Davide Battisti

Can an AI truly be your digital twin? Technology companies, startups, and even academic researchers increasingly claim so. From grief-bots that promise to let you talk with deceased loved ones to clinical tools designed to predict patients' treatment preferences, personalized Large Language Models are being marketed as faithful replications of individual identity, personality, and values. The digital twin label—borrowed from industrial engineering, where it describes computational models precisely mirroring physical systems—lends these claims an aura of scientific credibility. But is this metaphor appropriate, or is it dangerously misleading? This paper argues that applying the digital twin metaphor to personalized LLMs constitutes a systematic mischaracterization with serious ethical consequences. To this end, we first outline three plausible interpretations of the PDT metaphor—behaviorist, representational, and phenomenal. We then show that current AI systems do not satisfy the conditions of any of these interpretations, rendering the PDT metaphor ultimately inappropriate. The consequences of this metaphorical overreach are far from abstract. When vulnerable individuals—grieving families, patients facing incapacity, people seeking psychological support—interact with systems marketed as preserving human essence, they risk forming attachments to sophisticated illusions. The metaphor fosters misplaced trust, distorts public understanding of AI capabilities, and shapes policy debates on false premises. As these technologies proliferate into healthcare, legal proceedings, and intimate relationships, metaphorical precision becomes an ethical imperative. We conclude by proposing alternative frameworks that honestly represent what these systems can and cannot do.

It is plausible that time of birth affects one's prospects for wellbeing. Being born during a war or recession might have a negative impact on early life and lifetime wellbeing. In natural reproduction, delaying conception does not result in the same child being born later, but rather a different child altogether; therefore, prospective parents cannot harm/benefit their children by choosing their time of birth. However, we argue that for prospective parents undergoing the IVF process, things are different. Since it is possible to freeze and store embryos indefinitely before implantation, parents can choose their child's time of birth. Because certain birth timings may better support wellbeing, this introduces the possibility of repro‐timing harms and benefits. This paper explores this new concept by outlining its theoretical assumptions and examining the moral reasons prospective parents in IVF might have for delaying implantation in the short, medium, and long term.

Assisted reproductive technologies have greatly increased our control over reproductive choices, leading some bioethicists to argue that we face unprecedented moral obligations towards progeny. Several models attempting to balance the principle of procreative autonomy with these obligations have been proposed. The least demanding is the minimal threshold model (MTM), according to which every reproductive choice is permissible, except creating children whose lives will not be worth living. Hence, as long as the future child is likely to have a life worth living, prospective parents may be allowed to use preimplantation genetic diagnosis (PGD) to select embryos with genetic diseases or disabilities. Assuming a consequentialist person‐affecting view of morality, this paper investigates whether the MTM is an appropriate tool to guide procreative decisions given the continuous development of reproductive genetic technologies. In particular, I consider germline genome editing (GGE) and I argue that its application in human reproduction, unlike PGD, should be conceived as person‐affecting towards future progeny. I claim that even if we assume the plausibility of the MTM within PGD, we are committed to accepting that a greater moral obligation towards progeny should guide procreative decisions if GGE were available. In this case, the MTM should no longer be considered an appropriate instrument to guide procreative choices. Finally, I investigate when we face this greater moral obligation, concluding that it applies only when prospective parents have already engaged in the in vitro fertilization process.

Fröding and Peterson ( 2025 ) offer four objections challenging my argument that using ChatGPT to fulfill authenticity-based obligations is generally problematic, as it fails to respect what I call “second-person authenticity”. In this paper, I respond to each of these criticisms and conclude that they do not undermine the core of my argument. Second-person authenticity remains a morally relevant and independent dimension of human-to-human relationships, one that must be urgently considered in an era where AI mediation is becoming increasingly pervasive.

In this paper, I offer a reply to Lavazza (2025), who states that using an LLM as a co-author to apologize to a partner – far from compromising second-person authenticity – can improve relational morality. I agree that some valuable aspects of the relationship may be enhanced in the co-authorship context; however, the second-person authenticity standard cannot still be adequately met. At best, using ChatGPT as a co-author might be compatible with a scenario in which the second-person authenticity assessment is suspended and postponed to a later point in time; this allows us to capture a potential diachronic dimension in such an assessment that has not yet been explored. In the remainder of the article, I criticize Lavazza’s Kantian argument and offer some clarifications on the analogy between using ChatGPT and friend-suggested communication, as well as on the terminology used.

The structural scarcity of healthcare resources has deeply challenged their fair distribution, prompting the need for allocation criteria. Long under the spotlight of the bioethical debate with an extraordinary peak during the recent COVID-19 pandemic, micro-allocation of healthcare has been extensively discussed in the literature with regard to issues of substantive and formal justice. This paper addresses a relatively underdiscussed question within the field of formal justice: who should define micro-allocation criteria in healthcare? To explore this issue, we first establish formal requirements that must be met for allocation criteria to be considered fair and legitimate. Then, we introduce three possible answers to the research question: the attending physician, the team of physicians, and the team of experts. We discuss and then reject all of them, arguing that the task of defining allocation criteria should be assigned to a political representative, supported by a cross-disciplinary team of experts. This proposal is based on the need to take democracy seriously as a tool for making substantive allocative decisions in light of the inevitable disagreement on such matters within a community. To support this claim, we present two key arguments—the democracy argument and the consistency argument. We also pre-emptively respond to two significant critiques: the too-specificity of the decision critique and the catastrophic outcomes critique. In conclusion, we argue that our proposal offers the fairest and most legitimate decision-making process for healthcare micro-allocation.

The structural scarcity of healthcare resources raises im- portant bioethical issues regarding their allocation, such as who should make such decisions. This paper evaluates whether or not physicians should be responsible for deciding how to allocate healthcare resources in the micro-allocation context. Addressing this issue is essential for determining the moral or legal responsibility of physicians when allocating scarce healthcare resources in both ordinary and emer- gency conditions. The paper is structured as follows: First, I discuss the perspective of the physician as a double agent, balancing their duty to their patient with that towards other patients and society. This perspective aims to justify bedside rationing by physicians. After discussing some critical issues with this conception, I propose a critique based of the prin- ciple of justice. I then define the necessary requirements for a fair and legitimate allocation choice in healthcare and argue that the specificity of such a choice makes it morally problematic to attribute a direct decision-making role to the treating physician when rationing healthcare resources in the micro-allocation context. This leads to a rejection of the conception of the physician as a double agent and bedside rationing, although I observe that this does not preclude the physician from some involvement in the process of defining allocation criteria and methods.

Questo contributo propone una riflessione sul tema dell’expertise bioetica. In primo luogo, si definirà questo tipo di expertise come una competenza metodologica. Questa scelta è motivata dalla necessità di rispondere alla critica secondo cui non potrebbe esistere l’expertise in ambito bioetico. In secondo luogo, si sosterrà che definire tale exper- tise in termini metodologici non basta per esaurire la riflessione sul tema; verranno dunque accennate alcune questioni da affrontare per una definizione completa in questo ambito.

Newborn screening is a publicly funded test aimed at identifying genetic diseases in healthy infants where early diagnosis can lead to timely and effective clinical intervention. Recently, there has been growing interest in applying genomic sequencing, in particular Whole Genome Sequencing and Whole Exome Sequencing, to this screening, significantly increasing the number of identifiable conditions. Considering the promises of this approach and the specificity of genomic data, some have suggested that newborn sequencing could serve the interests of not only screened newborns but also their parents, relatives, and even society. Determining which interests should legitimately be considered in genomic newborn sequencing is crucial for defining which genes to include in the gene panel of neonatal genomic screening. Stemming from a bioethical perspective, this paper discusses which interests should be considered in newborn sequencing, what the implications are for gene panel definition, and what conflicts between interests might emerge. Specifically, the newborn clinical interest, the reproductive interest, the family clinical interest, personal utility, and social utility will be considered.

At the height of the Covid pandemic, there was much discussion in the literature about using human challenge trials (HCTs) to expedite the development of effective Covid-19 vaccines. Historically, reluctance to fully accept HCTs has largely been due to potential conflicts with the principle of nonmaleficence in bioethics. Only a few commentators have explored this topic in depth. In this paper, we claim that to address ethical concerns regarding HCTs, two types of ethical reasons should be identified and investigated: first-order reasons that can be given to claim that a practice in itself is in direct conflict with the principles of bioethics; and second-order reasons that take into consideration how a practice is carried out and its consequences. We argue that understanding these ethical reasons is crucial for guiding the implementation of HCTs. We investigate a first-order reason against HCTs when the practice is in conflict with the principle of nonmaleficence, and when it is not. Following this argument and assuming there is no first-order reason based on nonmaleficence that hinders using HCTs, we argue there may be second-order reasons to guide implementation of this practice, such as difficulty in obtaining informed consent; protection of the weaker party; and trust in the scientific enterprise.

This book rethinks procreative responsibility considering the continuous development of Assisted Reproductive Technologies. It presents a person-affecting moral argument, highlighting that the potential availability of future Assisted Reproductive Technologies brings out new procreative obligations. Traditionally, Assisted Reproductive Technologies are understood as practices aimed at extending the procreative freedom of prospective parents. However, some scholars argue that they also give rise to new moral constraints. This book builds on this viewpoint by presenting a person-affecting perspective on the impact of current and future Assisted Reproductive Technologies on procreative responsibility, with a specific focus on reproductive Genome Editing and ectogenesis. The author shows that this perspective is defensible both from a consequences-based person-affecting perspective and from a person-affecting account that considers morally relevant intuitions and attitudes.

The development of AI tools, such as large language models and speech emotion and facial expression recognition systems, has raised new ethical concerns about AI’s impact on human relationships. While much of the debate has focused on human-AI relationships, less attention has been devoted to another class of ethical issues, which arise when AI mediates human-to-human relationships. This paper opens the debate on these issues by analyzing the case of romantic relationships, particularly those in which one partner uses AI tools, such as ChatGPT, to resolve a conflict and apologize. After reviewing some possible, non-exhaustive, explanations for the moral wrongness of using AI tools in such cases, I introduce the notion of second-person authenticity: a form of authenticity that is assessed by the other person in the relationship (e.g., a partner). I then argue that at least some actions within romantic relationships should respect a standard of authentic conduct since the value of such actions depends on who actually performs them and not only on the quality of the outcome produced. Therefore, using AI tools in such circumstances may prevent agents from meeting this standard. I conclude by suggesting that the proposed theoretical framework could also apply to other human-to-human relationships, such as the doctor-patient relationship, when these are mediated by AI; I offer some preliminary reflections on such applications.

This paper puts forward a wish list of requirements for formal fairness in the specific context of triage in emergency departments (EDs) and maps the empirical and conceptual research questions that need to be addressed in this context in the near future. The pandemic has brought to the fore the necessity for public debate about how to allocate resources fairly in a situation of great shortage. However, issues of fairness arise also outside of pandemics: decisions about how to allocate resources are structurally unavoidable in healthcare systems, as value judgements underlie every allocative decision, although they are not always easily identifiable. In this paper, we set out to bridge this gap in the context of EDs. In the first part, we propose five formal requirements specifically applied for ED triage to be considered fair and legitimate: publicity, accessibility, relevance, standardisability and accountability. In the second part of the paper, we map the conceptual and empirical ethics questions that will need to be investigated to assess whether healthcare systems guarantee a formally just ED triage. In conclusion, we argue that there is a vast research landscape in need of an in-depth conceptual and empirical investigation in the context of ED triage in ordinary times. Addressing both types of questions in this context is vital for promoting a fair and legitimate ED triage and for fostering reflection on formal fairness allocative issues beyond triage.

Procreative obligations are often discussed by evaluating only the consequences of reproductive actions or omissions; less attention is paid to the moral role of intentions and attitudes. In this paper, I assess whether intentions and attitudes can contribute to defining our moral obligations with regard to assisted reproductive technologies already available, such as preimplantation genetic diagnosis (PGD), and those that may be available in future, such as reproductive genome editing and ectogenesis, in a way compatible with person‐affecting constraints. I propose the parent–child relationship argument, which is based on the moral distinction between creating and parenting a child. Hence, I first argue that intentions and attitudes can play a role in defining our moral obligations in reproductive decisions involving PGD. Second, I maintain that if we accept this and recognize reproductive genome editing and ectogenesis as person‐affecting procedures, we should be committed to arguing that prospective parents may have moral reasons to prefer reproduction via such techniques than via sexual intercourse. In both cases, I observe an extension of our procreative responsibility beyond what is proposed by the consequentialist person‐affecting morality.

Knowledge brokers are among the main channels of communication between scientists and the public and a key element to establishing a relation of trust between the two. But translating knowledge from the scientific community to a wider audience presents several difficulties, which can be accentuated in times of crisis. In this paper we study some of the problems that knowledge brokers face when communicating in times of crisis. During the first wave of the COVID-19 pandemic, we collected interviews with Italian experts that played a major role as knowledge brokers in the local media. We asked them questions about five main topics: the features and role of science communicators; the use of language in communicating science; the importance of the relation of trust with the public; the peculiarity of communicating in a context of emergency; the problem of disagreement among experts, and its public perception and communication. The goal of this paper is to understand, through the words of knowledge brokers themselves, what they consider as best practices (and obstacles) to create trust between scientists and the public. Our empirical work can inform normative accounts of what knowledge brokering should be about.

During the first wave of the COVID-19 pandemic in Italy, practitioners had to make tragic decisions regarding the allocation of scarce resources in the ICU. The Italian debate has paid a lot of attention to identifying the specific regulatory criteria for the allocation of resources in the ICU; in this paper, however, we argue that deciding such criteria is not enough for the implementation of fair and transparent allocative decisions. In this respect, we discuss three ethical issues: (a) in the Italian context, the treating physician, rather than a separate committee, was generally the one responsible for the allocation decision; (b) although many allocative guidelines have supported moral equivalence between withholding and withdrawing treatments, some health professionals have continued to consider it a morally problematic aspect; and (c) the health workers who have had to make the aforementioned decisions or even only worked in ICU during the pandemic often experienced moral distress. We conclude by arguing that, even if these problems are not directly related to the above-mentioned issues of distributive justice, they can nevertheless directly affect the quality and ethics of the implementation of allocative criteria, regardless of those chosen.

In Italy, during the first wave of the Covid-19 pandemic, the Italian Society of Resuscitators and Pain Therapists (SIAARTI) and the Italian National Bioethics Committee (CNB) published ethical guidance on the allocation of scarce intensive care resources. In this paper, we outline and compare these documents in detail, highlighting differences and similarities. In particular, we argue that major differences exist with respect to the principles and values underpinning the documents and the normative allocation criteria proposed. Conversely, similarities can be traced with respect to a functional rather than substantial endorsement of the age criterion, the importance of transparency, and the consideration over healthcare professionals’ responsibility regarding allocative decisions. In conclusion, we argue that Italy has lacked a comprehensive and publicly-accountable policy articulating principles and operational criteria geared to strengthen the “ethical preparedness” of the country in dealing with current and possible future public health emergencies.

In this paper, I analyze the ethical implications of genetic enhancement within the specific framework of the “child’s right to an open future” argument (CROF). Whilst there is a broad ethical consensus that genetic modifications for eradicating diseases or disabilities are in line with – or do not violate – CROF, there is huge disagreement about how to ethically understand genetic enhancement. Here, I analyze this disagreement and I provide a revised formulation of the argument in the specific field of genetic enhancement. First, I argue that CROF is not in contrast with every kind of enhancement. I subsequently discuss whether CROF requires some moral obligations to enhance progeny. My argument is that parents do not have the moral obligation to open as many options as possible for their children. Rather, they should provide them with a reasonable range of opportunities. Finally, I contend that the moral obligations required by CROF are directly dependent on what Allen Buchanan calls the ‘dominant cooperative framework’ in a given society. I conclude by claiming that, at present, parents are not morally obliged to genetically enhance their children since a non-enhanced person already might have access to a reasonable range of opportunities. However, the moral obligation to enhance progeny might arise if a structural modification of the dominant cooperative framework occurs.

In this paper, I will present the empirical version of the slippery slope argument (SSA) in the field of genome editing. According to the SSA, if we adopt germline manipulation of embryos we will eventually end up performing or allowing something morally reprehensible, such as new coercive eugenics. I will investigate the actual possibility of sliding towards eugenics: thus, I will examine enhancement and eugenics both in the classical and liberal versions, through the lens of SSA. In the first part, I will discuss the classical eugenics from a historical perspective and conclude that classical eugenics is morally deplorable; but by currently accepting genome editing I argue that it is not possible to ‘slip’ into classical eugenics. Then, I will analyze liberal eugenics: I will consider Habermas’ and Sandel’s objections to liberal eugenics and genetic human enhancement. Subsequently, I will reply to these arguments affirming that, although it is not possible to refuse any form of genetic enhancement, liberal eugenics would not consider the principles of justice, non-maleficence, and non-instrumentalization; hence, it should be considered not morally acceptable. In addition, I will support the thesis according to which the possibility of relapsing into liberal eugenics is more likely than relapsing into classical eugenics. Then, I will present a strategy that, while avoiding falling into the undesirable scenarios related to SSA, still accepts some application of germline genome editing of embryos and gametes. In such a way, I will show that even if we accept the plausibility of a certain slip into an undesirable scenario, SSA does not offer conclusive reasons to forbid any use of germline genome editing technique in both therapeutic and enhancement fields.

The article by Conrad et al. (AJOB Neuroscience, 2019, 10:1) does not take into account another, still hypothetical, procedure for cognitive enhancement (CE) which would be appropriate to consider in the surveys, i.e. the possibility to genetically enhance the cognitive abilities of a future individual using genome editing techniques. In this case, the conclusions of the article in the context of the “self-others difference” and “safety/naturalness” would be questioned. In fact, the results of the hypothetical surveys with the variant “genome editing” could be significantly different from those obtained in the survey proposed by the authors: an individual would decide not for himself, but for the CE in a future child. In light of these considerations, we hold that the article highlights just the attitudes toward the principle of autonomy and redistributive justice; however, by introducing the new hypothetical scenario of CE with genome editing the attitudes toward the principles of beneficence and non-instrumentalisation could also be appreciated. Special attention to future generations is necessary to inform potential CE public policy, though using genome editing to enhance cognition abilities is just a future hypothetical perspective.