Nancy Jecker

AI is increasingly being deployed for patients in mental health settings. While attention has been given to ensuring AI for mental health is person-centered, no study we are aware of has considered how understandings of ‘person-centered’ healthcare vary across cultures or examined the implications for designing AI for mental health. This paper fills this critical gap. We ask, how do understandings of ‘person-centered’ healthcare differ in Japanese and Western societies and how do these differences manifest when AI is used for mental health? To answer these questions, we use Japanese and Western philosophical frameworks to analyze cases involving conversational AI and social robots for mental health and identify salient differences. The analyses suggest the need to ensure AI for mental health is culturally calibrated. We translate this requirement to actionable guidelines that recommend designing AI for mental health to be culturally competent, people-centered, able to keep humans ‘in the loop,’ personalized, privacy respecting, relationally oriented, and decolonized. More research is needed to develop metrics for culturally responsive AI, test guidelines in diverse settings, and consider their application to other healthcare areas.

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.

This paper asks how bioethics navigates, and should navigate, value pluralism in the increasingly global spaces in which bioethics operates. We juxtapose the ethical approaches suggested by East Asian societies, drawing primarily on Confucian ethics, with approaches more prevalent in Western societies, especially North America and Western Europe. Drawing on the Confucian virtue of _li_ (禮) (ritual propriety and decorum), we argue for greater tolerance, respect, epistemic justice, cultural humility and civility. We show how to translate these values into practice using the examples of international bioethics policies governing abortion practice, artificial intelligence governance and climate change. The ‘Introduction’ section raises the question of how to engage in bioethics across borders. The section, ‘Leading Views of Bioethics are WEIRD’ explores how the field of bioethics currently navigates value pluralism. It characterises leading bioethics approaches as WEIRD—Western, educated, industrialised, rich and democratic. The section, ‘East Asian and Western Views of Personhood’ illustrates WEIRD approaches, juxtaposing Eastern and Western accounts of personhood in three cases: social robots, prenatal human life, and nature. The section, ‘Epistemic Justice and Value Pluralism’ argues that bioethics’ WEIRDness violates epistemic justice by assigning excess credibility to the West while deflating the credibility of the East. We propose a pluriversal alternative and apply it to bioethics practice by drawing on the Confucian virtue of _li_. The paper concludes that bioethicists should embrace a pluriversal approach to global value diversity.

This chapter draws on sub-Saharan African ethics to develop an argument for mitigating climate change and easing adaptation for the world's most vulnerable people. Section 1 sets forth a theoretical groundwork that appeals to two prominent African views of personhood. Section 2 elaborates these frameworks in the context of climate change, discussing ubuntu, solidarity, and common humanity. Section 3 considers the practical implications of the ethical analysis with special attention to justly transitioning toward sustainable development. Section 4 concludes that African ethics brings important insights to debates about climate change and duties to future people, especially duties to those most vulnerable to climate change's effects.

This Commentary critiques an extremely relational view of robot moral status, drawing out its practical implications for ethics and law. It also suggests next steps for AI ethics if extremely relational reasoning is compelling. Section I introduces the topic, distinguishing an ‘extremely relational’ view from more moderate relational views. Section II illustrates extremely relational views using the example of embodiment. Section III explores practical implications of extremely relational views for ethics and law. Section IV offers possible responses to extreme relationism. Section V concludes by suggesting next steps for AI ethics.

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 implications 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.

This chapter addresses the close association between withholding and withdrawing futile life-sustaining medical treatments and assisting patients with hastening ending their lives. Section 12.2 sets forth a definition of medical futility and places this concept in the broader context of bioethical principles of autonomy, beneficence, nonmaleficence and justice. Section 12.3 draws out futility’s ethical implications and considers the view that physicians are ethically permitted to refrain from medically futile treatments, should be encouraged to refrain, or have a duty to refrain. Section 12.4 examines ethical arguments that physicians also have a positive duty to assist patients with terminal conditions who are imminently dying to end their lives. It explores ethical arguments for assisted dying that appeal to the physicians’ significant responsibility and relationship with patients, the claimed moral equivalence of actions and omissions, and the medical goal of helping patients have a peaceful and dignified death.

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 …

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.

There is an ongoing debate about the ethics of research on lifespan extension: roughly, using medical technologies to extend biological human lives beyond the current “natural” limit of about 120 years. At the same time, there is an exploding interest in the use of artificial intelligence (AI) to create “digital twins” of persons, for example by fine-tuning large language models on data specific to particular individuals. In this paper, we consider whether digital twins (or digital doppelgängers, as we refer to them) could be a path toward a kind of life extension—or more precisely, a kind of person extension—that does not rely on biological continuity. We discuss relevant accounts of consciousness and personal identity and argue that digital doppelgängers may at least help us achieve some of the aims or ostensible goods of person-span extension, even if they may not count as literal extensions of our personhood on dominant philosophical accounts. We also consider relational accounts of personhood and discuss how digital doppelgängers may be able to extend personhood in a relational sense, or at least secure some of the goods associated with relevant relationships. We conclude by suggesting that a research program to investigate such issues is relevant to ongoing debates about the ethics of extending the human lifespan.

Stepping back from the above analysis, it is helpful to ask whether the shift to a more individualistic conception of persons carries traction for those who do not share its religious underpinnings. Judeo-Christian personhood was grounded on the idea that all and only human beings are made in the image of God (imago dei); for contemporary secular philosophers, there seems to be no corollary justification for claiming that all and only human beings qualify as persons. Some contemporary Christians, such as Noonan, have sought to defend an exclusive moral status for human beings by arguing that possessing the human genetic code affords the secular underpinnings for such a position. Yet, this proposal was eventually rebuffed as 'speciesist.' 'Speciesism,' a term coined in the 1970s by Ryder and popularized by Singer, is the position that assigning moral standing on the basis of species membership is morally arbitrary.

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, …

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.

This Commentary critiques Paul Showler’s combination view of robot moral status, which combines sophisticated cognitive capacities like consciousness with highly valued machine-human relationships. Showler holds that a combined approach carries the advantage of more fully accounting for ordinary folk psychology views about of what it means to have moral standing and be a person. This commentary paper is largely sympathetic to Showler, but argues for a stronger view: being a person is a cluster concept that can include a combination of different possible sufficient conditions, none of which is necessary. What must be constrained, then, is the strong claim that a quality is necessary for personhood. Since most approaches that appeal to sophisticated cognitive capacities make the strong claim, they require constraint. Since most approaches that appeal to highly valued relationships, do not make the stronger claim, they generally do not require constraint.

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.