In leaning forward to better see the details of a Breughel wedding scene, an elderly man with thick glasses bumped his head on the wooden frame. He saw stars. “Careful, that painting is irreplaceable,” the guard said. “Please stand back a few feet.”

Based on the case report of Nathan Goldstein et al., “But I have a pacer…there is no point in engaging in hypothetical scenarios”: A Non-imminently Dying Patient’s Request for Pacemaker Deactivation, it is reasonable to conclude that it was, all-things-considered, ethically appropriate to grant the patient’s request to deactivate her pacemaker. Philosophically, and as a clinical ethicist, I support the team’s decision to honor the patient’s request for pacemaker deactivation. However, it is worth exploring a bit further whether the distress on the part of the outside hospital’s ethics committee and providers—who declined to honor the patient’s request for pacemaker deactivation—may actually track something of moral significance. In this commentary, I argue that there are reasonable grounds for holding that deactivation of a ‘biofixture’ such as a pacemaker may be more analogous in moral terms to medical aid in dying than it is to standard cases of withdrawal of life support at the end of a patient’s life.

Neurorights are widely discussed as a means of protecting phenomena like cognitive liberty and freedom of thought. This article is especially interested in example cases where these protections are sought in light of fast-paced developments in neurotechnologies that appear capable of reading the mind in some significant sense. While it is prudent to take care and seek to protect the mind from prying, questions remain over the kinds of claims that prompt concerns over mind reading. The nature of these claims should influence how exactly rights may or may not offer justifiable solutions. Overall, the exploration of neurotechnological mind reading questions here will come in terms of philosophical accounts of mental content and neuroreductionism. The contribution will be to present a contextualization of questions arising from ‘mind-reading’ neurotechnology, and appraisal of if or how neurorights respond to them.

Within bioethics, two issues dominate the discourse on suffering: its nature (who can suffer and how) and whether suffering is ever grounds for providing, withholding, or discontinuing interventions. The discussion has focused on the subjective experience of suffering in acute settings or persistent suffering that is the result of terminal, chronic illness. The bioethics literature on suffering, then, is silent about a crucial piece of the moral picture: agents’ intersubjectivity. This paper argues that an account of the intersubjective effects of suffering on caregivers could enrich theories of suffering in two ways: first, by clarifying the scope of suffering beyond the individual at the epicenter, i.e., by providing a fuller account of the effects of suffering (good or bad). Second, by drawing attention to how and why, in clinical contexts, the intersubjective dimensions of suffering are sometimes as important, if not more important, than whether an individual is suffering or not.

The terminology of “lives not worth living,” “worthwhile lives,” and “unworthwhile lives,” used by John Harris and many others, has become an accepted linguistic convention in bioethical discussions. These terms are used to distinguish lives of overwhelming negative experience from lives that are or are expected to be of overall positive value. As such, this terminology seems helpful in discussions around resource allocation, end-of-life decision making and questions of when it might be acceptable (and unacceptable) to reproduce. This paper argues that there is, however, a problematic ambiguity inherent in these general terms that is particularly evident when it comes to discussing reproductive choices. It is suggested that in this context, this ambiguity can conceal authoritarian eugenic motivations that are difficult to justify and that many using these terms would not adhere to. As a result, it is argued that we should replace these terms with the terms “intrinsically valuable” and “intrinsically harmful.” This would make it more explicit what exactly is meant and would allow these matters to be debated with greater clarity.

The translation of bedside experience to pedagogical content presents a unique challenge for the field of bioethics. The contributions are multidisciplinary, the practices are heterogeneous, and the work product is characteristically nuanced. While academic bioethics education programs have proliferated, developing content and pedagogy sufficient to teach clinical ethics effectively remains a longstanding challenge. The authors identify three reasons why progress towards this goal has been slow. First, there is a lack of robust, empirical knowledge for education focused on praxis. Second, the methods employed in academic education tend to focus on traditional didactic approaches rather than engendering competency through interaction and practice—the principle means by which clinical ethicists work. Third, the data practitioners have captured has not been presented in a medium educators and students can most meaningfully interact with.

In this paper, the authors describe a novel pedagogical tool: the Armstrong Clinical Ethics Coding System (ACECS) and interactive visual analytics dashboard. Together, these components comprise an educational platform that utilizes the empirical data collected by the institution’s ethics service. The tool offers four advantages. First, it aids with the identification of ethical issues that present during a consultation at that specific institution or medical unit by making use of a lingua franca comprehensible to both ethicists and non-ethicists. Second, content is centered on issue frequency, type, and relation to other issues. Iterating through cases, requestors, or hospital units allows one to understand cases typologically and through metanarratives that reveal relationships and subtle patterns. Third, the use of interactive data visualizations and data storytelling aids comprehension and retention. Fourth, the process of using the system necessitates understanding the manifold ways each case can be understood, accommodating a wide range of perspectives and ethical lenses, enhancing case analysis and self-reflection conducive to life-long learning.

There is an ongoing debate in bioethics regarding the nature of suffering. This conversation revolves around the following question: What kind of thing, exactly, is suffering? Specifically, is suffering a subjective phenomenon—intrinsically linked to personhood, personal values, feelings, and lived experience—or an objective affair, amenable to impersonal criteria and existing as an independent feature of the natural world? Notably, the implications of this determination are politically and ethically significant. This essay attempts to bring clarity to the subjective versus objective debate in suffering scholarship by examining the history of the concept of “objectivity,” and putting that history in conversation with physician Eric Cassell’s famous theory of suffering. It concludes with a novel, albeit tentative, definition of suffering: suffering is the experience of a gap between how things are and how things ought to be.

Increased interest in suffering has given rise to different accounts of what suffering is. This paper focuses the debate between experientialists and non-experientialists about suffering. The former hold that suffering is necessarily experiential—for instance, because it is necessarily unpleasant or painful; the latter deny this—for instance, because one can suffer when and because one’s objective properties are damaged, even if one does not experience this. After surveying how the two accounts fare on a range of issues, the paper presents a decisive argument in favor of experientialism. The central claim is that non-experientialist accounts cannot accommodate cases of suffering that are virtuous and that directly contribute to some objective good.

John Harris has made many seminal contributions to bioethics. Two of these are in the ethics of resource allocation. Firstly, he proposed the “fair innings argument” which was the first sufficientarian approach to distributive justice. Resources should be provided to ensure people have a fair innings—when Harris first wrote this, around 70 years of life, but perhaps now 80. Secondly, Harris famously advanced the egalitarian position in response to utilitarian approaches to allocation (such as maximizing Quality Adjusted Life Years [QALYs]) that what people want is the greatest chance of the longest, best quality life for themselves, and justice requires treating these claims equally. Harris thus proposed both sufficientarian and egalitarian approaches. This chapter compares these approaches with utilitarian and contractualist approaches and provides a methodology for deciding among these (Collective Reflective Equilibrium). This methodology is applied to the allocation of ventilators in the pandemic (as an example) and an ethical algorithm for their deployment created. This paper describes the concept of algorithmic bioethics as a way of addressing pluralism of values and context specificity of moral judgment and policy, and addressing complex ethics.

Parental surrogacy remains a highly controversial issue in contemporary ethics with considerable variation in the legal approaches of different jurisdictions. Finding a societal consensus on the issue remains highly elusive. John Rawls’ theory of public reason, first developed in his A Theory of Justice (1971), offers a unifying model of political discourse and engagement that enables reasonable citizens to accept policies that they do not necessarily support at a personal level. The theory established a promising framework for private citizens with distinct moral positions on the subject to find common ground and, in doing so, to negotiate a consensus regarding the degree and nature of regulation that is palatable to all rational citizens.

Who should decide what passes for disinformation in a liberal democracy? During the COVID-19 pandemic, a committee set up by the Dutch Ministry of Health was actively blocking disinformation. The committee comprised civil servants, communication experts, public health experts, and representatives of commercial online platforms such as Facebook, Twitter, and LinkedIn. To a large extent, vaccine hesitancy was attributed to disinformation, defined as misinformation (or data misinterpreted) with harmful intent. In this study, the question is answered by reflecting on what is needed for us to honor public reason: reasonableness, the willingness to engage in public discourse properly, and trust in the institutions of liberal democracy.

This special section brings together international scholars celebrating the 40th anniversary of John Harris’ book, The Value of Life: An Introduction to Medical Ethics (1985), and John Harris and his contributions to the field of bioethics more generally.

Ethicists frequently suppose that suffering has special moral significance. It is often claimed that a main goal of medicine—perhaps its primary goal—is the alleviation of human suffering. Following Eric Cassell and others, this essay considers suffering understood as the experience of distress—negative emotions—in response to threats to something that one cares about. It examines whether, on this value-based account of suffering, we should accept the claim that suffering has special moral significance. It argues that we should not: suffering does not add significantly to the value of other human interests and rarely changes our moral obligations itself; it merely seems to have strong moral relevance because it often attends to interests that matter. This is because negative emotions themselves have only limited moral significance, which is due to the fact that their primary mental role is to indicate to us the relative importance of non-emotional goods.

This paper critically engages with the work of John Harris. Its central focus is his 1985 book, The Value of Life: a foundational text in philosophical bioethics, whose relevance and resonance continue firmly to endure. My aim is to examine what it says—and omits to say—about political authority. Through analysis of apparent and substantive contradictions, and of John’s core focus on moral reasons rather than a basic moral theory, I argue that John says too little about the founding of political obligation. This is so even while he sees political obligation as morally required. I argue that the framings he gives in favor of moral requirements to accept political obligations are particularly significant because they indicate problems in the fundamentality and import of the idea of respect for persons as it features in The Value of Life.

Conscious but incapacitated patients need protection from both undertreatment and overtreatment, for they are exceptionally vulnerable, and dependent on others to act in their interests. In the United States, the law prioritizes autonomy over best interests in decision making. Yet U.S. courts, using both substituted judgment and best interests decision making standards, frequently prohibit the withdrawal of life-sustaining treatment from conscious but incapacitated patients, such as those in the minimally conscious state, even when ostensibly seeking to determine what patients would have wanted. In the United Kingdom, under the Mental Capacity Act of 2005, courts decide on the best interests of incapacitated patients by, in part, taking into account the past wishes and values of the patient. This paper examines and compares those ethicolegal approaches to decision making on behalf of conscious but incapacitated patients. We argue for a limited interpretation of best interests such that the standard is properly used only when the preferences of a conscious, but incapacitated patient are unknown and unknowable. When patient preferences and values are known or can be reasonably inferred, using a holistic, all-things-considered substituted judgment standard respects patient autonomy.

This interview with Peter Singer AI serves a dual purpose. It is an exploration of certain—utilitarian and related—views on sentience and its ethical implications. It is also an exercise in the emerging interaction between natural and artificial intelligence, presented not as just ethics of AI but perhaps more importantly, as ethics with AI. The one asking the questions—Matti Häyry—is a person, in the contemporary sense of the word, sentient and self-aware, whereas Peter Singer AI is an artificial intelligence persona, created by Sankalpa Ghose, a person, through dialogue with Peter Singer, a person, to programmatically model and incorporate the latter’s writings, presentations, recipes, and character qualities as a renowned philosopher. The interview indicates some subtle differences between natural perspectives and artificial representation, suggesting directions for further development. PSai, as the project is also known, is available to anyone to chat with, anywhere in the world, on almost any topic, in almost any language, at www.petersinger.ai

This is a personal narrative of my stroke and recovery experience, and the medical, psychological, and social circumstances surrounding it.

Language is the primary technology clinical ethicists use as they offer guidance about norms. Like any other piece of technology, to use the technology well requires attention, intention, skill, and knowledge. Word choice becomes a matter of professional practice. The Brief Report offers clinical ethicists several reasons for rejecting the phrase “aggressive care.” Instead, ethicists should consider replacing “aggressive care” with the adjacent concept of a “recovery-focused path.” The virtues of this neologism include: the opportunity to set aside the emotion of “aggression,” the phrase’s accuracy when capturing the intention of the patient or their representative, and an unappreciated rhetorical force—and transparent logic—that arises when the patient’s recovery is unlikely.