Despite progress, discrimination in public health remains a problem. A significant aspect of this problem relates to how medical resources are allocated. The paradigm of quality-adjusted-life-year (QALY) dictates that medical resources should be allocated on the basis of units measured as length of life and quality of life that are expected after the implementation of a treatment. In this article, I discuss some of the ethical shortcomings of QALY, by focusing on some of its flawed moral aspects, as well as the way it relates to discrimination on the basis of age, race, and disability status. I argue that while this approach seeks to maximize efficiency, it does not place sufficient value on the preservation of life itself. Even more concerning is the fact that the use of QALY disproportionately harms minorities. While QALY is a well-intentioned approach to the allocation of scarce healthcare resources, new alternatives must be sought.

“INTELLECTUAL LIGHTENING”: A tribute to John Harris through a collection of memories, imaginary books, fictional reviews, and an interview. John Harris’ impressive and diverse academic career is illustrated and remembered by his colleagues who each contribute with a special memory, story or fake book review, in order to thank John and to cherish the memories. A good philosopher, a kind person, a teacher, different aspects of his work are discussed.

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying.

Patients from religious minorities can face unique challenges reconciling their beliefs with the values that undergird Western Medical Ethics. This paper explores homologies between approaches of Orthodox Judaism and Islam to medical ethics, and how these religions’ moral codes differ from the prevailing ethos in medicine. Through analysis of religious and biomedical literature, this work examines how Jewish and Muslim religious observances affect decisions about genetic counseling, reproductive health, pediatric medicine, mental health, and end-of-life decisions. These traditions embrace a theocentric rather than an autonomy-based ethics. Central to this conception is the view that life and the body are gifts from God rather than the individual and the primacy of community norms. These insights can help clinicians provide care that aligns Muslim and Jewish patients’ health goals with their religious beliefs and cultural values. Finally, dialogue in a medical context between these faith traditions provides an opportunity for rapprochement amidst geopolitical turmoil.

This paper motivates institutional epistemic trust as an important ethical consideration informing the responsible development and implementation of artificial intelligence (AI) technologies (or AI-inclusivity) in healthcare. Drawing on recent literature on epistemic trust and public trust in science, we start by examining the conditions under which we can have institutional epistemic trust in AI-inclusive healthcare systems and their members as providers of medical information and advice. In particular, we discuss that institutional epistemic trust in AI-inclusive healthcare depends, in part, on the reliability of AI-inclusive medical practices and programs, its knowledge and understanding among different stakeholders involved, its effect on epistemic and communicative duties and burdens on medical professionals and, finally, its interaction and alignment with the public’s ethical values and interests as well as background sociopolitical conditions against which AI-inclusive healthcare systems are embedded. To assess the applicability of these conditions, we explore a recent proposal for AI-inclusivity within the Dutch Newborn Screening Program. In doing so, we illustrate the importance, scope, and potential challenges of fostering and maintaining institutional epistemic trust in a context where generating, assessing, and providing reliable and timely screening results for genetic risk is of high priority. Finally, to motivate the general relevance of our discussion and case study, we end with suggestions for strategies, interventions, and measures for AI-inclusivity in healthcare more widely.

Animal experimentation raises value conflicts between animal protection and other goods, such as freedom of inquiry or health and safety. If governments can phase out the practice by non-prohibitive incentive-setting, the pro tanto moral rationale for doing so is obvious. So why should they not? This article first sketches a fictional scenario in which a government adopts a phase-out plan for animal experimentation. It then considers two moral objections to this plan: First, the plan unduly restricts freedom of inquiry, and second, it merely displaces animal experimentation across borders and thus fails to reduce animal suffering. Both arguments are refined premise by premise to articulate their strongest versions. The two objections can help to narrow down desiderata for good phase-out plans. However, they do not provide a compelling case against phase-out planning as such because they miss its incremental and constructive nature. Unless better arguments can be provided, it appears that government inaction on phasing out animal experimentation lacks moral justification.

The authors critique the NY Declaration on Animal Consciousness, which does not denounce continued captivity and invasive research in the pursuit of animal consciousness markers. They argue that such research often increases animal suffering by accepting harmful practices. Instead, they propose a nonanthropocentric, ethical framework aligned with the Belmont Report’s principle of beneficence, advocating for noninvasive methods in natural habitats. This approach prioritizes animal well-being, recognizing and safeguarding the intrinsic value of all conscious beings.

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

With the progress of artificial intelligence, the digitalization of the lifeworld, and the reduction of the mind to neuronal processes, the human being appears more and more as a product of data and algorithms. Thus, we conceive ourselves “in the image of our machines,” and conversely, we elevate our machines and our brains to new subjects. At the same time, demands for an enhancement of human nature culminate in transhumanist visions of taking human evolution to a new stage. Against this self-reification of the human being, the present book defends a humanism of embodiment: our corporeality, vitality, and embodied freedom are the foundations of a self-determined existence, which uses the new technologies only as means instead of submitting to them. The book offers an array of interventions directed against a reductionist naturalism in various areas of science and society. As an alternative, it offers an embodied and enactive account of the human person: we are neither pure minds nor brains, but primarily embodied, living beings in relation with others. This general concept is applied to issues such as artificial intelligence (AI), transhumanism and enhancement, virtual reality, neuroscience, embodied freedom, psychiatry, and finally to the accelerating dynamics of current society which lead to an increasing disembodiment of our everyday life. The book thus applies cutting-edge concepts of embodiment and enactivism to current scientific, technological, and cultural tendencies that will crucially influence our society’s development in the twenty-first century.

This response engages critically with Harzheim’s review of Thomas Fuchs’ In Defense of the Human Being: Foundational Questions of an Embodied Anthropology. Fuchs’ work offers a profound exploration of embodied cognition, arguing that human cognition and existence are deeply shaped by our physical interactions. Harzheim’s critique highlights significant aspects of Fuchs’ framework, including his critique of functionalist models, the impact of transhumanist technologies, and ethical concerns in healthcare technology. This paper extends Harzheim’s review by proposing an integration of functionalist and embodied cognitive models, emphasizing the need for a comprehensive evaluation of technological impacts, and advocating for a more robust ethical framework that considers social equity. Additionally, it addresses the is-ought distinction and explores the implications of technological advancements on human identity and mental health. Doede’s critique is also discussed, underscoring the importance of integrating diverse cognitive models and addressing technological determinism. Overall, this response calls for a more nuanced and inclusive approach to the discourse on embodied cognition, aiming to enrich the scholarly conversation and address the complexities and implications of Fuchs’ analysis.