Steven R. Kraaijeveld

People in vulnerable positions who need support in their daily lives often face challenges in receiving timely access to care; for instance, due to disabilities or individual and situational vulnerabilities. There has been an increasing turn to technology-mediated ways to improve access to care, which has raised ethical questions about the appropriateness and inclusiveness of digitalising care requests. Specifically, for people in vulnerable positions, digitalisation is meant to facilitate requests for access to healthcare resources and to simplify the process of navigating the healthcare system. In a multidisciplinary research project, we examined the use and value of a ‘sensitive’ virtual assistant that can accommodate different needs of target groups through inclusive design, adaptive technology and artificial intelligence. This paper presents empirical findings from focus groups with care recipients and caregivers about the sensitive virtual assistant and relates the findings to five larger ethical issues associated with the use of virtual assistants in healthcare settings and care practices more generally. It highlights the risk that, even with the inclusion of target groups in the design of digitalised care assistants, some people may benefit significantly less than others.

Deepfakes are becoming increasingly sophisticated and pervasive in society. While deepfakes are often associated with negative applications and risks (e.g., threats to privacy and security), more positive applications are also being explored, like the potential benefits that deepfakes could have for psychotherapy (e.g., to cope with grief or process trauma). To date, there has been insufficient discussion about the philosophical and ethical issues raised of these developments. In this paper, we therefore examine four ethical issues raised by the use of deepfakes for psychotherapy: (1) the deceptive nature of deepfakes, including self-deception, (2) the problem of obtaining consent from depicted persons, (3) treating depicted persons as mere means, and (4) the risks of unintended harmful effects, like increased emotional and psychological dependence on deepfakes. We also reflect on larger potential implications for society and human care practices. We finally offer two concrete recommendations, namely that more empirical research should be conducted to determine the effects of using deepfakes for psychotherapy, and that regulatory oversight is needed if deepfakes are to become more widely adopted as therapeutic tools in the future.

Health is often moralized not only by individuals, but also by governments, which was particularly conspicuous during the COVID-19 pandemic. This paper addresses the ethics of whether governments should moralize health. It first introduces a definition of moralizing health. It then distinguishes between different ways of moralizing health that affect its moral acceptability, including negative or positive framing, as well as different potential targets toward which moralizing may be directed: (1) persons, (2) behavior, or (3) society. It concludes that targeting individual persons and behavior, especially negatively, is morally unacceptable. Positive moralizing about a healthy society by governments may be more acceptable, but important conditions remain. Governments should not single out individuals or groups and moralizing should not be excessive. Moralized health outcomes should be equally achievable by all citizens and implementation of moral frames should be grounded in robust evidence that it will bring about desired outcomes (i.e., a healthier society) without being harmful or counterproductive. In short, governments should be very cautious about moralizing health. If one of the basic tasks of governments is to protect collective health, this is all too easily undermined by undue moralizing.

The AI Act advances a risk-based approach to the legal regulation of AI systems in the European Union. While we support this development, we argue that adequate AI governance requires paying attention to the broader implications of AI systems on the socio-technical landscape in which they are designed, developed, and used. In addition to risk-based impact assessments, this involves coming to terms with the socially disruptive implications of AI, which should be governed and guided in a dynamic ecosystem of regulation, law, ethics, and evolving human practice. In this paper, we outline a ‘social disruptiveness-based’ approach to AI governance aimed at addressing disruptions by AI that are not easily captured by legal regulation, but that are nonetheless of great societal and ethical concern. We argue that integrating the AI Act risk-based approach with a social disruptiveness-based approach can offer a more nuanced understanding of the dimensions of impact of AI systems on society at large, thus enhancing the governance of AI and other socially disruptive technologies.

Large consumer technology corporations are becoming increasingly influential in health and medicine. While this is sometimes beneficial to public health, it also raises many risks, like inequitable returns to the public sector in public-private medical partnerships or new dependencies on technology firms for the provision of public health goods and services. These risks are not always fully captured by existing frameworks. In this paper, we argue that it is time to adopt a public health ethics perspective on the increasing influence of Big Tech in health and medicine. A public health ethics perspective can not only capture the effects of Big Tech on the health of entire populations, but it also raises the important question of whether governments ought sometimes to intervene in the activities of Big Tech in order to safeguard public health.

People in vulnerable positions who need support in their daily lives often face challenges in receiving timely access to care; for instance, due to disabilities or individual and situational vulnerabilities. There has been an increasing turn to technology-mediated ways to improve access to care, which has raised ethical questions about the appropriateness and inclusiveness of digitalising care requests. Specifically, for people in vulnerable positions, digitalisation is meant to facilitate requests for access to healthcare resources and to simplify the process of navigating the healthcare system. In a multidisciplinary research project, we examined the use and value of a ‘sensitive’ virtual assistant that can accommodate different needs of target groups through inclusive design, adaptive technology and artificial intelligence. This paper presents empirical findings from focus groups with care recipients and caregivers about the sensitive virtual assistant and relates the findings to five larger ethical issues associated with the use of virtual assistants in healthcare settings and care practices more generally. It highlights the risk that, even with the inclusion of target groups in the design of digitalised care assistants, some people may benefit significantly less than others.

Onychectomy involves the surgical amputation of a cat's claws. Tendonectomy entails surgically cutting tendons to prevent the extension and full use of a cat's claws. Both surgeries practically declaw cats and are not only painful but also associated with high complication rates. While feline declawing surgeries have been banned in various places around the world, they are still elective in many countries and U.S. states. This article provides an ethical analysis of declawing cats. It discusses the harms posed by feline declawing surgeries, like pain and complications, which are not offset by any benefits to cats. Drawing on Martha Nussbaum's capabilities approach, it also offers an additional and broader ethical argument against declawing, namely that removing cats' claws is unjust because it thwarts important capabilities for feline flourishing (e.g., play, bodily integrity, control over one's environment). It concludes that declawing cats for non-medical purposes is unethical and must be opposed.

For Albert Camus, plague was both a fact of life and a powerful metaphor for the human condition. Camus engaged most explicitly and extensively with the subject of plague in his 1947 novel, The Plague (La peste), which chronicles an outbreak of what is presumably cholera in the French-Algerian city of Oran. I often thought of this novel—and what it might teach us—during the recent COVID-19 pandemic. In this article, I discuss seven important insights from The Plague about epidemics, public health and morality.

The rapid expansion of Big Tech companies into various societal domains (e.g., health, education, and agriculture) over the past decade has led to increasing concerns among governments, regulators, scholars, and civil society. While existing theoretical frameworks—often revolving around privacy and data protection, or market and platform power—have shed light on important aspects of Big Tech expansionism, there are other risks that these frameworks cannot fully capture. In response, this editorial proposes an alternative theoretical framework based on the notion of sphere transgressions, which draws on political philosopher Michael Walzer's theory of justice. The editorial not only introduces the sphere transgressions framework, but it also highlights its potential to generate novel research questions. Furthermore, this editorial introduces eight articles and one commentary from a group of interdisciplinary scholars that critically examine Big Tech expansionism by reflecting on this expansionism from the perspective of different societal spheres or by engaging with the sphere transgressions framework itself.

Should people get vaccinated for the sake of others? What could ground—and limit—the normative claim that people ought to do so? In this paper, we propose a reasons-based consequentialist account of vaccination for the benefit of others. We outline eight harm-based and probabilistic factors that, we argue, give people moral reasons to get vaccinated. Instead of understanding other-directed vaccination in terms of binary moral duties (i.e., where people either have or do not have a moral duty to get vaccinated), we develop a scalar approach according to which people can have stronger or weaker moral reasons to get vaccinated in view of the moral good of vaccination. One advantage of our approach is that it can capture why a person might have strong moral reasons to get vaccinated with Vaccine A, but only weak moral reasons to get vaccinated with Vaccine B. We discuss theoretical strengths of our approach and provide a case study of vaccination against COVID-19 to demonstrate its practical significance.

This dissertation explores the idea and ethics of vaccination for the sake of others. It conceptually distinguishes four different kinds of vaccination—self-protective, paternalistic, altruistic, and indirect—based on who receives the primary benefits of vaccination and who ultimately makes the vaccination decision. It describes the results of focus group studies that were conducted to investigate what people who might get vaccinated altruistically think of this idea. It also applies the different kinds of vaccination to ethical issues surrounding COVID-19, such as lockdown measures, routine or mandatory vaccination of healthy children, and the ethical justification of restrictive measures for unvaccinated people. A more general philosophical account of vaccination ethics is ultimately developed, which is based not on moral duties, but on the moral reasons that people may have to get vaccinated for the sake of others. It is argued that such reasons may be stronger or weaker, depending on various factors related to the vaccines in question and the specific epidemiological circumstances.

The potential for vaccines to prevent the spread of infectious diseases is crucial for vaccination policy and ethics. In this paper, I discuss recent evidence that the current COVID-19 vaccines have only a modest and short-lived effect on reducing SARS-CoV-2 transmission and argue that this has at least four important ethical implications. First, getting vaccinated against COVID-19 should be seen primarily as a self-protective choice for individuals. Second, moral condemnation of unvaccinated people for causing direct harm to others is unjustified. Third, the case for a harm-based moral obligation to get vaccinated against COVID-19 is weak. Finally, and perhaps most significantly, coercive COVID-19 vaccination policies (e.g., measures that exclude unvaccinated people from society) cannot be directly justified by the harm principle.

Vaccination can protect vaccinated individuals and often also prevent them from spreading disease to other people. This opens up the possibility of getting vaccinated for the sake of others. In fact, altruistic vaccination has recently been conceptualized as a kind of vaccination that is undertaken primary for the benefit of others. In order to better understand the potential role of altruistic motives in people’s vaccination decisions, we conducted two focus group studies with a total of 37 participants. Study 1 included three focus groups on the subject of HPV vaccination for boys. Study 2 included three focus groups on the subject of pertussis and measles vaccination for childcare workers. We found substantial evidence of other-regarding motives across all focus groups, which suggests that altruistic motives could be an important factor when it comes to people’s vaccination decisions. We address the significance of these findings for vaccination policy surrounding HPV vaccination for boys and vaccination for childcare workers. We also extend the findings to normative work on vaccination for the sake of others more generally.

Moralization is a social-psychological process through which morally neutral issues take on moral significance. Often linked to health and disease, moralization may sometimes lead to good outcomes; yet moralization is often detrimental to individuals and to society as a whole. It is therefore important to be able to identify when moralization is inappropriate. In this paper, we offer a systematic normative approach to the evaluation of moralization. We introduce and develop the concept of ‘mismoralization’, which is when moralization is metaethically unjustified. In order to identify mismoralization, we argue that one must engage in metaethical analysis of moralization processes while paying close attention to the relevant facts. We briefly discuss one historical example and two contemporary cases related to COVID-19 that we contend to have been mismoralized in public health. We propose a remedy of de-moralization that begins by identifying mismoralization and that proceeds by neutralizing inapt moral content. De-moralization calls for epistemic and moral humility. It should lead us to pull away from our tendency to moralize—as individuals and as social groups—whenever and wherever moralization is unjustified.

COVID-19 vaccination of children has begun in various high-income countries with regulatory approval and general public support, but largely without careful ethical consideration. This trend is expected to extend to other COVID-19 vaccines and lower ages as clinical trials progress. This paper provides an ethical analysis of COVID-19 vaccination of healthy children. Specifically, we argue that it is currently unclear whether routine COVID-19 vaccination of healthy children is ethically justified in most contexts, given the minimal direct benefit that COVID-19 vaccination provides to children, the potential for rare risks to outweigh these benefits and undermine vaccine confidence, and substantial evidence that COVID-19 vaccination confers adequate protection to risk groups, such as older adults, without the need to vaccinate healthy children. We conclude that child COVID-19 vaccination in wealthy communities before adults in poor communities worldwide is ethically unacceptable and consider how policy deliberations might evolve in light of future developments.

Experimental philosophy is a relatively recent discipline that employs experimental methods to investigate the intuitions, concepts, and assumptions behind traditional philosophical arguments, problems, and theories. While experimental philosophy initially served to interrogate the role that intuitions play in philosophy, it has since branched out to bring empirical methods to bear on problems within a variety of traditional areas of philosophy—including metaphysics, philosophy of language, philosophy of mind, and epistemology. To date, no connection has been made between developments in experimental philosophy and philosophy of technology. In this paper, I develop and defend a research program for an experimental philosophy of technology.

Governments around the world have faced the challenge of how to respond to the recent outbreak of a novel coronavirus disease. Some have reacted by greatly restricting the freedom of citizens, while others have opted for less drastic policies. In this paper, I draw a parallel with vaccination ethics to conceptualize two distinct approaches to COVID-19 that I call altruistic and lockdown. Given that the individual measures necessary to limit the spread of the virus can in principle be achieved voluntarily as well as through enforcement, the question arises of how much freedom governments ought to give citizens to adopt the required measures. I argue that an altruistic approach is preferable on moral grounds: it preserves important citizen freedoms, avoids a number of potential injustices, and gives people a much-needed sense of meaning in precarious times.

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D.

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions.

Robotization is an increasingly pervasive feature of our lives. Robots with high degrees of autonomy may cause harm, yet in sufciently complex systems neither the robots nor the human developers may be candidates for moral blame. John Danaher has recently argued that this may lead to a retribution gap, where the human desire for retribution faces a lack of appropriate subjects for retributive blame. The potential social and moral implications of a retribution gap are considerable. I argue that the retributive intuitions that feed into retribution gaps are best understood as deontological intuitions. I apply a debunking argument for deontological intuitions in order to show that retributive intuitions cannot be used to justify retributive punishment in cases of robot harm without clear candidates for blame. The fundamental moral question thus becomes what we ought to do with these retributive intuitions, given that they do not justify retribution. I draw a parallel from recent work on implicit biases to make a case for taking moral responsibility for retributive intuitions. In the same way that we can exert some form of control over our unwanted implicit biases, we can and should do so for unjustifed retributive intuitions in cases of robot harm.

Recently, Joshua Greene has argued that we need a metamorality to solve moral problems for which evolution has not prepared us. The metamorality that he proposes is a utilitarian account that he calls deep pragmatism. Deep pragmatism is supposed to arbitrate when the values espoused by different groups clash. To date, no systematic appraisal of this argument for a metamorality exists. We reconstruct Greene’s case for deep pragmatism as a metamorality and consider three lines of objection to it. We argue that, in the end, only one of these objections seriously threatens Greene’s position. Greene has to commit to the nonexistence of moral truth in order for his argument for the need of a metamorality to get off the ground. This, however, leads to a tension in his overall argument for deep pragmatism: ultimately, it casts his rejection of antiutilitarian moral intuitions into doubt.