Caesar Alimsinya Atuire

We appreciate the helpful commentaries on our paper, ‘AI and the falling sky: interrogating X-Risk’.1 We agree with many points commentators raise, which opened our eyes to concerns we had not previously considered. This reply focuses on the tension many commentators noted between AI’s existential risks (X-Risks) and justice here and now. In ‘Existential risk and the justice turn in bioethics’, Corsico frames the tension between AI X-Risk and justice here and now as part of a larger shift within bioethics.2 They think the field is increasingly turning away from ‘big picture’ questions new technologies raise and focusing on narrower justice concerns of less significance. They compare our paper’s emphasis on justly transitioning to more AI-centred societies with the approach of environmentalists fretting about human protection against climate change while losing sight of the need to protect the planet and all living things. Corsico doubts there is much point to pressing for ‘justice on a dead planet’, so too Corsico questions our concern with just transitions. Presumably, that matters little if intelligent life on Earth is destroyed. Corsico’s recommends bioethicists return to big questions, like: ‘Should we develop AI at all, given AI X-Risk?’. Yet this question is increasingly moot. The genie is already out of the bottle. The Future of Life Institute’s 2023 call for a temporary pause on training AI systems more powerful than ChatGPT fell on deaf ears, in part because freely accessible source codes enable anyone to train systems and create AI applications.3 The focus now must be managing the genie. While we take AI X-Risk seriously, …

The Buddhist Jātaka tells the tale of a hare lounging under a palm tree who becomes convinced the Earth is coming to an end when a ripe bael fruit falls on its head. Soon all the hares are running; other animals join them, forming a stampede of deer, boar, elk, buffalo, wild oxen, rhinoceros, tigers and elephants, loudly proclaiming the earth is ending.1 In the American retelling, the hare is ‘chicken little,’ and the exaggerated fear is that the sky is falling. The story offers a cautionary tale for considering the trend towards calamity thinking in artificial intelligence (AI). A growing chorus of tech leaders has warned that AI poses existential risk (X-Risk) that could result in the extinction of the human species, the collapse of civilisation, or a colossal decline in human potential and culture. In 2014, Hawking told the Washington Post that AI, ‘could spell the end of the human race’.2 Musk has repeatedly warned about AI’s perils, calling AI, ‘more dangerous than nukes’, recommending colonising Mars to ensure ‘a bolt-hole if AI goes rogue and turns on humanity’,3 and donating 10 million dollars to the Future of Life Institute to jumpstart research on AI’s X-Risk. Gates has stated, ‘I am in the camp…concerned about super intelligence…I agree with … Musk and some others on this and don’t understand why some people are not concerned’.4 Altman, CEO of OpenAI, has fretted that technologies OpenAI was building could endanger humanity—‘even destroying the world as we know it’.5 This paper offers a critical appraisal of the rise of calamity thinking in the scholarly AI ethics literature. It cautions against viewing X-Risk in isolation and highlights ethical considerations sidelined when X-Risk takes centre stage. Section I introduces a working definition of X-Risk, considers its likelihood and …

We address an ethical challenge in climate change adaptation and global health research. The challenge stems from two pairs of intuitions about justice and responsibility in climate change and health. One pair assigns responsibility for adaptation research to high-income countries given their historical emissions, disproportionate share of resources and capacity to intervene. The other pair assigns responsibility to low- and middle-income countries given their agency, right to self-determination, local authority and legitimacy, and disproportionate burden of climate and health risks. The intuitions create conflicting views: obligation and assistance pull in one direction, and agency and authority pull in another. To resolve the tension, we distinguish two forms of responsibility: (i) adaptation-enabling responsibilities; and (ii) adaptation-enacting responsibilities. The resulting division of labour reflects different forms of justice and aligns with the principle of subsidiarity’s core elements, namely: non-abandonment, non-absorption, and cooperation and coordination. We thus propose a framework that ascribes adaptation-enabling responsibilities to high-income countries, including adaptation financing, capacity-building and other forms of support; and adaptation-enacting responsibilities to low- and middle-income countries, including priority-setting in local adaptation research, and creation and implementation of their adaptation plans and policies. Our framework also suggests a third form of responsibility: shared adaptation responsibilities, which are jointly assigned to high-income countries, low- and middle-income countries and agents at multiple levels within them. We conclude that genuine collaboration in adaptation research, where high-income countries enable without dominating and low- and middle-income countries act without being abandoned, will be essential for just and effective adaptation to climate change.

Chapter 7 asks whether extraterrestrial life, if it exists, could be persons and if the lands and soils such life inhabits could be morally considerable. Using examples from fiction to illustrate, it examines a forced choice scenario in which we must decide whether to save Earthlings or extraterrestrial life. It also considers a case involving terraforming Mars for human benefit. These examples showcase salient differences between Emergent Personhood and leading Western views. Unlike Kantian and utilitarian ethics, which are purportedly ‘species neutral,’ Emergent Personhood privileges human relationships. Unlike these views, which purport to be valid for all rational or conscious creatures, Emergent Personhood espouses humble anthropocentrism, a standpoint that underscores epistemic and phenomenological constraints associated with being human. Emergent Personhood bears resemblance to some African and recent Western approaches, including African relational environmentalism, deep ecology, and Leopold’s land ethic.

Chapter 6 examines the moral standing of animals and nature and further develops the position we call _Emergent Personhood_. Emergent Personhood holds that non-humans can become persons by being incorporated in pro-social ways with human beings. This account has affinities with African views, such as African relational environmentalism. It also resembles some recent Western views, like deep ecology and Leopold’s land ethic, that stress relational features of animals and nature as a basis for moral considerability. Emergent Personhood contrasts with Kantian and utilitarian ethics because these approaches focus exclusively on interior mental states such as consciousness, rationality, or the capacity to suffer. Chapter 6 strengthens the argument for Emergent Personhood by showing that it gives ethical backing to important moral duties to animals and nature. Emergent Personhood embraces _humble anthropocentrism_, which acknowledges epistemic and phenomenological limits of a human standpoint while rejecting human superiority over nature.

Chapter 5 explores the moral standing of various forms of artificial intelligence (AI). It introduces this topic using the provocative example of zombies to consider whether entities without sentience or consciousness could be morally considerable. The chapter argues that personhood could emerge for non-conscious AI provided it is incorporated in the human community and acts in consistently pro-social ways. It applies this insight to large language models, social robots, and characters from film and fiction. The analysis reveals strong affinities between Emergent and African views. Both hold that non-humans can acquire personhood under certain conditions irrespective of consciousness. By contrast, utilitarianism and Kantian philosophies require consciousness. After replying to objections, Chapter 5 concludes that we could make a person by building an artificial agent that was pro-social and deploying it in ways that foster positive machine-human relationships.

Chapter 4 asks when the superlative moral worth we associate with human persons reaches a terminus. Drawing insights from Africa and the West, Emergent Personhood argues that the declaration of death marks a profound change in the way individuals relate, forever separating the newly dead from every other human being and altering human-human relationships that existed previously. This ends the human-human associations that enable persons to emerge. Emergent Personhood differs from some African views, which hold that moral status diminishes gradually, as deceased human beings become unincorporated from their community, reaching a terminus only after the deceased is forgotten and joins the ‘nameless dead.’ Emergent personhood also differs from leading Western philosophies, such as Kantian and utilitarian ethics, which point to the cessation of consciousness as the indicator that personhood has ended. Chapter 4 examines the implications of these diverse stances for practical debates about voluntary active euthanasia and assisted suicide.

Chapter 3 explores human personhood across the lifespan. It argues that Emergent Personhood has important advantages over leading African and Western views, because it alone gives a foothold to equality. Emergent Personhood holds that human beings of all ages have equal moral standing. It regards human beings with variable intellectual capacities as equals, reasoning that the human-human relationships that give rise to exceptional moral worth remain stable throughout life. By contrast, some African views understand personhood as an arc that can increase as individuals move through their lives and become increasingly incorporated and able to show pro-social virtues. Emergent Personhood also contrasts with Kantian and utilitarian views, which generally accord higher moral standing to mature, cognitively intact adults than infants, children, or older people with dementia. Chapter 3 closes with a forced choice involving selecting research subjects from a pool of people representing diverse ages and mental capacities.

Chapter 1 introduces the book’s central questions and chief claims. It asks: What makes individuals ‘persons’ in a moral sense, beings with a certain dignity or worth, entitled to others’ respect? Are all humans persons? Are any non-humans persons? How does personhood begin and end? Philosophers from Africa and the West have not worked collaboratively on personhood to address these questions. Chapter 1 begins to fill this gap, engaging African and Western traditions in critical conversation. This brings to light five salient differences, which relate to whether personhood is (1) intrinsic or extrinsic, (2) earned or unearned, (3) binary or scalar, (4) mostly stable or mostly changing, and (5) foundational or derivative. Chapter 1 proposes that these five notable differences were not always present, are hardly inevitable, and can and should be bridged.

The Introduction sets out the main questions the book will explore and offers a chapter-by-chapter summary. The chapters are not only philosophically grounded but also show applications to bioethics issues at the beginning and end of life, artificial intelligence, environmental ethics, and space ethics/astrophysics. Specific chapter topics are Chapter 1, A conversation between Africa and the West; Chapter 2, Emergent personhood; Chapter 3, Personhood across the lifespan; Chapter 4, Becoming a non-person; Chapter 5, Zombies and robots; Chapter 6, Animals and nature; Chapter 7, Space aliens and terraforming. The Introduction also explains how the book does philosophy differently by engaging perennial questions about personhood across borders. Its aim is to generate a new concept of personhood, less tethered to the restrictions of any single tradition.

As the scope of morally relevant considerations widens and new challenges emerge at the frontiers of health innovation, there are questions about the appropriate role and remit for research ethics review, within the broader context of the whole health research ecosystem. Drawing on discussion at a satellite meeting at the 2022 Global Forum on Bioethics in Research in Cape Town, we argue that the ethical conduct of research is the responsibility of all stakeholders in the research ecosystem – from funders, governments and research institutions to individual research teams and ethics committees. As a research community we need to espouse, and take action to achieve, more distributed approaches to ethical scrutiny and reflexivity. A crucial element of such a shift should be the development of collaborative and non-adversarial relationships between researchers and ethics committees that recognise and respect the mutual responsibilities of all parties to promote ethical research conduct. In tandem with the development of systems to support the exercise of ethical responsibilities across the research ecosystem, committees need to reconceptualise their role, in partnership with communities, as one of providing accountability through a focus on how research promotes participant agency and the common good.

This paper sets forth and defends a pluriversal approach to religion in the context of an increasingly global bioethics. Section I introduces a pluriversal view as a normative technique for engaging across difference. A normative pluriversal approach sets five constraints: civility, change from within, justice, non-domination, and tolerance. Section II applies a pluriversal approach to religion. It argues that this approach is epistemically just, recognizes diverse standpoints, and represents a productive, preferred, way to tackle global bioethics concerns. Section II also considers an opposing viewpoint, which holds that religious perspectives have no place in bioethics. We show that this viewpoint would have adverse effects on bioethics publishing, conferencing, and training programmes. The paper concludes (in Section III) that bioethicists should engage with people who hold different worldviews, including religious worldviews, and should do so in accordance with pluriversal ethical constraints.

This paper argues that bioethics as a field should broaden its scope to include the ethics of war, focusing on war’s public health effects. The “Introduction” section describes the bioethics literature on war, which emphasizes clinical and research topics while omitting public health. The section, “War as a public health crisis” demonstrates the need for a public health ethics approach by framing war as a public health crisis. The section, “Bioethics principles for war and public health” proposes six bioethics principles for war that address its public health dimensions: health justice, accountability, dignified lives, public health sustainability, nonmaleficence, and public health maximization. The section, “Justifying and applying bioethical principles” shows how these principles inform ethical analysis, including just war theory and military ethics. The section, “From principles to practice” envisions ways in which bioethicists can promote these principles in practice through research, teaching, and service. The “Conclusion” section urges bioethicists to engage with war as a public health crisis, including calling attention to war’s impact on civilians, especially women, children, and other vulnerable groups.

This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics’ (IAB’s) selection of Qatar to host the 2024 World Congress of Bioethics. IAB’s choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles.One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing?

We are grateful to Owen G. Schaefer1 and Thaddeus Metz2 for thought-provoking commentaries on our book, What is a Person? Untapped Insights from Africa.3 Our book combines insights from contemporary Africa and the West to furnish a new view, emergent personhood, that is less bound by a single tradition. Schaefer and Metz raise a number of challenges to emergent personhood. In this brief commentary, we welcome the opportunity to respond to some of them. ### Reply to critics 1. What is the special relationship all humans share? Metz asks us to clarify what is special about human–human relationships and gives rise to personhood.2 In reply, as humans, we share a human kind of life that connects us to every other human being and makes it possible to speak intelligently of belonging to ‘a human family’. When human beings are configured in a family-like way, the outstanding moral worth we associate with persons emerges. When we refer to persons emerging, we mean that the remarkable moral worth of persons is novel and did not exist before human relationships joined together in a certain way; holistic or more than the sum of the parts of individuals considered on their own, before the relationship; and irreducible, meaning that ‘person’ cannot be analysed fully in terms of other moral notions. An emergent account of persons makes sense of the fact that in all moral codes that we (the authors) are aware of, the indiscriminate killing of innocent humans is morally disturbing. We suggest the reason relates to the fact that humans belong to one and the same family such that injuring one disrupts the whole interconnected group of which each is a part. An …

African understandings of personhood are complex, with different accounts emphasizing distinct aspects of what it means to be a person. Some accounts stress excellence of character and performing well in social roles and relationships, while others focus on innate moral qualities of individuals independent of their conduct and character. This paper sheds new light on these twin aspects of personhood. It proposes a way to navigate these dual features by bringing African and Western personhood into conversation, building on the strengths of each approach, and developing a new view of personhood that we call, Emergent Personhood. Section 1 introduces diverse approaches to personhood within African thought. Section 2 compares African and Western approaches. Section 3 evaluates advantages and disadvantages of each and identifies conditions that any account of personhood must meet to leverage the advantages and avoid the disadvantages identified. Section 4 introduces Emergent Personhood, which meets these conditions. Section 5 concludes that expanding the conversation about personhood across cultures enriches an ongoing conversation about what it means to be a person.

Philosophers invoke the concept of a ‘person’ widely—not only as a basic building block for normative theories prescribing conduct, but to furnish a conceptual grounding for political and social philosophies about a just state. The concept is legion not just in philosophy, but across a wide swath of disciplines, including psychology, law, biomedicine, anthropology and others. The oldest known meaning of the word ‘person’ relates to performance before others in fiction or real life: the Latin persōna, referred to a mask used by a player in a dramatic role, or the part or role played by a person in life. Today, broad agreement about personhood exists at a high level of abstraction, yet sharp divisions emerge as we move closer to the ground. Philosophers generally agree that to be a person differs from being a member of a species, and generally characterise ‘person’ in normative, rather than purely biological, terms. They generally converge in thinking that ‘person’ indicates a superlative moral worth, variously expressed as dignity, rights or deserving to be respected or treated as an end. However, little consensus exists when it comes to delineating necessary and sufficient conditions for personhood or determining whether particular beings (or things) count as persons. Are fetuses, cows, great apes, trees, soils, ecosystems or artificially intelligent social robots persons? People holding religious views may ask, ‘Is God(s) a person?’ Views diverge. As we cross borders not only of time, but culture, accounts of personhood splinter further. Compare the account of persons frequently espoused by people indigenous to sub-Saharan Africa with the one predominant in the West today. African personhood often underscores that persons exist only within their communal relationships. This idea finds expression in pithy sayings, such as, a person is a person through other persons, and I am because …

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles.

With the world grappling with continued spread of monkeypox internationally, vaccines play a crucial role in mitigating the harms from infection and preventing spread. However, countries with the greatest need - particularly historically endemic countries with the highest monkeypox case-fatality rates - are not able to acquire scarce vaccines. This is unjust, and requires rectification through equitable allocation of vaccines globally. We propose applying the Fair Priority Model for such allocation, which emphasizes three key principles: 1) preventing harm; 2) prioritizing the disadvantaged; and 3) treating people with equal moral concern. Post-exposure prophylaxis (PEPV) has the most potential to mitigate harm, and so ensuring countries have sufficient supply for PEPV should be the first priority. And historically endemic countries, which face disadvantages that compound potential harms from monkeypox, should be the first recipients of such vaccines. Once sufficient supply is allocated for countries to apply PEPV, global allocation could move on to pre-exposure prophylaxis (PrEP), again prioritizing historically endemic countries first before distribution to the rest of the global community, based on projected number of cases and vulnerability to harm.

Background The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Methods The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022. Results We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships. Conclusions The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

This paper replies to a commentary by John-Stewart Gordon on our paper, “The Moral Standing of Social Robots: Untapped Insights from Africa.” In the original paper, we set forth an African relational view of personhood and show its implica- tions for the moral standing of social robots. This reply clarifies our position and answers three objections. The objections concern (1) the ethical significance of intelligence, (2) the meaning of ‘pro-social,’ and (3) the justification for prioritizing humans over pro-social robots.

Pratt and de Vries1 pose an important and uncomfortable question to all stakeholders in the global bioethics space. If global bioethics as they define it is ‘the ethics of public health and healthcare problems that are characterised by a global level effect or that require action beyond individual countries, and the ethics of research related to such problems’, one would expect justice and inclusivity to be among the ethical priorities. Yet, Pratt and de Vries carefully demonstrate how different forms of epistemic injustice and coloniality are embedded in the structure, generation of knowledge and praxis of global bioethics. They do this by unpicking three layers at which coloniality and epistemic injustice operate; knowledge-producer, knowledge-applied and knowledge-solicited. The authors also offer a three-pronged incremental approach to how individual and institutional actors in global bioethics can contribute to epistemic justice in the field. Pratt and de Vries present their work as ‘a first step towards reorienting the field’ of global health bioethics away from epistemic injustice. Indeed, theirs is a mapping, problem statement and recommendations piece …

Bioethics urges us to question and debate fundamental moral issues that arise in health-related sciences. However, as a result of Western dominance and globalization, bioethical thinking and practice has inevitably been shaped and defined by Western theories. With recent discussions centering on the relationship between culture and bioethics, it is important to consider how and to what extent can bioethics reflect and accommodate non-Western values and beliefs? Debatably, many scholars working in the field of ‘African bioethics’ seek to construct a bioethical practice that is grounded in indigenous African values. Yet, how relevant are ancient African cultural norms to the lives and realities of the 21st century Sub-Saharan-Africans? This edited volume explores bioethics in Africa from pluralistic and inter-cultural perspectives. The selected papers offer diverse theoretical and practical perspectives on the bioethical challenges that are common and specific to the lives of Sub-Sahara Africans. The contributors define bioethics broadly (beyond ethical issues relating to biomedical and biotechnological science) to include applied ethics that concern all aspects of life. Multidisciplinary in approach, the contributions to this book consider bioethics in relation to philosophy, social work, psychiatry, African studies, religious studies, psychology, and medicine. The broad scope of this volume means it will be of interest to those studying and working in bioethics as well as the fields mentioned above.

The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent in sub-Saharan Africa. The paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, and a proposed international Pandemic Treaty. It proposes a path forward that better realizes ubuntu in global health.