Karola Kreitmair

Abstract“Empathic AI” is being adopted in clinics as a means of offloading some of the work of clinician‐patient encounters. Indeed, a recent study reported that generative large language models such as GPT4 were perceived as being more empathetic than human physicians. I argue that encounters between AI chatbots and patients lack an essential feature of good clinical encounters—recognition. More fundamental than empathy, Hegelian recognition is a precondition for features such as honesty and respect for autonomy that are central tenets of medical ethics. I argue that patients have a justified expectation of mutual recognition in a clinical encounter and that, given specific limitations of AI chatbots, this justified expectation cannot be met by them. Problematically, however, AI chatbots are designed to mimic human expressions of recognition, resulting in an alienating absurdity at the heart of “empathic AI.” This fundamental incoherence is not merely a philosophical curiosity; it is an issue that must be directly addressed if AI chatbots are to take on roles in clinical encounters.

The possibility of consciousness in human brain organoids is sometimes viewed as determinative in terms of the moral status such entities possess, and, in turn, in terms of the research protections such entities are due. This commonsense view aligns with a prominent stance in neurology and neuroscience that consciousness admits of degrees. My paper outlines these views and provides an argument for why this picture of correlating degrees of consciousness with moral status and research protections is mistaken. I then provide an alternative account of the correlation between moral status and consciousness, and consider the epistemic ramifications for research protections of this account.

Transplant surgeons in the USA have begun performing a novel organ procurement protocol in the setting of circulatory death. Unlike traditional donation after circulatory death (DCD) protocols, in situ normothermic perfusion DCD involves reperfusing organs, including the heart, while still contained in the donor body. Some commentators, including the American College of Physicians, have claimed that in situ reperfusion after circulatory death violates the widely accepted Dead Donor Rule (DDR) and conclude that in situ reperfusion is ethically impermissible. In this paper I argue that, in terms of respecting the DDR, in situ reperfusion cardiac transplantation does not differ from traditional DCD cardiac transplantation. I do this by introducing and defending a refined conception of circulatory death, namely vegetative state function permanentism. I also argue against the controversial brain occlusion feature of the in situ reperfusion DCD protocol, on the basis that it is ethically unnecessary and generates the problematic appearance of ethical dubiousness.

According to the mainstream conception of research involving human participants, researchers have been trained scientists acting within institutions and have been the individuals doing the studying, while participants, who are nonscientist members of the public, have been the individuals being studied. The relationship between the public and scientists is evolving, however, giving rise to several new concepts, including crowdsourcing and citizen science. In addition, the practice of gamification has been applied to research protocols. The role of gamified, crowdsourced citizen scientist is new in the domain of scientific research and does not fit into the existing taxonomy of researchers and participants. We delineate and explicate this role and show that, while traditional roles are governed by well‐established norms and regulations, individuals engaged in gamified, crowdsourced citizen science—gamers—fall through the cracks of research protections and regulations. We consider the issues this raises, including exploitation and the absence of responsibility and accountability. Finally, we offer suggestions for how the current lack of appropriate norms may be rectified.

Mobile Health (m-health) technologies, such as wearables, apps, and smartwatches, are increasingly viewed as tools for improving health and well-being. In particular, such technologies are conceptualized as means for laypersons to master their own health, by becoming “engaged” and “empowered” “managers” of their bodies and minds. One notion that is especially prevalent in the discussions around m-health technology is that of empowerment. In this paper, I analyze the notion of empowerment at play in the m-health arena, identifying five elements that are required for empowerment. These are (1) knowledge, (2) control, (3) responsibility, (4) the availability of good choices, and (5) healthy desires. I argue that at least sometimes, these features are not present in the use of these technologies. I then argue that instead of empowerment, it is plausible that m-health technology merely facilitates a feeling of empowerment. I suggest this may be problematic, as it risks placing the burden of health and behavior change solely on the shoulders of individuals who may not be in a position to affect such change.

Humans are a species endowed with considerable cognitive plasticity, existing in a malleable social environment. As a result, behavioural constraints emerge, which ensure the smooth functioning of the whole. In order to enable the negotiation of social contracts, individuals are under pressure to adopt consistent behavioural track-records that instil trust in potential interaction partners. This leads to the emergence of stable selves. The pressure towards consistency facilitates the proliferation of normative relations. The arrival of language intensifies this consistency-enhancing pressure on the individual, as it opens up the cognitive domain as an additional target of pressurization.