral enhancement (bio)technologies, rather than (solely) ‘traditional’ means of moral development like schooling and socialization, cheapen the ‘achievement’ of morally improving oneself? We argue that, to the extent that the ‘cheapened achievement’ objection succeeds in the domains of cognitive or athletic enhancement, it could plausibly also succeed in the domain of moral enhancement—but only regarding certain forms. Specifically, although the value of moral self‐improvement may be diminished by some of the more speculative and impractical forms of moral enhancement proposed in the literature, this worry has less force when applied to more plausibly viable forms of moral enhancement: forms in which drugs or technologies play an adjunctive or facilitative, rather than a determinative, role in moral improvement. We illustrate this idea with three examples from recent literature: the possible use of psychedelic drugs in certain moral‐learning contexts, ‘Socratic Al’ (a proposed Al‐driven moral enhancer) and empathy enhancement through virtual reality (VR). We argue that if one assumes that these technologies work roughly as advertised (which is an open empirical question), the ‘cheapened achievement’ objection loses much of its bite. The takeaway lesson is that moral enhancement in its most promising and practical forms ultimately evades a leading critique of cognitive and athletic enhancement. We end by reflecting on the potential upshot of our analysis for enhancement debates more widely.

The current revival of interest in classic psychedelics and other psychoactives such as ketamine and MDMA, coupled with changes to their regulatory status in many jurisdictions, necessitates rigorous ethical guidelines both within and beyond clinical and scientific contexts. This paper examines crucial ethical, philosophical, and policy considerations needed to ensure psychedelic use across various settings remains equitable, beneficial, consensual, and safe, with appropriate accountability mechanisms for addressing potential harms. We seek to broaden the lens beyond the medical model of psychedelics to include potentially valuable non-medical applications that could benefit individuals, communities, and society. With popular interest in psychedelics growing outside of therapeutic and research settings, there is a need to determine which aspects of any proffered guidelines, or underlying principles, should be applied similarly across contexts and in what ways there should be flexibility and/or context-sensitivity in their interpretation or application. In developing such guidelines, we suggest the “treatment versus enhancement” distinction – and associated debates familiar from bioethics and philosophy of medicine – requires renewed attention. We argue that neglecting non-medical and broad scientific use cases for psychedelics may have important implications for a range of ethical issues surrounding psychedelic use and research, including concerns about psychedelic hype and exceptionalism (both positive and negative), therapeutic touch, informed consent, data-gathering, and balancing access and safety. We conclude with suggestions for future directions in research and policy in the burgeoning area of psychedelic bioethics, stressing the importance of incorporating the perspectives of a diversity of stakeholders and fostering cross-sector collaboration.

Recent news reports describe a multibillion dollar health cooperation agreement between the Kenyan government and the USA, under which access to ‘de-identified and aggregated’ data from Kenyan health systems would be provided to US researchers within a legally governed framework, alongside substantial US funding commitments for healthcare infrastructure and services that are needed in Kenya.1 The arrangement has been cast, by representatives of both governments, as reasonable, efficient and legally regulated with all due protections and oversight2 (see box 1). It is also framed as mutually beneficial: Kenya gains urgently needed health investment, while the USA gets privileged access to national-level data that could enhance its biomedical research.3 This research, in turn, could ultimately yield medical discoveries and health technologies that benefit Kenyans themselves, including improved disease surveillance, diagnostics and system-level planning.4 Box 1 ### A mutually beneficial deal? Announcing the agreement in Washington in December of 2025, Kenya’s Health Cabinet Secretary, Aden Duale, argued that ‘health data is a national strategic asset’ and promised that any data transfers would remain ‘fully governed’1 by Kenya’s Digital Health Act of 2023 and its Data Protection Act of 2019, which together set out legal requirements for the processing, governance and protection of personal and health data, while also establishing individual rights and independent oversight mechanisms.2,29 30US officials, for their part, framed the deal as part of a shift towards ‘sustainable … government-to-government cooperation,’1 with Secretary of State, Marco Rubio, describing it as a move away from fragmented donor models and towards long-term system strengthening. Another possible benefit is improving the performance and equity of data-driven health tools, since people from Africa, including Kenya, remain under-represented in many of the datasets used to develop health data-science models.5 The exchange thus appears to be not only scientifically pragmatic or economically …