Gerald Dworkin has argued that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. He does this by proposing a principle by which we are to judge whether an action is consistent with the proper ends of medicine. I argue: (a) that this principle, if valid, does not show that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by (...) class='Hi'>lethal injection; and (b) that this principle is not valid, and this is because it mistakenly views the promotion of patient autonomy as one of the proper ends of medicine. Rather, I propose, we should view respect for a patient's autonomy as a constraint on the pursuit of the proper ends of medicine, rather than as one of the proper ends itself. With this revised understanding of the proper ends of medicine, we can conclude that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. (shrink)

Current precursors in the development of lethal, autonomous systems (LAS) point to the use of biometric devices for assessing, identifying, and verifying targets. The inclusion of biometric devices entails the use of a probabilistic matching program that requires the deliberate targeting of noncombatants as a statistically necessary function of the system. While the tactical employment of the LAS may be justified on the grounds that the deliberate killing of a smaller number of noncombatants is better than the accidental killing (...) of a larger number, it may nonetheless contravene a reemerging conception of right intention. Originally framed by Augustine of Hippo, this lesser-known formulation has served as the foundation for chivalric code, canon law, jus in bello criteria, and the law of armed conflict. Thus it serves as a viable measure to determine whether the use of lethal autonomy would accord with these other laws and principles. Specifically, examinations of the LAS through the lenses of collateral damage, the principle of double effect, and the principle of proportionality, reveal the need for more attention to be paid to the moral issues now, so that the promise of this emerging technology—that it will perform better than human beings—might actually come to pass. (shrink)

The ethics of warfare and military leadership must pay attention to the rapidly increasing use of artificial intelligence and machines. Who is responsible for the decisions made by a machine? Do machines make decisions? May they make them? These issues are of particular interest in the context of Lethal Autonomous Weapon Systems. Are they autonomous or just automated? Do they violate the international humanitarian law which requires that humans must always be responsible for the use of lethal force (...) and for the assessment that civilian casualties are proportionate to the military goals? The article analyses relevant documents, opinions, government positions, and commentaries using the methods of applied ethics. The main conceptual finding is that the definition of autonomy depends on what the one presenting it seeks to support. Those who want to use lethal autonomous weapon systems call them by another name, say, automated instead of autonomous. They impose standards on autonomy that machines do not meet, such as moral agency. Those who wish to ban the use of lethal autonomous weapon systems define them much less broadly and do not require them to do much more than to be a self-standing part of the causal chain.The article’s argument is that the question of responsibility is most naturally perceived by abandoning the most controversial philosophical considerations and simply stating that an individual or a group of people is always responsible for the creation of the equipment they produce and use. This does not mean that those who press the button, or their immediate superiors, are to blame. They are doing their jobs in a system. The ones responsible can probably be found in higher military leadership, in political decision-makers who dictate their goals, and, at least in democracies, in the citizens who have chosen their political decision-makers. (shrink)

Plans to automate killing by using robots armed with lethal weapons have been a prominent feature of most US military forces? roadmaps since 2004. The idea is to have a staged move from ?man-in-the-loop? to ?man-on-the-loop? to full autonomy. While this may result in considerable military advantages, the policy raises ethical concerns with regard to potential breaches of International Humanitarian Law, including the Principle of Distinction and the Principle of Proportionality. Current applications of remote piloted robot planes or (...) drones offer lessons about how automated weapons platforms could be misused by extending the range of legally questionable, targeted killings by security and intelligence forces. Moreover, the alleged moral disengagement by remote pilots will only be exacerbated by the use of autonomous robots. Leaders in the international community need to address the difficult legal and moral issues now, before the current mass proliferation of development reaches fruition. (shrink)

The underlying thesis of the research in ethical autonomy for lethal autonomous unmanned systems is that they will potentially be capable of performing more ethically on the battlefield than are human soldiers. In this article this hypothesis is supported by ongoing and foreseen technological advances and perhaps equally important by an assessment of the fundamental ability of human warfighters in today's battlespace. If this goal of better-than-human performance is achieved, even if still imperfect, it can result in a (...) reduction in noncombatant casualties and property damage consistent with adherence to the Laws of War as prescribed in international treaties and conventions, and is thus worth pursuing vigorously. (shrink)

The UN Convention on Certain Conventional Weapons (CCW) can, on the one hand, be considered vital for the global governance process—in the sense of urging international cooperation on the ethical, developmental, and standards aspects of lethal autonomous weapon systems (LAWS). On the other hand, the CCW may also embody a global trend that does not augur well for international solidarity, namely the lack of credible and comprehensive collaboration to advance global objectives of peace and security. In 2022, a majority (...) of the 125 nations that belong to the CCW requested limits on a specific type of lethal autonomous weapons: “killer robots.” Yet, most of the major global powers—namely the United States, Russia, and China—opposed not only a ban on LAWS but also on any restrictions on the development of these weapons, not least because the United States, Russia, and China are actively developing this weapons technology. While there is currently much focus on the technological evolution of LAWS, less has been written about how ethical values can exert influence on a growing global consciousness around factors such as power, technology, human judgment, accountability, autonomy, dehumanization, and the use of force. This introduction lays the groundwork for dealing with these issues. It does so by showing that all these factors warrant a pluralist approach to the global governance of LAWS, based on multiple grounds, including the military, tech, law, and distinctive theoretical-ethical orientations; the rationale being to combine this expertise into a collection for publication. Reflecting the contributing authors’ firsthand experiences of the ethics surrounding the management of LAWS to address decisive and critical questions at an expert level, it provides a framing for the collection, showing that the use of international legal mechanisms like the CCW are crucial to considering both the potential and the limits of LAWS, as well as what it can contribute to areas such as international law, human rights, and national security. (shrink)

These remarkable essays include Cornelius Castoriadis's latest contributions to philosophy, political and social theory, classical studies, development theory, cultural criticism, science, and ecology. Examining the "co-birth" in ancient Greece of philosophy and politics, Castoriadis shows how the Greeks' radical questioning of established ideas and institutions gave rise to the "project of autonomy". The "end of philosophy" proclaimed by Postmodernism would mean the end of this project. That end is now hastened by the lethal expansion of technoscience, the waning (...) of political and social conflict, and the resignation of intellectuals who blindly defend Western culture as it is or who merely denounce or "deconstruct" it as it has been. Discussing and criticizing Plato, Aristotle, Leibniz, Kant, Hegel, Weber, Heidegger, and Habermas, the author of The Imaginary Institution of Society and Crossroads in the Labyrinth poses a radical challenge to our inherited philosophy. (shrink)

This article discusses the response of our ethics consultation service to an exceptional request by a patient to have his implantable cardioverter defibrillator removed. Despite assurances that the device had saved his life on at least two occasions, and cautions that without it he would almost certainly suffer a potentially lethal cardiac event within 2 years, the patient would not be swayed. Although the patient was judged to be competent, our protracted consultation process lasted more than 8 months as (...) we consulted, argued with, and otherwise cajoled him to change his mind, all to no avail. Justifying our at times aggressive paternalistic intervention helped us to reflect on the nature of autonomy and the dynamics of the legal, moral, and personal relationships in the clinical decision-making process. (shrink)

Systematic killing has long been associated with some of the darkest episodes in human history. Increasingly, however, it is framed as a desirable outcome in war, particularly in the context of military AI and lethal autonomy. Autonomous weapons systems, defenders argue, will surpass humans not only militarily but also morally, enabling a more precise and dispassionate mode of violence, free of the emotion and uncertainty that too often weaken compliance with the rules and standards of war. We contest (...) this framing. Drawing on the history of systematic killing, we argue that lethal autonomous weapons systems reproduce, and in some cases intensify, the moral challenges of the past. Autonomous violence incentivizes a moral devaluation of those targeted and erodes the moral agency of those who kill. Both outcomes imperil essential restraints on the use of military force. (shrink)

Abstract This article evaluates the ?drive toward greater autonomy? in lethally-armed unmanned systems. Following a summary of the main criticisms and challenges to lethal autonomy, both engineering and ethical, raised by opponents of this effort, the article turns toward solutions or responses that defense industries and military end users might seek to incorporate in design, testing and manufacturing to address these concerns. The way forward encompasses a two-fold testing procedure for reliability incorporating empirical, quantitative benchmarks of performance (...) in compliance with formalized and programmable rules of engagement, and a conception of ?due care? in product liability. This would be designed in analogy with procedures currently followed by well-intentioned governments and militaries with their own (human) military personnel, both to ensure against failure, and to accept responsibility and compensate victims of inadvertent and unintended accidents. The procedure is designed specifically to address objections first posed by Robert Sparrow (2007) and Noel Sharkey (2007), and echoed in P.W. Singer's critically acclaimed Wired for War (2009), that lethal autonomous systems cannot be meaningfully held accountable for commission of war crimes, and thus the development, manufacture, and deployment of such systems would constitute a violation of international law. (shrink)

Artificial intelligence and robotics is pervasive in daily life and set to expand to new levels potentially replacing human decision-making and action. Self-driving cars, home and healthcare robots, and autonomous weapons are some examples. A distinction appears to be emerging between potentially benevolent civilian uses of the technology (eg unmanned aerial vehicles delivering medicines), and potentially malevolent military uses (eg lethal autonomous weapons killing human com- batants). Machine-mediated human interaction challenges the philosophical basis of human existence and ethical conduct. (...) Aside from technical challenges of ensuring ethical conduct in artificial intelligence and robotics, there are moral questions about the desirability of replacing human functions and the human mind with such technology. How will artificial intelligence and robotics engage in moral reasoning in order to act ethically? Is there a need for a new set of moral rules? What happens to human interaction when it is mediated by technology? Should such technology be used to end human life? Who bears responsibility for wrongdoing or harmful conduct by artificial intelligence and robotics? -/- Whilst Kant may be familiar to international lawyers for setting restraints on the use of force and rules for perpetual peace, his foundational work on ethics provides an inclusive moral philosophy for assessing ethical conduct of individuals and states and, thus, is relevant to discussions on the use and development of artificial intelligence and robotics. His philosophy is inclusive because it incorporates justifications for morals and legitimate responses to immoral conduct, and applies to all human agents irrespective of whether they are wrongdoers, unlawful combatants, or unjust enemies. Humans are at the centre of rational thinking, action, and norm-creation so that the rationale for restraints on methods and means of warfare, for example, is based on preserving human dignity as well as ensuring conditions for perpetual peace among states. Unlike utilitarian arguments which favour use of autonomous weapons on the basis of cost-benefit reasoning or the potential to save lives, Kantian ethics establish non-consequentialist and deontological rules which are good in themselves to follow and not dependent on expediency or achieving a greater public good. -/- Kantian ethics make two distinct contributions to the debate. First, they provide a human-centric ethical framework whereby human exist- ence and capacity are at the centre of a norm-creating moral philosophy guiding our understanding of moral conduct. Second, the ultimate aim of Kantian ethics is practical philosophy that is relevant and applicable to achieving moral conduct. -/- I will seek to address the moral questions outlined above by exploring how core elements of Kantian ethics relate to use of artificial intelli- gence and robotics in the civilian and military spheres. Section 2 sets out and examines core elements of Kantian ethics: the categorical imperative; autonomy of the will; rational beings and rational thinking capacity; and human dignity and humanity as an end in itself. Sections 3-7 consider how these core elements apply to artificial intelligence and robotics with discussion of fully autonomous and human-machine rule-generating approaches; types of moral reasoning; the difference be- tween ‘human will’ and ‘machine will’; and respecting human dignity. (shrink)

The development of new technologies that enable autonomous weapon systems poses a challenge to policymakers and technologists trying to balance military requirements with international obligations and ethical norms. Some have called for new international agreements to restrict or ban lethal autonomous weapon systems. Given the tactical and strategic value of the technologies and the proliferation of threats, the military continues to explore the development of new autonomous technologies to execute national security missions. The rapid global diffusion and dual-use nature (...) of autonomous systems necessitate a proactive approach and a shared understanding of the technical realities, threats, military relevance, and strategic implications of these technologies from these communities. Ultimately, developing AI-enabled defense systems that adhere to global norms and relevant treaty obligations, leverage emerging technologies, and provide operational advantages is possible. The development of a workable and realistic regulatory framework governing the use of lethal autonomous weapons and the artificial intelligence that underpins autonomy will be best supported through a coordinated effort of the regulatory community, technologists, and military to create requirements that reflect the global proliferation and rapidly evolving threat of autonomous weapon systems. This essay seeks to demonstrate that: (1) the lack of coherent dialogue between the technical and policy communities can create security, ethical, and legal dilemmas; and (2) bridging the military, technical, and policy communities can lead to technology with constraints that balance the needs of military, technical, and policy communities. It uses case studies to show why mechanisms are needed to enable early and continuous engagement across the technical, policymaking, and operational communities. The essay then uses twelve interviews with AI and autonomy experts, which provide insight into what the technical and policymaking communities consider fundamental to the progression of responsible autonomous development. It also recommends practical steps for connecting the relevant stakeholders. The goal is to provide the Department of Defense with concrete steps for building organizational structures or processes that create incentives for engagement across communities. (shrink)

Background Most jurisdictions that allow euthanasia and assisted suicide (AS) regulate it through the medical profession. However, the extent and nature of how medicine should be involved are debated. Swiss AS practice is unusual in that it is managed by lay AS organizations that rely on a law that permits AS when done for nonselfish reasons. Physicians are not mentioned in the law but are usually called upon to prescribe the lethal medications and perform capacity evaluations.Methods We analyzed in-depth (...) interviews of 23 Swiss AS experts including ethicists, lawyers, medical practitioners, and senior officials of AS organizations for their views on AS.Results Although there was agreement on some issues (e.g., need for better end-of-life care), the interviewees’ preferred model for AS, and the nature of preferred medical involvement, varied, which we categorized into five types: preference for AS practice as it occurred prior to lay AS organizations; preference for the current lay model; preference for a modified lay model to increase autonomy protections while limiting medical AS normalization; preference for various types of more medicalized models of AS; and, ambivalence about any specific model of medical involvement. The rationales given for each type of model reflected varying opinions on how medicine’s role would likely impact AS practice and demonstrated the experts’ attitudes toward those impacts.Conclusion The dynamics within the Swiss AS regime, as reflected in the varying views of Swiss AS experts, shed light on the dilemmas inherent to medical scope and involvement in AS, which may have implications for debates in other jurisdictions. (shrink)

Oppressive governments that use violence against citizens, e.g. murder and torture, are usually thought of as liable to armed revolutionary attack by the oppressed population. But oppression may be non-violent. A government may greatly restrict political rights and personal autonomy by using surveillance, propaganda, manipulation, strategic detention and similar techniques without ever resorting to overt violence. Can such regimes be liable to revolutionary attack? A widespread view is that the answer is ‘no’. On this view, unless a government is (...) or is likely to turn violent, revolution against it is disproportional. After all, revolution would involve launching potentially lethal attacks against oppressors who do not threaten the lives and bodily integrity of their subjects but pose only lesser threats. I argue that this claim of disproportionality is false. Armed revolution against Stably Non-violent Oppressive Regimes can be proportional under some circumstances, thus they may be liable to revolutionary attack. My argument relies on the Responsibility-Sensitive Account of Proportionality. This account holds that responsibility for posing threats renders agents liable to greater defensive harms than the harms with which they threaten. Even if non-violent oppressive regimes do not threaten citizens with murder, serious physical injury, or enslavement, their responsibility for creating an environment in which citizens’ political rights and personal autonomy are extremely restricted may loosen the proportionality requirement of inflicting defensive harm and render them liable to revolutionary attack. (shrink)

Gilbertson, Savulescu, Oakley and Wilkinson propose extending the availability of terminal sedation (TS) to patients with intractable pain and/or suffering who are expected to live more than 2 weeks (hence the designation of extended TS (ETS)) and to patients whose values are known but who do not have decision-making capacity.1 Their plan is worthy of serious consideration: it is, after all, based on the fundamental and well-recognised medical ethical values of patient autonomy and beneficence. But, even when restricted to (...) jurisdictions that allow assisted dying, the ETS proposal raises three important issues. When the authors speak of ‘assisted dying’ and of ‘Voluntary Assisted Dying (VAS)’, they refer specifically to the laws in Australia and similar ones in New Zealand, the Netherlands, Belgium, Luxembourg, Switzerland, Spain and Canada that permit clinicians either to provide patients with lethal medications for self-administration (formerly called physician-assisted suicide) or to administer lethal medications themselves (voluntary euthanasia). First, the authors distinguish—as do many patients and the public—between sedation to unconsciousness and death. Indeed, as the authors point out, the difference seems obvious: unconsciousness can be reversed, death cannot. Yet in the case of TS, this may be …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Refusals of Treatment and Requests for DeathTom L. Beauchamp (bio)It would be hard to overestimate the importance of two decisions on physician-assisted suicide delivered recently by the Ninth and Second Circuit Courts (Compassion in Dying v. State of Washington, 79 F.3d 790 (9th Cir. 1996) (en banc), aff’g 850 F.Supp. 1454 (W.D. Wash. 1994), rev’g 49 F.3d 586 (9th Cir. 1995); Quill v. Vacco, 80 F.3d 716 (2nd Cir. (...) 1996). They are the highest courts yet to render an opinion on this subject, and their decisions have set the stage for the U.S. Supreme Court to take one of two paths: It will either say that (1) all citizens have a liberty interest in physician-assisted suicide, or that (2) each state may set its own policy on such matters. Whichever path is elected, a right to request physician-assisted suicide is a virtual certainty, at least in some states.These opinions are later segments of an evolving legal history in which courts have held that no criminal liability exists for withholding or withdrawing a life-sustaining treatment when physicians are directed to do so by a patient or an authorized surrogate (see Alan Meisel 1992). The decriminalization of suicide and the right to refuse a life-sustaining treatment now appear to be evolving into a rule that a patient has a legal right to control his or her death, or at least to obtain a lethal prescription. We are at a delicate point in this evolving history. Neither in law nor in bioethics is the justification of physician assistance in suicide the received opinion at the present time, but support for physician assistance in dying could soon become the received opinion in both disciplines.The leading edge of the wedge producing these changes has been widespread acceptance of an extensive right to refuse treatment. This right is today axiomatic in even conservative quarters of bioethics, but 20 years ago it was far from axiomatic that all patients have a right to refuse treatment. Few at that time judged that it would be both immoral and illegal for a physician not to forgo treatment in the face of a competent, authoritative refusal of any form of medical service or treatment.The justification for assistance in bringing about death in medicine is an extension of the justification for letting patients die. Letting a patient die by accepting a valid refusal to continue in life is directly analogous to helping a patient die by accepting a valid request for help. The high value we place on [End Page 371] rights of autonomy thereby spills over from the right to refuse to the underexplored right to request active assistance. 1 As the autonomy interest in this choice increases, denial of help to the patient becomes more burdensome.Those who defend the view that euthanasia and physician-assisted suicide are morally prohibited typically assume that assistance involves an act of killing, that acts of killing are impermissible, and that a defensible distinction exists between killing and letting die. However, this distinction has proved difficult to explicate, and the category of killing often seems distant from the problem at hand. For example, it is an eccentric view that a physician who prescribes a lethal medication to a patient thereby kills the patient (or, for that matter, lets the patient die) when the patient voluntarily ingests the medication and dies. So poor are the conceptual understandings of “killing” and “letting die” that conceptual confusion abounds as to which term to use in almost all morally difficult and controversial cases.A common view is that “letting die” is a matter of “ceasing useless treatments” after which patients die (Gaylin, Kass, Pellegrino, and Siegler 1988). This account is attractive, but too narrow. “Letting die” occurs in medicine under at least two circumstances: cessation of treatment because it is useless and cessation of treatment because it has been refused (which can occur even with useful treatments). Neither conceptually nor morally is “ceasing useless treatment” the proper way to state the condition under which many “letting-die” cases occur. It follows that the type of action—killing or letting... (shrink)

Aid‐in‐dying laws in the United States have two important restrictions. First, only patients who are terminally ill, defined as having a prognosis of six months or less to live, qualify. Second, at the time the patients take the lethal medication, they must be competent to make medical decisions. This means that an advance directive requesting aid in dying for a later time when the patient lacks decision‐making capacity would be invalid. However, many people are more concerned about avoiding living (...) into severe dementia for years—a time when they will lack decision‐making capacity—than they are about preventing suffering or the loss of dignity or autonomy for a few months at the end of life.Gillian Bennett is an example of someone determined not to live into severe dementia. She opted for preemptive suicide in 2014, explaining why in a letter she posted online: “Every day I lose bits of myself, and it’s obvious that I am heading toward the state that all dementia patients eventually get to: not knowing who I am and requiring full‐time care.”A major problem with Bennett’s solution, however, is that the individual is likely thereby to be giving up some “good time.” A legal alternative to preemptive suicide is to create an advance directive stating the circumstances under which one wants not to receive any lifesaving or life‐sustaining treatment, even the most basic and noninvasive. This option is our focus in this paper: how to create effective advance directives to avoid living into severe dementia. To be relevant to progressive dementia, the directive would need to state what kinds of care should be withheld and when. At the same time, advance directives for severe dementia face serious challenges. Before addressing these, we review the normative force of directives themselves. (shrink)

The development of autonomous, robotic weaponry is progressing rapidly. Many observers agree that banning the initiation of lethal activity by autonomous weapons is a worthy goal. Some disagree with this goal, on the grounds that robots may equal and exceed the ethical conduct of human soldiers on the battlefield. Those who seek arms-control agreements limiting the use of military robots face practical difficulties. One such difficulty concerns defining the notion of an autonomous action by a robot. Another challenge concerns (...) how to verify and monitor the capabilities of rapidly changing technologies. In this article we describe concepts from our previous work about autonomy and ethics for robots and apply them to military robots and robot arms control. We conclude with a proposal for a first step toward limiting the deployment of autonomous weapons capable of initiating lethal force. (shrink)

AI has numerous applications and in various fields, including the military domain. The increase in the degree of autonomy in some decision-making systems leads to discussions on the possible future use of lethal autonomous weapons systems (LAWS). A central issue in these discussions is the assignment of moral responsibility for some AI-based outcomes. Several authors claim that the high autonomous capability of such systems leads to a so-called “responsibility gap.” In recent years, there has been a surge in (...) philosophical literature around the concept of responsibility gaps and different solutions have been devised to close or bridge these gaps. In order to move forward in the research around LAWS and the problem of responsibility, it is important to increase our understanding of the different perspectives and discussions in this debate. This paper attempts to do so by disentangling the various arguments and providing a critical overview. After giving a brief outline of the state of the technology of LAWS, I will review the debates over responsibility gaps using three differentiators: those who believe in the existence of responsibility gaps versus those who do not, those who hold that responsibility gaps constitute a new moral problem versus those who argue they do not, and those who claim that solutions can be successful as opposed to those who believe that it is an unsolvable problem. (shrink)

The chief executive of the Law Society proposes that the Mental Capacity Bill is a progressive initiative enhancing personal autonomy. Laing replies to this by showing that the Bill, for from enhancinging personal autonomy explodes it by inviting homicide by unaccountable third parties, allowing non-therapeutic research and organ-removal without consent and creating a secret and unaccountable court with a lethal power over the vulnerable incapacitated.

Background In February, 2015, the Supreme Court of Canada struck down the ban on medical assistance in dying. In June, 2016, the federal government passed Bill C-14, permitting MAiD. Current medical students will be the first physician cohort to enter a system permissive of MAiD, and may help to ensure equitable access to care. This study assessed medical student views on MAiD, factors influencing these views, and opportunities for medical education. Methods An exploratory cross-sectional survey was developed and distributed to (...) medical students across all years of a three-year Canadian undergraduate medical program. The investigators administered the survey to participants during academic sessions from November to December, 2015. Analysis of the results included summary descriptive statistics, Pearson’s chi-square test of independence to identify differences between participants by year of study, logistic regression to identify factors that influence students’ stances on MAiD, and Wilcoxon signed rank test to measure changes in student support for MAiD and comfort discussing MAiD. Results There were 405 participants for a response rate of 87%. The majority of students supported the Supreme Court’s decision, 61% would provide the means for a patient to end their life, and 38% would personally administer a lethal medication. Students who were more willing to provide the means for MAiD found medical education/clinical experience and patient autonomy to be important contributors to their stances on MAiD. Those students who were less willing to provide the means for MAiD found religious/spiritual beliefs and teachings, as well as concern about potential negative consequences, to be important contributors to their stances on MAiD. Educational training desired by participants included medicolegal, communication skills, technical skills, and religious. Conclusions Medical students generally supported and would provide the means for MAiD to patients. They also indicated a desire for directed medical education on MAiD. (shrink)

AI has numerous applications and in various fields, including the military domain. The increase in the degree of autonomy in some decision-making systems leads to discussions on the possible future use of lethal autonomous weapons systems (LAWS). A central issue in these discussions is the assignment of moral responsibility for some AI-based outcomes. Several authors claim that the high autonomous capability of such systems leads to a so-called “responsibility gap.” In recent years, there has been a surge in (...) philosophical literature around the concept of responsibility gaps and different solutions have been devised to close or bridge these gaps. In order to move forward in the research around LAWS and the problem of responsibility, it is important to increase our understanding of the different perspectives and discussions in this debate. This paper attempts to do so by disentangling the various arguments and providing a critical overview. After giving a brief outline of the state of the technology of LAWS, I will review the debates over responsibility gaps using three differentiators: those who believe in the existence of responsibility gaps versus those who do not, those who hold that responsibility gaps constitute a new moral problem versus those who argue they do not, and those who claim that solutions can be successful as opposed to those who believe that it is an unsolvable problem. (shrink)

The Hasting Center's, "Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying" (1987), outlines a position on assisted suicide that I argue is contradictory. On one hand the guidelines offers a position on human dignity and autonomy that accords competent patients the right to intentionally kill themselves by requesting doctors to terminate life-support. Yet, on the other hand, the guidelines argue that terminating life-support upon request is not ever the moral equivalent of doctored-assisted suicide, and (...) granting the right to the former does not grant a right to the latter. In this paper I argue that in some circumstances a right to obligate your doctor to pull the plug on life-support is morally equivalent to the right to obligate your doctor to assist you in dying by more direct means, e.g. administering a lethal dose of medication. If the fundamental values of autonomy, self-determination, and human dignity justify this right in the one case, they eo ipso justify this right in the other. Both circumstances are subject to the same potential abuse, so citing such potential abuse does not defeat granting an autonomy right in either case. (shrink)

The self-defense argument maintains that, even if a fetus is a person, abortion on demand is morally permissible on the grounds that the fetus is using his mother’s body in an intimate way, and, in an unwanted pregnancy, without her ongoing consent. According to the argument, this sort of use justifies lethal self-defense on the part of the mother against her unwanted fetus. I produce a counterexample to one of the premises of this argument and show that it cannot (...) be successfully revised. I further show the underlying commitments of the self-defense argument lead to the absurd conclusion that a woman who has consensual sex that results in pregnancy thereby violates the fetus’ right to bodily autonomy and so such an act would be morally impermissible. We thereby have good reason to abandon the argument. (shrink)

Restricting a person’s liberty presents society with many inherent ethical challenges. The historical purposes of confinement have included punishment, penitence, containment, rehabilitation, and habilitation. While the purposes are indeed complex, multifaceted, and at times ambiguous or contradictory, the fact of incarceration intrinsically creates many ethical challenges for psychiatrists working in correctional settings. Role definition of a psychiatrist may be ambiguous, with potential tensions between forensic and therapeutic demands. Privacy may be limited or absent and confidentiality may be compromised. Patient (...) class='Hi'>autonomy may be threatened to address real or perceived security concerns. Care delivery may actually have harmful consequences in court cases for pretrial detainees or lethal consequences for those under a death sentence. An absence of data and targeted research hampers the development of evidence-based care delivery for the disenfranchised, understudied, and disproportionately ill prisoner population. In this review paper, I discuss a few of the challenges and dilemmas routinely faced and present a series of questions. Where feasible, proposed resolutions are offered. (shrink)

The literature on the ethics of defensive harming frequently addresses imminent threats and threats of future harm; but it rarely addresses threats of continuing harm. Real-world cases of kidnapping, slavery, and domestic abuse can include threats of continuing harm. In cases such as these, the harm the victim suffers—and therefore proportionate defensive harm—depends upon both the magnitude and the duration of the harm threatened. Because continuing harms are, by definition, less than lethal, there is a _prima facie _sense in (...) which using lethal force to defend against threats of continuing harm is disproportionate. In this paper, I develop a conception of threats of continuing harm and apply that conception to individual cases of self-defense and to just war theory. Ultimately, I argue that violations of a victim’s right to freedom or autonomy can justify lethal defensive harm, but only if the harm threatened is of a sufficient duration. (shrink)

PurposeMedical assistance in dying (MAiD) in Canada places the medical provider at the centre of the process. The MAiD provider holds primary responsibility for determining eligibility and becomes acquainted with patients’ inner desires and expressions of suffering. This is followed by the MAiD procedure of administering the lethal agent and being present at the death of eligible patients. We report participants’ perceptions of the emotional and moral impacts of this role.MethodologyTwo years after MAiD was legalised in Canada, 22 early-adopting (...) physician providers were interviewed. Data were examined using both phenomenological analysis and a novel ChatGPT-enhanced analysis of an anonymised subset of interview excerpts.FindingsParticipants described MAiD as emotionally provocative with both challenges and rewards. Providers expressed a positive moral impact when helping to optimise a patient’s autonomy and moral comfort with their role in relieving suffering. Providers experienced tensions around professional duty and balancing self with service to others. Personal choice and patient gratitude enhanced the provider experience, while uncertainty and conflict added difficulty.ConclusionsParticipants described MAiD provision as strongly aligned with a patient-centred ethos of practice. This study suggests that, despite challenges, providing MAiD can be a meaningful and satisfying practice for physicians. Understanding the emotional and moral impact and factors that enhance or detract from the providers’ experience allows future stakeholders to design and regulate assisted dying in ways congruent with the interests of patients, providers, families and society. (shrink)

On 26 February 2020, the German Constitutional Court rejected a law from 2015 that prohibited any form of ‘business-like’ assisted suicide as unconstitutional. The landmark ruling of the highest federal court emphasised the high priority given to the rights of autonomy and free personal development, both of which constitute the principle of human dignity, the first principle of the German constitution. The ruling echoes particularities of post-war Germany’s end-of-life debate focusing on patient self-determination while rejecting any discussion of active (...) assistance to die through a lethal injection administered by a doctor. This brief report discusses the ruling in the light of the broader sociopolitical and historical context of the German end-of-life debate. (shrink)

David Rodin denies that defensive wars against unjust aggression can be justified if the unjust aggression limits itself, for example, to the annexation of territory, the robbery of resources or the restriction of political freedom, but would endanger the lives, bodily integrity or freedom from slavery of the citizens only if the unjustly attacked state actually resisted the aggression. I will argue that Rodin's position is not correct. First, Rodin's comments on the necessity condition and its relation to an alleged (...) "duty to retreat" misinterpret the law, and a correct interpretation of the law is not only compatible with, but implies a permission to resist the "bloodless invader," and this is also the correct view from the perspective of morality. Second, Rodin's remarks on the proportionality of self-defense against conditional threats focus on physical or material harm but implausibly ignore the severity of the violations of autonomy and of the socio-legal or moral order that such conditional threats involve. Third, I will address Rodin's claim that defensive wars against "political aggression" are disproportionate because they risk the lives of those defended in an attempt to secure lesser interests. I will argue that this take on proportionality misses the point in an important respect, namely by confusing wide and narrow proportionality, and makes unwarranted assumptions about the alleged irrationality or impermissibility of incurring or imposing lethal risks to safeguard less vital interests. Next, I will also show that while Rodin talks of a "myth of national self-defense" and of the necessity of moving beyond traditional just war theory and international law, it is actually his interpretation of just war theory and international law that weaves myths. Finally, I will argue that Rodin's views on national self-defense on the one hand, and "war as law enforcement" on the other, are incoherent. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Criminal Law, Pain Relief, and Physician Aid in DyingFaye Girsh, Ed.D., Executive DirectorMadam:The article by Cantor and Thomas on “Pain Relief, Acceleration of Death, and Criminal Law” (KIEJ, June 1996) was a tortured attempt to develop criteria for the humane and compassionate physician who tries to serve the needs of a patient in unremitting pain. There are three areas that merit comment.The authors dealt with pain medications that might (...) have the undesirable side effect of causing death. They did not mention tolerance, which usually occurs in a patient with chronic pain and which would require exceedingly high doses to be effective. They did not mention barbiturates, which are preferable to opiates in causing death and which are used increasingly by compassionate physicians to answer the pleas of their suffering patients, but for which there is no excuse about alleviating pain. Would the criminal law just call the prescription of a lethal dose of barbiturates a reckless act and require conviction? Fortunately, juries, as the authors point out, do not balance these formulas on the head of a pin. When they see the circumstances under which these doctors do help their patients, they choose to nullify the law and would ignore the suggestions made in this article.The authors refer to the “consent” of the patient. They do not mention that these doctors are operating with more than consent; they are administering these medications because suffering patients are begging them to put them out of their pain and the indignities of the dying process. The article discusses the process as though it were the same as consent to elective surgery. These patients—with AIDS, cancer, and hopeless neurological degeneration—are not simply agreeing to a procedure; they are desperately seeking a way out. If the criminal law were to develop criteria for physician aid in dying, certainly one of them should be the active, witnessed, repeated request of such a patient for a certain, quick, painless, gentle death.The third point is that physicians do not face prosecution when administering no treatment to a patient whose life could be saved with treatment but who chooses not to receive it. This has been upheld by the U.S. Supreme Court; no criteria for suffering, alternatives, terminality, justifiability, or unbearability are required. The doctor can stand by while the patient dies what may be a protracted, difficult death, but it is within the law. What matters in this situation is the decision of the patient to refuse treatment, and that is absolute. How ironic that the patient who cannot refuse treatment must, with his or her doctor, jump through all these hoops to achieve a peaceful death.One worries that the physician who must balance the risk of “risky pain relief” against the accusation of recklessness will err in the direction of allowing [End Page 103] the patient to bear the pain rather than help with a dose of analgesics that might be considered beyond the stipulated “risk.”Why don’t we just be honest about it? Allow dying or hopelessly ill patients to make the decision about what they want by passing a carefully defined law allowing euthanasia rather than balancing the risk and trying to determine the “purpose” of the physician’s ministrations. We protect some patients from themselves while allowing others almost complete autonomy to make the choice of ending their lives. The authors were right in saying that proponents of rational laws consider this sheer hypocrisy.Faye Girsh, Executive DirectorHemlock Society U.S.A. Denver, COFaye Girsh misconceives our article’s objective as an “attempt to develop criteria” for the humane physician. Our goal in writing the paper was to analyze the current criminal law framework in the hope of sharpening debate and engendering normative critiques. We readily acknowledge tensions in the current legal framework and would support changes in that framework.Copyright © 1997 The Johns Hopkins University Press... (shrink)

Background Doctors often deal with end-of-life issues other than assisted death, such as incompetent patients and treatment withdrawal, including food and fluids. Methods A link to a questionnaire was sent by email three times, at one-week intervals, to the doctors registered in the Northern Section of the Portuguese Medical Association. Results The questionnaire was returned by 1148 (9%) physicians. This study shows that only a minority of Portuguese doctors were willing to administer drugs in lethal doses to cognitively incompetent (...) patients at the request of a family member or other close person, and even less would do it on their initiative. Most doctors favored the withdrawal of life support measures in advanced and progressive diseases at the patient’s request. Still, much fewer doctors agreed with the suspension of supportive life measures at the request of a family member, another close person, or by their own unilateral decision. However, fewer agreed with that action concerning the rest of the food and fluids. Portuguese doctors favor the administration of drugs for suffering control, even foreseeing they could shorten life. Conclusion Most doctors in this study respect patients’ autonomy but disagree with measures decided by others that have an impact on patients’ survival. They also agree with the administration of drugs for suffering control, even considering the possibility of shortening life. (shrink)

The international debate on the ethics and legality of autonomous weapon systems (AWS), along with the call for a ban, primarily focus on the nebulous concept of fully autonomous AWS. These are AWS capable of target selection and engagement absent human supervision or control. This paper argues that such a conception of autonomy is divorced from both military planning and decision-making operations; it also ignores the design requirements that govern AWS engineering and the subsequent tracking and tracing of moral (...) responsibility. To show how military operations can be coupled with design ethics, this paper marries two different kinds of meaningful human control (MHC) termed levels of abstraction. Under this two-tiered understanding of MHC, the contentious notion of ‘full’ autonomy becomes unproblematic. (shrink)

In October 2003 the Supreme Court of the United States allowed Arkansas officials to force Charles Laverne Singleton, a schizophrenic prisoner convicted of murder, to take drugs that would render him sane enough to be executed. On January 6 2004 he was killed by lethal injection, raising many ethical questions. By reference to the Singleton case, this article will analyse in both moral and legal terms the controversial justifications of the enforced medical treatment of death-row inmates. Starting with a (...) description of the Singleton case, I will highlight the prima facie reasons for which this case is problematic and merits attention. Next, I will consider the justification of punishment in Western society and, in that context, the evolution of the notion of insanity in the assessment of criminal responsibility during the past two centuries, both in the US and the UK. In doing so, I will take into account the moral justification used to enforce treatment, looking at the conflict between the prisoner’s right to treatment and his right to refuse medication where not justified by outcomes that can be reasonably expected to be positive for the individual. Finally, in contrast with some retributivist arguments in favour of enforced treatment to enable execution, I will propose a possible alternative, necessary if we are to consistently uphold the notion of autonomy. (shrink)

To be autonomous is to be a law to oneself; autonomous agents are self-governing agents. Most of us want to be autonomous because we want to be accountable for what we do, and because it seems that if we are not the ones calling the shots, then we cannot be accountable. More importantly, perhaps, the value of autonomy is tied to the value of self-integration. We don't want to be alien to, or at war with, ourselves; and it seems (...) that when our intentions are not under our own control, we suffer from self-alienation. What conditions must be satisfied in order to ensure that we govern ourselves when we act? Philosophers have offered a wide range of competing answers to this question. (shrink)

This is a book in the ‘Thinking in Action’ series, which ‘takes philosophy to the public’. The review outlines the argument in the two halves of the book: on educational aims; and on controversial policy issues. In its assessment of the arguments it focuses on the following topics: problems in the relationships between happiness, flourishing, and personal autonomy; the justification of the traditional subject‐centred curriculum; the role of conjecture in the argument for state‐funded faith‐based schools; and a defence of (...) education for patriotism in the face of Brighouse's critique. (shrink)

Challenging many of the currently accepted conceptions of autonomy and of how it is valued, Oshana develops a social-relational account of autonomy that is constituted by a person's relations with others and by the absence of certain social relations. She denies that command over one's motives and the freedom to realize one's will are sufficient to secure the kind of command over one's life that autonomy requires, and argues against psychological, procedural, and content neutral accounts of (...) class='Hi'>autonomy. (shrink)

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide (...) a sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

This paper looks at two 20th century theories of tragedy: those of Cornelius Castoriadis and Albert Camus. The theories that each proffer of this ancient cultural form are striking. Against more standard views, both theorists stress that tragedy is a cultural form that has only arisen historically in cultures whose forms of religious thought have been laid open to question. In this way, both argue that tragedy is an important democratic cultural form, which stages the confrontation between a no longer (...) unquestionable divine order, and human autonomy.The intent of the paper, from the start, is a political one. It wants to place Camus alongside Castoriadis as a 'post-Marxist' thinker, who belongs meaningfully to what Dick Howard has called 'the Marxian legacy'. More than this, it aims to do this by staging Camus' theorisation of tragedy, with Castoriadis', as a powerful riposte to the conservative criticism of democracy as a modern political form, that is, that it cannot muster sacral cultural forms forceful enough to meaningfully unite people beneath its banner. (shrink)

J. B. Schneewind's "The Invention of Autonomy" has been hailed as a major interpretation of modern moral thought. Schneewind's narrative, however, elides several serious interpretive issues, particularly in the transition from late medieval to early modern thought. This results in potentially distorted accounts of Thomas Aquinas, Hugo Grotius, and G. W. Leibniz. Since these thinkers play a crucial role in Schneewind's argument, uncertainty over their work calls into question at least some of Schneewind's larger agenda for the history of (...) ethics. (shrink)

The practice of medicine—and especially the patient-doctor relationship—has seen exceptional shifts in ethical standards of care over the past few years, which by and large originate in occidental countries and are then extrapolated worldwide. However, this phenomenon is blind to the fact that an ethical practice of medicine remains hugely dependent on prevailing cultural and societal expectations of the community in which it serves. One model aiming to conceptualise the dichotomous efforts for global standardisation of medical care against differing sociocultural (...) expectations is the individualism-collectivism model, with the ‘West’ being seen as individualistic and the ‘East’ being seen as collectivistic. This has been used by many academics to explain differences in approach towards ethical practice on key concepts such as informed consent and patient autonomy. However, I argue that this characterisation is incomplete and lacks nuance into the complexities surrounding cross-cultural ethics in practice, and I propose an alternative model based on the ethics of clinical care in Hong Kong, China. Core ethical principles need not be culture-bound—indeed, their very existence mandates for them to be universal and non-derogable—but instead cultural alignment occurs in the particular implementation of these principles, insofar as they respect the general spirit of contemporary ethical standards. (shrink)