This paper examines questions concerning elective ventilation, contextualised within English law and policy. It presents the general debate with reference both to the Exeter Protocol on elective ventilation, and the considerable developments in legal principle since the time that that protocol was declared to be unlawful. I distinguish different aspects of what might be labelled elective ventilation policies under the following four headings: ‘basic elective ventilation’; ‘epistemically complex elective ventilation’; ‘practically complex elective ventilation’; and ‘epistemically and practically complex elective ventilation’. (...) I give a legal analysis of each. In concluding remarks on their potential practical viability, I emphasise the importance not just of ascertaining the legal and ethical acceptability of these and other forms of elective ventilation, but also of assessing their professional and political acceptability. This importance relates both to the successful implementation of the individual practices, and to guarding against possible harmful effects in the wider efforts to increase the rates of posthumous organ donation. (shrink)

This issue of the Journal of Medical Ethics features a special symposium on ‘elective ventilation’ . EV ) was originally described in the 1990s by doctors working in Exeter in the UK.1 At that time there was concern about the large shortfall in organs for transplantation. Patients could become organ donors if they were diagnosed as being brain dead, but this only ever occurred in patients on breathing machines in intensive care who developed signs of brainstem failure. Doctors wondered if (...) there were patients dying outside intensive care who, if they were ventilated, could become brain dead and hence eligible to donate their organs. They embarked on a process of identifying patients who were dying who would not normally be taken to intensive care because their prognosis was judged to be too poor, and then ‘electing’ to insert breathing tubes when they stopped breathing.1 With the consent of family members the patients were supported in intensive care until they were diagnosed as having signs of brain death, or until the family and doctors together judged that this was unlikely to occur.1 The Exeter team saw a 50% increase in their numbers of organs for transplantation.Box 1 Definition of elective ventilation Elective ventilation is the provision to a patient of intensive medical treatment with the sole purpose of facilitating organ donation, in the absence of an expected medical benefit.EV was a controversial practice at the time. There were a number of papers written from points of view defending2 ,3 and criticising it.4 A Department of Health guideline in 1994 concluded that EV was not in the best interests of patients and was therefore unlawful5; subsequently, the practice effectively ceased.2 However, debate about EV has not …. (shrink)

With the aging of the general population and the ability of intensivists to support patients using ventilator support, tracheostomy has become a vital tool in the medical management of critically ill patients. While much of the medical literature on tracheostomy has focused on the optimal timing of and indications for performing this procedure, little is written on the ethical tensions that can revolve around decisions by patients, surrogates, and physicians on its use. This article will elucidate the ethical dilemmas that (...) can arise surrounding the use of tracheostomy in critically ill patients and how ethics consultants and committees can approach these cases to allow resolution. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

This paper examines questions concerning elective ventilation, contextualised within English law and policy. It presents the general debate with reference both to the Exeter Protocol on elective ventilation, and the considerable developments in legal principle since the time that that protocol was declared to be unlawful. I distinguish different aspects of what might be labelled elective ventilation policies under the following four headings: ‘basic elective ventilation’; ‘epistemically complex elective ventilation’; ‘practically complex elective ventilation’; and ‘epistemically and practically complex elective ventilation’. (...) I give a legal analysis of each. In concluding remarks on their potential practical viability, I emphasise the importance not just of ascertaining the legal and ethical acceptability of these and other forms of elective ventilation, but also of assessing their professional and political acceptability. This importance relates both to the successful implementation of the individual practices, and to guarding against possible harmful effects in the wider efforts to increase the rates of posthumous organ donation. (shrink)

Advances in medicine have brought us the stethoscope, artificial kidneys, and computerized health records. They have also changed the doctor-patient relationship. This book explores how the technologies of medicine are created and how we respond to the problems and successes of their use. Stanley Joel Reiser, MD, walks us through the ways medical innovations exert their influence by discussing a number of selected technologies, including the X-ray, ultrasound, and respirator. Reiser creates a new understanding of thinking about how health (...) care is practiced in the United States and thereby suggests new methods to effectively meet the challenges of living with technological medicine. As healthcare reform continues to be an intensely debated topic in America, Technological Medicine shows us the pros and cons of applying technological solutions health and illness. (shrink)

As human–machine teams are being considered for a variety of mixed-initiative tasks, detecting and being responsive to human cognitive states, in particular systematic cognitive states, is among the most critical capabilities for artificial systems to ensure smooth interactions with humans and high overall team performance. Various human physiological parameters, such as heart rate, respiration rate, blood pressure, and skin conductance, as well as brain activity inferred from functional near-infrared spectroscopy or electroencephalogram, have been linked to different systemic cognitive states, (...) such as workload, distraction, or mind–wandering among others. Whether these multimodal signals are indeed sufficient to isolate such cognitive states across individuals performing tasks or whether additional contextual information (e.g., about the task state or the task environment) is required for making appropriate inferences remains an important open problem.In this paper, we introduce an experimental and machine learning framework for investigating these questions and focus specifically on using physiological and neurophysiological measurements to learn classifiers associated with systemic cognitive states like cognitive load, distraction, sense of urgency, mind wandering, and interference. Specifically, we describe a multitasking interactive experimental setting used to obtain a comprehensive multimodal data set which provided the foundation for a first evaluation of various standard state-of-the-art machine learning techniques with respect to their effectiveness in inferring systemic cognitive states. While the classification success of these standard methods based on just the physiological and neurophysiological signals across subjects was modest, which is to be expected given the complexity of the classification problem and the possibility that higher accuracy rates might not in general be achievable, the results nevertheless can serve as a baseline for evaluating future efforts to improve classification, especially methods that take contextual aspects such as task and environmental states into account. (shrink)

The esophageal obturator airway is a device used throughout the United States to facilitate artificial respiration of critically ill patients who are not hospitalized. Its use is restricted to persons who are over 15 years old because obturators for children are not available. A protocol submitted to an institutional review board intended to develop EOAs suitable for use in children. The investigators proposed to perform preliminary testing of these devices on children who had sustained irreversible loss of brain function. (...) In its review of this protocol, the IRB had to confront several vexing questions. (shrink)

BackgroundBioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die."DiscussionAdvances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent (...) support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death.SummaryDestination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Comment on Hospice of Washington's PolicyJohn A. Robertson (bio)The recent history of medical ethics may accurately be described as a history of coming to terms with personal autonomy and informed consent across the range of medical practice. Nowhere has this recognition been more important than in decisions to withhold or withdraw life-sustaining medical procedures from terminal and chronically ill patients.Despite the widespread acceptance of autonomy in these decisions, many (...) people—physicians, families, and policymakers—have balked at extending it to the withdrawal of artificially supplied fluids and nutrition. The symbolic connotations of food and water have led some persons to perceive cessation of medically-supplied fluids and nutrition to be a cruel, barbarous act, rather than the merciful respect for the dying patient that such withdrawal usually represents.Two recent events might help resolve the controversy, and ensure that decisions about artificial fluid and nutrition are handled like any other medical intervention—according to patient and family choice and patient welfare. One event is the Supreme Court decision in Cruzan (Cruzan v. Director of Missouri Department of Health, 110 S.Ct. 2841, 1990). Although the Supreme Court upheld Missouri's constitutional power to require artificial nutrition for a patient in a persistent vegetative state, its decision was not based on the symbolic importance of artificial fluids and nutrition. No Supreme Court justice saw a significant difference between medically-supplied nutrition and hydration and other medical interventions, thus allowing them to be discontinued either directly or by advance directive on the same basis as other medical interventions.The second event is the publication of the statement of "Philosophy Regarding Medical Intervention to Supply Fluids and Nutrition" by Hospice of Washington (or similar statements by other organizations). This statement is useful and important because it removes the issue of food and water from its symbolic overlay [End Page 139] and places it in the real context of dying hospice patients. It makes clear that the overriding consideration should be benefit to the patient "in accord with the patient's wishes or those of the appropriate surrogate(s) for the patient." Depending on those wishes and their impact on the patient, this position may or may not involve medically-supplied fluids and nutrition.This statement is also helpful in showing the medical complexity of such decisions in terms of their actual effect on dying patients. Rather than an either/or position, it recognizes that fluids may harm a dying patient by increasing discomfort, and that "persons near death do not ordinarily tolerate substantial volumes of enteral feedings." Thus rather than adhere to a symbolically-based position about the meaning of food and water to a dying patient, the important thing is to look to that patient's needs and give fluids or not, as the patient's wishes and situation demand.Fortunately, the law in most jurisdictions will recognize such a position. In those few jurisdictions that have made a fetish of artificial fluids and nutrition, the law should be changed, for the HOW statement makes clear that such a position may actually end up harming dying patients. Patient welfare should be privileged above all else, and patient welfare may often entail that fluids and nutrition not be medically supplied. Even then, however, caregivers will look to patient comfort and remedy dry mouths and lips with lubricants and ice chips.The HOW statement is, in my view, a very useful guideline not only for hospices but for hospitals, too—for any situation in which a patient is terminally ill and soon to die. A somewhat different set of issues arises, however, when the patient is chronically ill and incompetent, and will survive for long periods with medically-supplied fluids and nutrition. Recognition of patient rights in those situation should also permit cessation of fluids and nutrition on the same basis that respirators, antibiotics, and other life-sustaining measures may be withheld. But the withholding of medically-supplied fluids and nutrition from a patient who no longer has interests in surviving in an extremely debilitated condition raises different issues from withholding fluids that could cause such discomfort and nutrition when the patient is imminently dying. In either case, patient... (shrink)

The various proponents of the DDA differ over how it should be understood. It might be thought that the distinction between doing and allowing reduces to the distinction between action and inaction. As against this, Philippa Foot has argued that some actions, such as pulling the plug on an artificial respirator, should be treated as “allowings.” On her view, the relevant distinction is primarily one between initiating or sustaining a harmful causal sequence, and allowing or enabling a harmful causal (...) sequence to run its course. The view that this is the proper interpretation of the DDA has been challenged by Warren Quinn, who argues that Foot’s distinction either fails to account for our considered intuitions in some cases or collapses back into the action/inaction distinction. Quinn offers an interpretation of the DDA that is closer to the action/inaction distinction, but in which intentions are made to play a significant role. (shrink)

Critics of organ donation after circulatory death (DCD) argue that, even if donors are past the point of autoresuscitation, they have not satisfied the “irreversibility” requirement in the circulatory and respiratory criteria for determining death, since their circulation and respiration could be artificially restored. Thus, removing their vital organs violates the “dead-donor” rule. I defend DCD donation against this criticism. I argue that practical medical-ethical considerations, including respect for do-not-resuscitate orders, support interpreting “irreversibility” to mean permanent cessation of circulation and (...) respiration. Assuming a consciousness-related formulation of human death, I then argue that the loss of circulation and respiration is significant, because it leads to the permanent loss of consciousness and thus to the death of the human person. The DNR request by an organ donor should thus be interpreted to mean “do not restore to consciousness.” Finally, I respond to an objection that if “irreversibility” has a medical-ethical meaning, it would entail the absurd possibility that one of two individuals in the same physical state could be alive and the other dead—an implication that some think is inconsistent with understanding death as an objective biological state of the organism. I argue that advances in medical technology have created phenomena that challenge the assumption that human death can be understood in strictly biological terms. I argue that ethical and ontological considerations about our nature bear on the definition and determination of death and thus on the permissibility of DCD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...) the second half of the twentieth century prompted calls for a new, or at least expanded, definition of death: the development of intensive care medicine, especially the use of mechanical ventilators, and the advent of successful transplantation of vital organs. Patients with profound neurological damage, leaving them incapable of breathing on their own and in an irreversible coma, could be maintained for some period of time with the aid of mechanical ventilation. The situation of these patients posed two ethical questions. Is it appropriate to stop life-sustaining treatment? If so, is it acceptable to retrieve vital organs for transplantation to save the lives of others before stopping treatment?In 1968, the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death proposed that death could be determined on the basis of neurological criteria, thus providing a positive answer to these two questions (Ad Hoc Committee 1968). According to the position of this committee, patients diagnosed with the cessation of brain function are dead, despite the fact that they breathe and circulate blood with the aid of mechanical ventilation. [End Page 185] Because they are dead, it is appropriate, indeed imperative, to stop mechanical ventilation. And because they are dead, it becomes ethical to procure vital organs for transplantation before stopping what otherwise would be life-sustaining treatment. Remarkably, this innovative neurological determination of death became, with little debate or controversy, the established position in medical ethics and the law throughout the United States.The Harvard Committee articulated the diagnosis of “irreversible coma,” but merely asserted that this condition constituted death. No explanatory rationale was provided. It fell to the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research to provide an authoritative rationale in its 1981 report, Defining Death. The second paragraph of the report set the stage as follows: “The question addressed here is not inherently difficult or complicated. Simply, it is whether the law ought to recognize new means for establishing that the death of a human being has occurred” (President’s Commission 1981, p. 3). The Commission claimed that “death is a unitary phenomenon” (p. 7) and that the determination of death by neurological criteria, in terms of the absence of all brain function, is consistent with the traditional conception of death as the cessation of vital functioning of the organism as a whole. The key issue is the integrative functioning of the human organism, which ceases to exist, according to the Commission, when the whole brain, including higher cortical areas and the brain stem, fails to function. Although “brain-dead” patients do not appear to be dead—i.e., the reality of their death is “masked” by the activity of mechanical ventilation—the patient’s body has irreversibly lost all capacity for integrative functioning. In the words of the Commission: “When artificial means of support mask this loss of integration as measured by the old methods [cessation of respiration and heart beat], brain-oriented criteria and tests provide a new window on the same phenomenon” (p. 33). The President’s Commission was instrumental in developing and establishing “The Uniform Definition of Death Act”: “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead” (p. 2).Although the question posed by the President’s Commission was easy to articulate, the answer, over time, has proved complicated and controversial. The coherence and cogency of determining death by neurological criteria has been challenged. Various experts have demonstrated that “brain-dead” patients maintained on mechanical ventilation display a range of vital, integrative, functioning, which conflicts with the judgment that they are dead (Truog and... (shrink)

The ‘decapitation gambit’ holds that, if physical decapitation normally entails the death of the human being, then physiological decapitation, evident in cases of total brain failure, entails the death of the human being. This argument has been challenged by Franklin Miller and Robert Truog, who argue that physical decapitation does not necessarily entail the death of human beings and that therefore, by analogy, artificially sustained human bodies with total brain failure are living human beings. They thus challenge the current neurological (...) criterion for determining death and argue for a return to the traditional criterion of the irreversible loss of circulation and respiration. In this paper, I defend the decapitation gambit and total brain failure as a criterion for determining death against Miller and Truog's criticism. (shrink)

Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are (...) used for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Right to die legal cases in the United States have evolved over the last 25 years, beginning with the Karen Quinlan case in 1975. Different substantive and procedural issues have been raised in these cases, and society's thinking has changed as a result of the far more complex legal issues that appear today as opposed to the simplistic views raised in early landmark cases. Many of the early cases involved patients in a vegetative state, but more recently patients who were (...) in a minimally conscious state have been the center of attention. Early cases involved the withdrawal of respirators and other sophisticated technology, but later cases centered on the withdrawal of artificial nutrition and hydration, and even whether it was permissible for competent patients to stop eating and drinking in a normal manner. Initial cases pitted families who argued for withdrawal of treatment, usually against the attending physicians and hospitals and/or the state or federal government, who argued for continuation of treatment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:FEEDING THE COMATOSE AND THE COMMON GOOD IN THE CATHOLIC TRADITION ROBERT BARRY, O.P. University of Illinois Ohampaign-Urbana, IlUnoi8 AA RECENT convention :sponsored by the Catholic Health Associaition in Boston, Laurence J. O'Connell, vice-president for ethics and theology, ma.de the following comments: I am concerned that some of those who are legitimately alarmed by the potential abuses associated with the public policy that authorizes the withholding and withdrawing of (...) mechanical means of nutrition and hydration are sometimes publicly misrepresenting the Catholic moral tradition. In other words, in their well-intentioned and perfectly legitimate efforts to avoid the slippery-slope-that is, the wrongful withholding or withdrawing of nutrition or hydration from vulnerable dasses of patients-those advocates are placing the Roman Catholic moral tradition itself on the slippery slope. It is mistaken to say it is the church's teaching that we may never withhold or withdraw artificial nutrition and hydration. It is mistaken to uncritically refer to the removal of medically engineered nutrition in all cases as starvation-that is, the willful withholding of nutrition as morally obligatory. It is mistaken to say that the ethical standards of a single Catholic hospital are necessarily coextensive with the ethical standards of the Catholic Church. Just because an individual Catholic facility, for whatever reason, uniformly refuses to allow the withholding or withdrawing of technological feeding, does not mean that the Church itself disallows such withholdings or withdrawals.1 It is not clear how the Catholic moral tradition can be put on the " slippery slope " by opposing certain forms of with1 "Church and State Overlap in Ethical Debate", American Medicai News. February 27, 1987. p. I. 1 ROBERT BARRY, O.P. drawal of feeding from specific classes of patients. Dr. O'Connell has misrepresented the thought of most of those who oppose the recent American Medical Association's new opinion which holds that artificially administered nutrition and fluids can be removed from terminally ill patients, even when they are not imminently dying.2 There are no Catholic moralists who claim that it is always and everywhere morally wrong to withhold or withdraw feeding from patients. However, there are a number of moralists as well as bishops who now hold it to be wrong to withhold or withdraw feeding in those cases where the withholding or withdrawal becomes the fundamental and underlying cause of death. O'Connell is p11obably correct in saying that the policies of one hospital do not necessarily deteJ1IDine the moral doctrines of the universal Church, but neither does one national organization such as the Catholic Health Association with only a loose affiliation with the magisterial hierarchy of the Church necessarily do this either. The debate over the provision of,aissisted feeding is a debate over whether iit is morally legitimate ito withdraw feeding so 1tihat.t:he primary and fundamental reason why the person dies is that withdrawal. It is a debate over whether those with a certain " quality of life " can be permitted to be killed by omission. It is a debate over whether feeding provided by routine nursing measures that can significantly sustain the life is a medical treatment that should he governed by the criteria governing other treatments, or whether it is an 2 "Withholding or Withdrawing Life Prolonging :Medical Treatment" adopted by the Council on Ethical and Judicial.Affairs of the.Amercian Medical.Association on March 15, 1987, In its pertinent parts, it stated: The social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the choice of the patient, or his family or legal representative if the·patient to act in his own behalf, should prevail. Life prolonging medical treatment includes medication and artificially or technologically supplied respiration, nutrition or hydration. In treating a terminally ill or irreversibly comatose patient, the physician should determine whether the benefits of treatment outweigh its burdens..At all times, the dignity of the patient should be maintained.•. FEEDING THE COMATOSE 8 aspect of normal care, like protection from exposure or hygienic care, that is to be accorded to all patients. In this piece, I wish to review the thoughts of some... (shrink)

Ever since the 1960s, when medical science became capable of prolonging the dying process beyond bounds that many patients would find acceptable, people have sought “death with dignity,” or “a natural death,” or “a good death.” Once debilitation from a fatal affliction has reached a personally intolerable point, dying patients have sought to control the manner and timing of death via diverse techniques. Some sought the disconnection of life-sustaining medical interventions, such as respirators and dialysis machines. Beyond freedom from unwelcome (...) interventions, some patients intent on avoiding suffering sought access to pain relief medication—even in dosages posing some risk of hastening death. Other dying patients sought access to deep sedation, even knowing that they would never emerge from the resultant unconsciousness. Still other patients voluntarily refused to eat or drink or to accept artificial nutrition and hydration. (shrink)

This paper critically assesses the possibility of moral enhancement with ambient intelligence technologies and artificial intelligence presented in Savulescu and Maslen (2015). The main problem with their proposal is that it is not robust enough to play a normative role in users’ behavior. A more promising approach, and the one presented in the paper, relies on an artifi-cial moral reasoning engine, which is designed to present its users with moral arguments grounded in first-order normative theories, such as Kantianism or (...) utilitarianism, that reason-responsive people can be persuaded by. This proposal can play a normative role and it is also a more promising avenue towards moral enhancement. It is more promising because such a system can be designed to take advantage of the sometimes undue trust that people put in automated technologies. We could therefore expect a well-designed moral reasoner system to be able to persuade people that may not be persuaded by similar arguments from other people. So, all things considered, there is hope in artificial intelli-gence for moral enhancement, but not in artificial intelligence that relies solely on ambient intelligence technologies. (shrink)

We’ve seen a significant increase in the attention AI research is receiving this past decade, in large part due to some of the impressive feats of machine learning, particularly deep learning. This has resulted in something of a hype in the ability of AI’s in tackling various issues. The aim of the current essay is to examine the speculative questions “what would it mean for systems to transition from merely intelligently executing a task to knowledgably executing a task?” and “what (...) is the relation between consciousness and intelligence, such that specific evaluations about conscious AI might be made?” We offer what we hope is a roadmap for how to navigate asking these questions and a route forward in understanding how AI goes from intelligence to knowledge and potentially to some types of consciousness. (shrink)

Drawing on the analytic of the “colonial matrix of power” developed by Aníbal Quijano within the Latin American modernity/coloniality research program, this article theorises how a system of coloniality underpins the structuring logic of artificial intelligence (AI) systems. We develop a framework for critiquing the regimes of global labour exploitation and knowledge extraction that are rendered invisible through discourses of the purported universality and objectivity of AI. ​​Through bringing the political economy literature on AI production into conversation with scholarly (...) work on decolonial AI and the modernity/coloniality research program, we advance three main arguments. First, the global economic and political power imbalances in AI production are inextricably linked to the continuities of historical colonialism, constituting the colonial supply chain of AI. Second, this is produced through an international division of digital labour that extracts value from majority world labour for the benefit of Western technology companies. Third, this perpetuates hegemonic knowledge production through Western values and knowledge that marginalises non-Western alternatives within AI’s production and limits the possibilities for decolonising AI. By locating the production of AI systems within the colonial matrix of power, we contribute to critical and decolonial literature on the legacies of colonialism in AI and the hierarchies of power and extraction that shape the development of AI today. (shrink)

In response to Ferrario _et al_’s 1 work entitled ‘Ethics of the algorithmic prediction of goal of care preferences: from theory to practice’, we would like to point out an area of concern: the risk of artificial intelligence (AI) paternalism in their proposed framework. Accordingly, in this commentary, we underscore the importance of the implementation of safeguards for AI algorithms before they are deployed in clinical practice. The goal of documenting a living will and advanced directives is to convey (...) personal preferences regarding the acceptance of therapies, including life support, for future use in case of losing one’s capacity. This is standard practice in the care of incapacitated critically ill patients as it is considered to extend the individual’s autonomy. Notably, most of the documents that intensivists encounter in clinical practice are written in a generic fashion and lack context. This problem usually leads to the reliance on... (shrink)

An arms race for an artificial general intelligence would be detrimental for and even pose an existential threat to humanity if it results in an unfriendly AGI. In this paper, an all-pay contest model is developed to derive implications for public policy to avoid such an outcome. It is established that, in a winner-takes-all race, where players must invest in R&D, only the most competitive teams will participate. Thus, given the difficulty of AGI, the number of competing teams is (...) unlikely ever to be very large. It is also established that the intention of teams competing in an AGI race, as well as the possibility of an intermediate outcome, is important. The possibility of an intermediate prize will raise the probability of finding the dominant AGI application and, hence, will make public control more urgent. It is recommended that the danger of an unfriendly AGI can be reduced by taxing AI and using public procurement. This would reduce the pay-off of contestants, raise the amount of R&D needed to compete, and coordinate and incentivize co-operation. This will help to alleviate the control and political problems in AI. Future research is needed to elaborate the design of systems of public procurement of AI innovation and for appropriately adjusting the legal frameworks underpinning high-tech innovation, in particular dealing with patenting by AI. (shrink)

Frente a una narrativa distópica presente en los medios de comunicación y cultura popular que caracteriza el avance y desarrollo de la inteligencia artificial como una amenaza o riesgo existencial (e.g. desempleo tecnológico, sistemas de armas autónomas letales, robots asesinos, propaganda política computacional etc.) quiero valorar de manera crítica y constructiva el rol de la inteligencia artificial para el bien común (AI4SG). La tecnología digital también se puede aplicar para la solución de grandes problemas de la humanidad, como (...) los 17 Objetivos de Desarrollo Sostenible y sus 169 metas de la agenda 2030. En este artículo, comentaré distintos casos de uso y aplicación de la inteligencia artificial y la robótica encaminados a conseguir los 17 Objetivos de Desarrollo Sostenible y qué principios éticos deben guiar su aplicación para que la inteligencia artificial consiga la ambiciosa agenda 2030. También comentaré el plan de acción de España y la estrategia nacional para cumplir la agenda 2030 y de qué manera incorpora las TIC. (shrink)

Public policies are designed to have an impact on particular societies, yet policy-oriented computer models and simulations often focus more on articulating the policies to be applied than on realistically rendering the cultural dynamics of the target society. This approach can lead to policy assessments that ignore crucial social contextual factors. For example, by leaving out distinctive moral and normative dimensions of cultural contexts in artificial societies, estimations of downstream policy effectiveness fail to account for dynamics that are fundamental (...) in human life and central to many public policy challenges. In this paper, we supply evidence that incorporating morally salient dimensions of a culture is critically important for producing relevant and accurate evaluations of social policy when using multi-agent artificial intelligence models and simulations. (shrink)

The possibility of AI consciousness depends much on the correct answer to the mind–body problem: how our materialistic brain generates subjective consciousness? If a materialistic answer is valid, machine consciousness must be possible, at least in principle, though the actual instantiation of consciousness may still take a very long time. If a non-materialistic one (either mentalist or dualist) is valid, machine consciousness is much less likely, perhaps impossible, as some mental element may also be required. Some recent advances in neurology (...) (despite the separation of the two hemispheres, our brain as a whole is still able to produce only one conscious agent; the negation of the absence of a free will, previously thought to be established by the Libet experiments) and many results of parapsychology (on medium communications, memories of past lives, near-death experiences) suggestive of survival after our biological death, strongly support the non-materialistic position and hence the much lower likelihood of AI consciousness. Instead of being concern about AI turning conscious and machine ethics, and trying to instantiate AI consciousness soon, we should perhaps focus more on making AI less costly and more useful to society. (shrink)

There is little consensus on what artificial intelligence (AI) systems may or may not embrace. Although this may point to multiplicity of interpretations and backgrounds, a lack of conceptual clarity could thwart the development of common ground around the concept among researchers, practitioners and users of AI and pave the way for misinterpretation and abuse of the concept. This article argues that one of the effective ways to delineate the concept of AI is to compare and contrast it with (...) human intelligence. In doing so, the article broaches the unique capabilities of humans and AI in relation to one another (human and machine tacit knowledge), as well as two types of AI systems: one that goes beyond human intelligence and one that is necessarily and inherently tied to it. It finally highlights how humans and AI can augment their capabilities and intelligence through synergistic human–AI interactions (i.e., human-augmented AI and augmented human intelligence), resulting in hybrid intelligence, and concludes with a future-looking research agenda. (shrink)

This book reports on the results of the third edition of the premier conference in the field of philosophy of artificial intelligence, PT-AI 2017, held on November 4 - 5, 2017 at the University of Leeds, UK. It covers: advanced knowledge on key AI concepts, including complexity, computation, creativity, embodiment, representation and superintelligence; cutting-edge ethical issues, such as the AI impact on human dignity and society, responsibilities and rights of machines, as well as AI threats to humanity and AI (...) safety; and cutting-edge developments in techniques to achieve AI, including machine learning, neural networks, dynamical systems. The book also discusses important applications of AI, including big data analytics, expert systems, cognitive architectures, and robotics. It offers a timely, yet very comprehensive snapshot of what is going on in the field of AI, especially at the interfaces between philosophy, cognitive science, ethics and computing. (shrink)

Technological progress may eventually produce sophisticated robots with human-like traits that result in humans forming meaningful relationships with them. Such relationships would likely lead to a demand for human–artificial intelligence matrimony. U.S. Supreme Court decisions that expanded the definition of marriage to include interracial and same-sex couples, as well as those that have not extended marriage to polygamous relationships, provide guidance regarding the criteria that human–AI would have to meet to successfully assert a right to marry. Ultimately, robots will (...) have to possess certain characteristics of personhood to marry, including the capacity to contract and to engage in an intimate relationship. Alternatively, if AIs can simulate these abilities sufficiently, we may believe that they have these capacities. Even if AIs genuinely possess the capabilities necessary to enter into a marriage, it is social acceptance of intelligent non-humans as life partners that will likely influence legal development is this realm rather than personhood criteria. However, AIs are likely to face bias due to their “artificial” rather than biological nature. Yet, Peter Singer’s influential argument regarding speciesism in the context of animal rights implies that AIs with specific human-like qualities cannot be justifiably denied certain rights. (shrink)

이 글은 인공적 도덕 행위자(Artificial Moral Agents)에 대한 융합(hybrid) 접근에 대해 철학적 분석과 기획을 목적으로 한다. 그리고 AMA를 둘러싼 여러 접근들 중 융합적 접근이 윤리학 차원에서 인간과 유사한 도덕적 인지를 갖추게 하는 현실적으로 기획 수립을 그 목표로 한다. 따라서 본 연구는 이러한 목적과 목표를 수행하기 위해 철학계에서, 특히 윤리학에서 지금까지 논의되고 있는 도덕적 인지 모형들을 정리하였다. 이 정리를 통해 본 연구는 도덕성이 형식적 추론으로 환원될 수 있다는 입장을 하향식의 주요 이념으로 간주하고 도덕성이 창발적 과정으로 자기 조작성을 가진다는 입장을 상향식의 (...) 주요 이념을 구분하였다. 그 결과로 본 연구는 웬델 월러치와 클린 알렌(W. Wallach & C. Allen)이 융합적 접근으로 강조한 덕 이론의 한계를 넘어, 보다 현실적인 AMA 융합적 접근에 대한 새로운 기획들을 제시하게 되었다. (shrink)

There has recently been a surge of development in augmented reality (AR) technologies that has led to an ecosystem of hardware and software for AR, including tools for artists and designers to accelerate the design of AR content and experiences without requiring complex programming. AR is viewed as a key “disruptive technology” and future display technologies (such as digital eyewear) will provide seamless continuity between reality and the digitally augmented. This article will argue that the technologization of human perception and (...) experience of reality, coupled with the development of artificial intelligence (AI)–based natural language assistants, may lead to a secular re‐enchantment of the world, in the sense outlined by Charles Taylor, where human existence is shaped through AR inhabited by advanced personal and social AI agents in the form of digital avatars and daemons, and that enchantment has been persistent throughout the formation of modernity and is being rekindled by the integration of AI in the plane of AR. (shrink)