Brian D. Earp

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.

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 …

This paper argues that interactions with chatbots are a form of engaging with fictional characters; so, by comparing chatbots with novels and video games as mediums of fictional engagement, we can gain a clearer understanding of who, if anyone, is responsible when users’ interactions with chatbots lead to self-harm or harm to others. We explore the differences between novels, video games, and chatbots across four dimensions: the degree of creators’ control over the content and user experience, the nature of the fictional world, the type of engagement each medium fosters, and the structure of the engagement experience. We take a minimal account of what it takes to be morally responsible and consider how responsibility can be assigned when engagement with fictional worlds results in harm caused to or by users. We argue that because AI companies have some control over chatbots after public release, and because they can monitor user engagement, they are morally responsible when chatbot use leads to harm, even if they can’t perfectly control chatbots’ outputs. In the last section, we point to what AI companies can do to mitigate chatbots’ negative influence on users.

This chapter evaluates the abolition of gender. There is a powerful set of assumptions in Western culture that influences how many of us think about sex and gender, even if we are not always fully aware of it. This set of assumptions can be called the “Dominant Gender Ideology” (DGI). Some people think it would better if sex was not linked to socially enforced gender roles that prescribe how people should be and behave on the basis of their sex. And their proposal for how to bring about this better future is to banish gender roles — and associated cultural norms — altogether. However, not everyone is a gender abolitionist. Many people think that gender roles are appropriate or worthwhile, perhaps even “natural” and inevitable. On one end of this spectrum are socially conservative religious people. At the other end of the spectrum are (some) progressive people who believe that gender can help members of certain disadvantaged groups make sense of their own minds and bodies in our social world.

Compared with high-income countries (HICs), developing ‘Chat-IRB’—application-specific large language models for research ethics review—may have different implications for resource-constrained Research Ethics Committees or Institutional Review Boards (IRBs) in low- and middle-income countries (LMICs). While certain concerns raised by Moodley, Malpani, and Reis—including resource challenges, reviewing research conducted in LMICs, and automation bias—are not entirely unique to LMIC IRBs, the hurdles they must overcome in developing a contextualised Chat-IRB will likely be greater. Crucially, Chat-IRB for LMICs presents a significant opportunity to strengthen ethics capacity and bolster oversight through: (1) stimulating greater investment in generating open-access, LMIC-centred research ethics scholarship that also serves as training data; (2) leveraging existing WHO or UNESCO programmes to develop an ‘always available’ training resource and review tool should international funding for ethics education and capacity-building be reduced or withdrawn; (3) mitigating inadequate human capacities by providing a ‘minimal acceptable standard’ of review, especially during time-sensitive matters; and (4) a national-level Chat-IRB as a centralised ‘governance’ mechanism and first-line defence against ethics dumping, IRB shopping, and other exploitative research practices. Taken holistically, purpose-built for LMICs, Chat-IRB represents a critical—but potentially unrecognised—opportunity for HICs to advance ethics capacity-building, and strengthen research oversight within LMICs.

On 16 April 2025, the Supreme Court of the UK ruled that when interpreting the UK’s Equality Act (2010)—the Act of the UK Parliament that details protections against unlawful discrimination—the terms ‘man’, ‘woman’ and ‘sex’ pick out ‘biological sex’ (defined in the Court’s ruling as ‘the sex of a person at birth’) and not also ‘certificated sex’ (defined in the Court’s ruling as ‘the sex attained by the acquisition of a Gender Recognition Certificate’). Some have argued that the Court’s decision represents a significant setback for trans people, while others have welcomed the perceived clarity the decision has provided. The decision has had, and will continue to have, wide impact, such as on the lawful operation of single-sex spaces and services in the UK. Scrutiny of the Court’s judgement is therefore warranted. The judgement was based on an interpretation of what Parliament intended in the Equality Act, but there are unresolved questions: (1) Is the Court’s interpretation of what Parliament intended the terms ‘man’, ‘woman’ and ‘sex’ to refer to correct? (2) Was the Court’s ruling made in a sufficiently just way? With these questions in mind, this article has two main aims. First, to summarise the Court’s recent decision and its social impacts. Second, to stress the importance of procedural justice in evaluating this verdict. This article thereby presents a preliminary case for the adequate consultation of all relevant stakeholders in potentially contentious legal decisions—especially where significant practical consequences for different social groups are likely.

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.

As recently appointed co-editors-in-chief of the Journal of Medical Ethics, our goal is to serve the community of authors, reviewers and readers by ensuring that the work we publish is timely, rigorous and distinctive. In this editorial, we want to share a few notes about how we are approaching editorial decisions, so that our rationale is clear, and to call attention to some simplification of the journal’s article types and what we’re hoping for from work in each of these categories. First, some important background. We are currently managing a full pipeline, with accepted articles scheduled for publication many months in advance. In fact, we have inherited enough excellent material from our predecessor, John McMillan, to fill almost a year of print issues without needing to accept a single new article. However, this means there is a lag between the acceptance of a paper and its assignment to a print issue of the journal. Another lag that some authors have commented on is the delay between submission of a paper (or its revision) and an editorial decision following peer review. This, in turn, is related to concerns about reviewer fatigue within our community. We describe our responses to these issues in the following subsections. ### Concerns about slow assignment of online-first articles to a print issue Given our prodigious queue of inherited manuscripts, we are exploring the possibility of publishing a number of online-only special issues consisting of thematically grouped papers from among those that have already been accepted, which we would then heavily promote and advertise. This should both raise the profile and visibility of these papers and allow authors to have their work receive its final citation information sooner than would otherwise be possible. For example, we may publish e-issues focused on AI ethics, reproductive ethics, environmental ethics and so on, making the material easier to find while also …

Artificial intelligence (AI) agents such as chatbots and personal AI assistants are increasingly popular. These technologies raise new privacy concerns beyond those posed by other AI systems or information technologies. For example, anthropomorphic features of AI chatbots may invite users to disclose more information with these systems than they would otherwise, especially when users interact with chatbots in relationship-like ways. In this paper, we aim to develop a framework for assessing the distinctive privacy ramifications of AI agents, especially as humans begin to interact with them in relationship-like ways. In particular, we draw from prominent theories of privacy and results from human relational psychology to better understand how AI agents may affect human behavior and the flow of personal information. We then assess how these effects could bear on eight distinct values of privacy, such as autonomy, the value of forming and maintaining relationships, security from harm, and more.

Healthcare systems often delegate surgical consent-seeking to members of the treating team other than the surgeon (e.g., junior doctors in the UK and Australia). Yet, little is known about public attitudes toward this practice compared to emerging AI-supported options. This first large-scale empirical study examines how laypeople evaluate the validity and liability risks of using an AI-supported surgical consent system (Consent-GPT). We randomly assigned 376 UK participants (demographically representative for age, ethnicity, and gender) to evaluate identical transcripts of surgical consent interviews framed as being conducted by either Consent-GPT, a junior doctor, or the treating surgeon. Participants broadly agreed that AI-supported consent was valid (87.6% agreement), but rated it significantly lower than consent sought solely by human clinicians (treating surgeon: 97.6% agreement; junior doctor: 96.2%). Participants expressed substantially lower satisfaction with AI-supported consent compared to human-only processes (Consent-GPT: 59.5% satisfied; treating surgeon 96.8%; junior doctor: 93.1%), despite identical consent interactions (i.e., the same informational content and display format). Regarding justification to sue the hospital following a complication, participants were slightly more inclined to support legal action in response to AI-supported consent than human-only consent. However, the strongest predictor was proper risk disclosure, not the consent-seeking agent. As AI integration in healthcare accelerates, these results highlight critical considerations for implementation strategies, suggesting that a hybrid approach to consent delegation that leverages AI’s information sharing capabilities while preserving meaningful human engagement may be more acceptable to patients than an otherwise identical process with relatively less human-to-human interaction.

Medical decision-making on behalf of individuals who have lost the capacity to make their own treatment choices poses significant challenges. The “substituted judgment” standard, which prioritizes individual autonomy, requires surrogate decision-makers to choose the course of action that the patient would have chosen or endorsed if they were able to do so. However, research suggests that surrogates often face difficulties in accurately predicting patient preferences, even when making a good-faith effort to adhere to the substituted judgment standard. To address these challenges, the Patient Preference Predictor (P3), a computer-based algorithm that correlates demographic data with expressed medical preferences, has been proposed to supplement or replace aspects of the surrogate decision-making process. However, critics argue that the P3 fails to respect patient autonomy due to relying on population-level data rather than accounting for individuals’ unique values, beliefs, and preferences. In response, we have proposed with our colleagues the Personalized Patient Preference Predictor (P4), an artificially intelligent (AI) system that would use machine learning to create a “digital psychological twin” or AI simulation of a patient, inclusive of their values, beliefs, and preferences, from individual-level data. While the P4 aims to address concerns raised by the P3, it has been argued that it may introduce new problems, particularly regarding its potential negative effects on the doctor–patient relationship and family relationships. In this chapter, we describe the P4, summarize objections related to its impact on human relationships, respond to these objections, and conclude with some thoughts on future directions.

Proposals to create AI chatbots or conversational ‘agents’ modelled on real human individuals, including specific bioethics scholars1 in the academic context, or individual patients (or potential future patients) in the medical context,2 have taken off in recent years. This has been accompanied by a lively and sometimes heated discussion about the ethics of creating or deploying such person-emulating chatbots in various contexts, both within and beyond the healthcare domain. Currently debated questions that are relevant to medical ethics and bioethics include: Not long ago, these questions would have seemed like science fiction. In the last few years, however, especially since the release of OpenAI’s ChatGPT in November of 2022, it has become increasingly easy to create digital simulations of individual human subjects, for example by fine-tuning large language models (LLMs) on person-specific corpora of speech, writing or other relevant data. Depending on …