Lily Frank

In this chapter we identify three potentially morally problematic behaviours that are common among users of dating and hook-up apps (DHAs) and provide arguments as to why they may or may not be considered (a) in a category of their own, distinct from similar behaviours outside of DHAs; (b) caused or facilitated by affordances and business logic of DHAs; (c) as indeed morally wrong. We also consider ways in which morally problematic behaviours can be anticipated, mitigated, or even prevented by analysis of the ethical and moral dimensions of technologies and their afforded uses. Finally, we offer some possible directions for future work on these topics in particular and on the ethical consequences of DHAs in general.

Engineering an artificial intelligence to play an advisory role in morally charged decision making will inevitably introduce meta-ethical positions into the design. Some of these positions, by informing the design and operation of the AI, will introduce risks. This paper offers an analysis of these potential risks along the realism/anti-realism dimension in metaethics and reveals that realism poses greater risks, but, on the other hand, anti-realism undermines the motivation for engineering a moral AI in the first place.

Dating and hookup apps (DHAs) are now widely used and may be transforming our intimate relationships. The apps are beneficial in fostering intimate connections among those who are lonely, who are members of minority or marginalized groups, or who live nomadic lifestyles because of work or recreational travel. However, the wider social and relational changes that DHAs portend are merely beginning to be seriously discussed by academics (Arias et al., 2017). In this chapter, we employ concepts from the philosophy of technology that inform our analysis of these changes. We also collate some of the morally significant impacts of DHAs and present some of the elements of the architecture of DHAs that facilitate them. Although there are many reasons to be concerned about DHAs, we argue that there is room for cautious optimism that DHAs may be vehicles of positive social and moral change.

In this chapter, we consider ethical and philosophical aspects of trust in the practice of medicine. We focus on trust within the patient-physician relationship, trust and professionalism, and trust in Western (allopathic) institutions of medicine and medical research. Philosophical approaches to trust contain important insights into medicine as an ethical and social practice. In what follows we explain several philosophical approaches and discuss their strengths and weaknesses in this context. We also highlight some relevant empirical work in the section on trust in the institutions of medicine. It is hoped that the approaches discussed here can be extended to nursing and other topics in the philosophy of medicine.

The development of highly humanoid sex robots is on the technological horizon. If sex robots are integrated into the legal community as “electronic persons”, the issue of sexual consent arises, which is essential for legally and morally permissible sexual relations between human persons. This paper explores whether it is conceivable, possible, and desirable that humanoid robots should be designed such that they are capable of consenting to sex. We consider reasons for giving both “no” and “yes” answers to these three questions by examining the concept of consent in general, as well as critiques of its adequacy in the domain of sexual ethics; the relationship between consent and free will; and the relationship between consent and consciousness. Additionally we canvass the most influential existing literature on the ethics of sex with robots.

This paper provides an analysis of the way in which two foundational principles of medical ethics–the trusted doctor and patient autonomy–can be undermined by the use of machine learning (ML) algorithms and addresses its legal significance. This paper can be a guide to both health care providers and other stakeholders about how to anticipate and in some cases mitigate ethical conflicts caused by the use of ML in healthcare. It can also be read as a road map as to what needs to be done to achieve an acceptable level of explainability in an ML algorithm when it is used in a healthcare context.

It is not clear to what the projects of creating an artificial intelligence (AI) that does ethics, is moral, or makes moral judgments amounts. In this paper we discuss some of the extant metaethical theories and debates in moral philosophy by which such projects should be informed, specifically focusing on the project of creating an AI that makes moral judgments. We argue that the scope and aims of that project depend a great deal on antecedent metaethical commitments. Metaethics, therefore, plays the role of an Archimedean fulcrum in this context, very much like the Archimedean role that it is often taken to take in context of normative ethics (Dworkin 1996; Dreier 2002; Fantl 2006; Ehrenberg 2008).

In this chapter we take stock of some of the complexities of the sprawling field of AI ethics. We consider questions like "what is the proper scope of AI ethics?" And "who counts as an AI ethicist?" At the same time, we flag several potential uses and abuses of AI ethics. These include challenges for the AI ethicist, including what qualifications they should have; the proper place and extent of futuring and speculation in the field; and the dilemmas concerning how we use our public and academic resources.

The proposition that digital innovations can put people in charge of their health has been accompanied by prolific talk of empowerment. In this paper we consider ethical challenges and opportunities of trying to achieve justice and empowerment using digital health initiatives. The language of empowerment can misleadingly suggest that by using technology, people can control their health and take responsibility for health outcomes to a greater degree than is realistic or fair. Also, digital health empowerment often primarily reaches people who already have high technological and health literacy, leaving others behind. We critically investigate whether the concept of health empowerment could be re-engineered to mean something different, namely the process of improving the health literacy and access of those who least possess it, in line with recent proposals for conceptual engineering in the service of justice. We settle on the weaker conclusion that underlying ethical values including justice should be used to interpret the existing concept of empowerment. To conclude, we take a high-level view of various strategies for achieving the ethical value associated with digital health empowerment.

How could ectogestative technology disrupt gender roles, parenting practices, and concepts such as ‘birth’, ‘body’, or ‘parent’? In this chapter, we situate this emerging technology in the context of the history of reproductive technologies and analyse the potential social and conceptual disruptions to which it could contribute. An ectogestative device, better known as ‘artificial womb’, enables the extra-uterine gestation of a human being, or mammal more generally. It is currently developed with the main goal of improving the survival chances of extremely premature neonates. We argue that the intended use of the technology in neonatal intensive care units, as an alternative to current incubators (’partial-ectogestation’), challenges concepts such as ‘birth’, ‘fetus’, and ‘neonate’, and has several ethico-legal implications. We moreover address a more futuristic scenario where the entire embryological and fetal development could happen within an artificial womb (’full-ectogestation’). Such a scenario reveals the disruption of gender roles, parenting practices, and concepts such as ‘mother’, ‘father’, and ‘parent’. Both full- and partial-ectogestation would have implications for engineering and design, law-making, ethics, and philosophical anthropology.

In the last few decades, several philosophers have written on the topic of moral revolutions, distinguishing them from other kinds of society-level moral change. This article surveys recent accounts of moral revolutions in moral philosophy. Different authors use quite different criteria to pick out moral revolutions. Features treated as relevant include radicality, depth or fundamentality, pervasiveness, novelty and particular causes. We also characterize the factors that have been proposed to cause moral revolutions, including anomalies in existing moral codes, changing honour codes, art, economic conditions and individuals or groups. Finally, we discuss what accounts of moral revolutions have in common, how they differ and how moral revolutions are distinguished from other kinds of moral change, such as drift and reform.

Addiction appears to be a deeply moralized concept. To understand the entwinement of addiction and morality, we briefly discuss the disease model and its alternatives in order to address the following questions: Is the disease model the only path towards a ‘de-moralized’ discourse of addiction? While it is tempting to think that medical language surrounding addiction provides liberation from the moralized language, evidence suggests that this is not necessarily the case. On the other hand non-disease models of addiction may seem to resuscitate problematic forms of the moralization of addiction, including, invoking blame, shame, and the wholesale rejection of addicts as people who have deep character flaws, while ignoring the complex biological and social context of addiction. This is also not necessarily the case. We argue that a deficit in reasons responsiveness as basis for attribution of moral responsibility can be realized by multiple different causes, disease being one, but it also seems likely that alternative accounts of addiction as developed by Flanagan, Lewis, and Levy, may also involve mechanisms, psychological, social, and neurobiological that can diminish reasons responsiveness. It thus seems to us that nondisease models of addiction do not necessarily involve moralization. Hence, a non-stigmatizing approach to recovery can be realized in ways that are consistent with both the disease model and alternative models of addiction.

The power of technology to transform religions, science, and political institutions has often been presented as nothing short of revolutionary. Does technology have a similarly transformative influence on societies’ morality? Scholars have not rigorously investigated the role of technology in moral revolutions, even though existing research on technomoral change suggests that this role may be considerable. In this paper, we explore what the role of technology in moral revolutions, understood as processes of radical group-level moral change, amounts to. We do so by investigating four historical episodes of radical moral change in which technology plays a noteworthy role. Our case-studies illustrate the plurality of mechanisms involved in technomoral revolutions, but also suggest general patterns of technomoral change, such as technology’s capacity to stabilize and destabilize moral systems, and to make morally salient phenomena visible or invisible. We find several leads to expand and refine conceptual tools for analysing moral change, specifically by crystallizing the notions of ‘technomoral niche construction’ and ‘moral payoff mechanisms’. Coming to terms with the role of technology in radical moral change, we argue, enriches our understanding of moral revolutions, and alerts us to the depths of which technology can change our societies in wanted and unwanted ways.

Moral bioenhancement, nudge-designed environments, and ambient persuasive technologies may help people behave more consistently with their deeply held moral convictions. Alternatively, they may aid people in overcoming cognitive and affective limitations that prevent them from appreciating a situation’s moral dimensions. Or they may simply make it easier for them to make the morally right choice by helping them to overcome sources of weakness of will. This paper makes two assumptions. First, technologies to improve people’s moral capacities are realizable. Second, such technologies will actually help people get morality right and behave more consistently with whatever the ‘real’ right thing to do turns out to be. The paper then considers whether or not humanity loses anything valuable, particularly opportunities for moral progress, when being moral is made much easier by eliminating difficult moral deliberation and internal moral struggle. Ultimately, the worry that moral struggle has value as a catalyst for moral progress is rejected. Moral progress is understood here as the discovery and application of new values or sensitization to new sources of harm.

The “attention economy” refers to the tech industry’s business model that treats human attention as a commodifiable resource. The libertarian critique of this model, dominant within tech and philosophical communities, claims that the persuasive technologies of the attention economy infringe on the individual user’s autonomy and therefore the proposed solutions focus on safeguarding personal freedom through expanding individual control. While this push back is important, current societal debates on the ethics of persuasive technologies are informed by a particular understanding of attention, rarely posited explicitly yet assumed as the default. They share the same concept of attention, namely an individualistic and descriptive concept of attention that is a cognitive process, an expendable resource, something that one should control individually. We step away from a negative analysis in terms of external distractions and aim for positive answers, turning to Buddhist ethics to formulate a critique of persuasive technology from a genuinely ethical perspective. Buddhist ethics points at our attention’s inescapable ethical and ontological embeddedness. Attention as practice requires “the right effort” to distinguish desirable and undesirable states, the “right concentration” to stop the flow we are caught in, and the “right mindfulness” to fortify the ability to attend to the present situation and keep in mind a general sense of life’s direction. We offer input for further philosophical inquiry on attention as practice and attention ecology. We put forward comfort/effort and individualism/collectivism as two remaining central tensions in need of further research.

Upon entering the examination room, Caitlyn encounters a woman sitting alone and in distress. Caitlyn introduces herself as the hospital ethicist and tells the woman, Mrs. Dennis, that her aim is to help her reach a decision about whether to perform an autopsy on her recently deceased husband. Mrs. Dennis begins the encounter by telling the ethicist that she has to decide quickly, but that she is very torn about what to do. Mrs. Dennis adds, “My sons disagree about the autopsy.” As a standardized patient, a specialized actor, the woman playing Mrs. Dennis has already delivered the same opening lines several times to different learners practicing their clinical ethics consultation skills. An SP encounter is a simulated patient encounter used for educational purposes that requires the standardization of verbal and behavioral responses. In the encounter, the simulator, or “patient,” uses a scripted medical history to enable the learner to employ a certain skill, say, the ability to perform a neurological exam. The use of standardized patients in the evaluation of clinical skills has become a staple in medical education. To tackle the challenge of teaching clinical ethics consultation skills, we have incorporated SP encounters into the curriculum of the Bioethics Program of The Union Graduate College and the Icahn School of Medicine at Mount Sinai. SP encounters are incorporated into one of our onsite classes, the Onsite Clinical Ethics Practicum, and they are part of the capstone examination, which all of our graduates must complete successfully. The inclusion of simulated encounters into the curriculum is one way in which we equip our students with the core competencies specified by the American Society for Bioethics and Humanities Task Force for clinical ethicists

Some critics of sex-robots worry that their use might spread objectifying attitudes about sex, and common sense places a higher value on sex within love-relationships than on casual sex. If there could be mutual love between humans and sex-robots, this could help to ease the worries about objectifying attitudes. And mutual love between humans and sex-robots, if possible, could also help to make this sex more valuable. But is mutual love between humans and robots possible, or even conceivable? We discuss three clusters of ideas and associations commonly discussed within the philosophy of love, and relate these to the topic of whether mutual love could be achieved between humans and sex-robots: (i) the idea of love as a “good match”; (ii) the idea of valuing each other in our distinctive particularity; and (iii) the idea of a steadfast commitment. We consider relations among these ideas and the sort of agency and free will that we attribute to human romantic partners. Our conclusion is that mutual love between humans and advanced sex-robots is not an altogether impossible proposition. However, it is unlikely that we will be able to create robots sophisticated enough to be able to participate in love-relationships anytime soon.