Pei-Hua Huang

Recently, several scholars have argued that governments worldwide should seriously consider using direct human engineering to curb global climate change. Prominent proposals include (1) cognitive enhancement, (2) moral bioenhancement, (3) preference modification, and (4) physiological modification. These direct human engineering programs could alleviate global climate change by reducing the consumption of resources, improving the understanding of the danger of climate change, and increasing moral motivations to adopt eco-friendly behaviors. Yet, each of these proposals raises several ethical concerns. This chapter provides a review of the rationale behind human engineering and the current state of the literature on human engineering and climate change, concluding that at the moment human engineering raises more problems than it solves.

It is widely accepted that a liberal state has a general duty to protect its people from undue health risks. However, the unprecedented emergent measures against the COVID-19 pandemic taken by governments worldwide give rise to questions regarding the extent to which this duty may be used to justify suspending a vaccine rollout on marginal safety grounds. In this chapter, I use the case of vaccination to argue that while a liberal state has a general duty to protect its people’s health, there is a limit to the measures this duty can be used to justify. First, I argue that since every available option involves different risks and benefits, the incommensurability of the involved risks and benefits forbids the prioritisation of a particular vaccine. Second, I argue that given epistemic limitations and uncertainty, policies that favour certain vaccines are not only epistemically ill-founded but also morally unacceptable. I conclude that in a highly uncertain situation such as the unfolding pandemic, the duty a liberal state ought to uphold is to properly communicate the knowns and unknowns to the general public and help people decide which option to choose for themselves. I call this duty the duty to facilitate risk-taking.

Background: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps the major ethical risks of digital twins for personalized health care services. Objective: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. Methods: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. Results: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. Conclusions: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner.

The rare but severe cerebral venous thrombosis occurring in some AstraZeneca vaccine recipients has prompted some governments to suspend part of their COVID-19 vaccination programmes. Such suspensions have faced various challenges from both scientific and ethical angles. Most of the criticisms against such suspensions follow a consequentialist approach, arguing that the suspension will lead to more harm than benefits. In this paper, I propose a rights-based argument against the suspension of the vaccine rollouts amid this highly time-sensitive combat of COVID-19. I argue that by suspending a vaccine rollout, a government infringes people's right to take the risks they deem worth taking for their health. I also consider four potential objections to my argument and explain why none of them undermines my argument.

Robert Sparrow recently argues that state-driven moral bioenhancement is morally problematic because it inevitably invites moral perfectionism. While sharing Sparrow’s worry about state-driven moral bioenhancement, I argue that his anti-perfectionism argument is too strong to offer useful normative guidance. That is, if we reject state-driven moral bioenhancement because it cannot remain neutral between different conceptions of the good, we might have to conclude that all forms of moral enhancement program ought not be made compulsory, including the least controversial and most popular state-driven program: compulsory (moral) education. In this paper, I argue that instead, the spirit of Sparrow’s worry should be recast in the language of the capability approach – an approach that strives to enhance people’s capabilities to develop their own conceptions of the good by restricting itself from endorsing thick conceptions of the good. The distinction made regarding thick and thin conceptions of the good helps better capture sentiments against state-driven bioenhancement programs without falling prey to the issues I raise against Sparrow’s anti-perfectionist arguments.

John Harris recently argues that the moral bioenhancement proposed by Persson and Savulescu can damage moral agency by depriving the recipients of their freedom to fall (freedom to make wrongful choices) and therefore should not be pursued. The link Harris makes between moral agency and the freedom to fall, however, implies that all forms of moral enhancement, including moral education, that aim to make the enhancement recipients less likely to “fall” are detrimental to moral agency. In this paper, I present a new moral agency-based critique against the moral bioenhancement program envisaged by Persson and Savulescu. I argue that the irresistible influences exerted by the bioenhancement program harms our capabilities for conducting accurate self-reflection and forming decisions that truly express our will, which subsequently undermine our moral agency.

Biomedical moral enhancement, or BME for short, aims to improve people’s moral behaviors through augmenting, via biomedical means, their virtuous dispositions such as sympathy, honesty, courage, or generosity. Recently, it has been challenged, on particularist grounds, however, that the manifestations of the virtuous dispositions can be morally wrong. For instance, being generous in terrorist financing is one such case. If so, biomedical moral enhancement, by enhancing people’s virtues, might turn out to be counterproductive in terms of people’s moral behaviors. In this paper, we argue, via a comparison with moral education, that the case for the practice of biomedical moral enhancement is not weakened by the particularists’ stress on the variable moral statuses of the manifestations of our virtues. The real challenge from the particularists, we argue, lies elsewhere. It is that practical wisdom, being essentially context-sensitive, cannot be enhanced via biomedical means. On the basis of this, we further argue that BME ought to be used with great caution, for it may wrongly enhance, for instance, a terrorist financier’s generosity, a robber’s courage, or an undercover detective’s honesty. Finally, we sketch how boundaries can be set on the use of BME, and address some potential objections to our position.

The human faculty of moral judgment is not well suited to address problems, like climate change, that are global in scope and remote in time. Advocates of ‘moral bioenhancement’ have proposed that we should investigate the use of medical technologies to make human beings more trusting and altruistic, and hence more willing to cooperate in efforts to mitigate the impacts of climate change. We survey recent accounts of the proximate and ultimate causes of human cooperation in order to assess the prospects for bioenhancement. We identify a number of issues that are likely to be significant obstacles to effective bioenhancement, as well as areas for future research.

This paper aims to provide a clarification of the long debate on whether enhancement will or will not diminish authenticity. It focuses particularly on accounts provided by Carl Elliott and David DeGrazia. Three clarifications will be presented here. First, most discussants only criticise Elliott’s identity argument and neglect that his conservative position in the use of enhancement can be understood as a concern over social coercion. Second, Elliott’s and DeGrazia’s views can, not only co-exist, but even converge together as an autonomy based theory of authenticity. Third, the current account of autonomy provided by DeGrazia fails to address the importance of rationality and the ability of self-correction, which, as a result impedes the theory to provide a fully developed account for authenticity. In conclusion, a satisfactory account of authenticity cannot focus only on identity or subjective preference.