Advance Medical Decision-Making Differs Across First- and Third-Person Perspectives.

BACKGROUND: Advance healthcare decision-making presumes that a prior treatment preference expressed with sufficient mental capacity ("T1 preference") should trump a contrary preference expressed after significant cognitive decline ("T2 preference"). This assumption is much debated in normative bioethics, but little is known about lay judgments in this domain. This study investigated participants' judgments about which preference should be followed, and whether these judgments differed depending on a first-person (deciding for one's future self) versus third-person (deciding for a friend or stranger) perspective. METHODS: A vignette-based survey was conducted (N = 1445 US Americans; gender-balanced sample), in a 3 (relationship: self, best friend, stranger) × 2 (T1 preference: treat, do not treat) × 2 (T2 contrary preference: ambiguous, unambiguous) design. RESULTS: Participants were more likely to defer to the incapacitated T2 preference of a third-party, while being more likely to insist on following their own T1 capacitated preference. Further, participants were more likely to conclude that others with substantial cognitive decline were still their "true selves," which correlated with increased deference to their T2 preferences. CONCLUSIONS: These findings add to the growing evidence that lay intuitions concerning the ethical entitlement to have decisions respected are not only a function of cognition, as would be expected under many traditional bioethical accounts, but also depend on the relationship of the decision to the decision-maker's true self.

Valuing the Acute Subjective Experience.

Psychedelics, including psilocybin, and other consciousness-altering compounds such as 3,4-methylenedioxymethamphetamine (MDMA), currently are being scientifically investigated for their potential therapeutic uses, with a primary focus on measurable outcomes: for example, alleviation of symptoms or increases in self-reported well-being. Accordingly, much recent discussion about the possible value of these substances has turned on estimates of the magnitude and duration of persisting positive effects in comparison to harms. However, many have described the value of a psychedelic experience with little or no reference to such therapeutic benefits, instead seeming to find the experience valuable in its own right. How can we make sense of such testimony? Could a psychedelic experience be valuable even if there were no persisting beneficial effects? If so, how? Using the concept of psychological richness, combined with insights from the philosophy of aesthetics and the enhancement literature, this essay explores potential sources of value in the acute subjective experience, apart from the value derived from persisting beneficial effects.

Strong Bipartisan Support for Controlled Psilocybin Use as Treatment or Enhancement in a Representative Sample of US Americans: Need for Caution in Public Policy Persists.

The psychedelic psilocybin has shown promise both as treatment for psychiatric conditions and as a means of improving well-being in healthy individuals. In some jurisdictions (e.g., Oregon, USA), psilocybin use for both purposes is or will soon be allowed and yet, public attitudes toward this shift are understudied. We asked a nationally representative sample of 795 US Americans to evaluate the moral status of psilocybin use in an appropriately licensed setting for either treatment of a psychiatric condition or well-being enhancement. Showing strong bipartisan support, participants rated the individual's decision as morally positive in both contexts. These results can inform effective policy-making decisions around supervised psilocybin use, given robust public attitudes as elicited in the context of an innovative regulatory model. We did not explore attitudes to psilocybin use in unsupervised or non-licensed community or social settings.

A Personalized Patient Preference Predictor for Substituted Judgments in Healthcare: Technically Feasible and Ethically Desirable.

When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such a PPP were more accurate, on average, than human surrogates in identifying patient preferences, the proposed algorithm would nevertheless fail to respect the patient's (former) autonomy since it draws on the 'wrong' kind of data: namely, data that are not specific to the individual patient and which therefore may not reflect their actual values, or their reasons for having the preferences they do. Taking such criticisms on board, we here propose a new approach: the Personalized Patient Preference Predictor (P4). The P4 is based on recent advances in machine learning, which allow technologies including large language models to be more cheaply and efficiently 'fine-tuned' on person-specific data. The P4, unlike the PPP, would be able to infer an individual patient's preferences from material (e.g., prior treatment decisions) that is in fact specific to them. Thus, we argue, in addition to being potentially more accurate at the individual level than the previously proposed PPP, the predictions of a P4 would also more directly reflect each patient's own reasons and values. In this article, we review recent discoveries in artificial intelligence research that suggest a P4 is technically feasible, and argue that, if it is developed and appropriately deployed, it should assuage some of the main autonomy-based concerns of critics of the original PPP. We then consider various objections to our proposal and offer some tentative replies.

Consent-GPT: is it ethical to delegate procedural consent to conversational AI?

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients' access to the relevant procedural information and therefore enhance informed decision-making.In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices.

AUTOGEN: A Personalized Large Language Model for Academic Enhancement-Ethics and Proof of Principle.

In this article, we explore the potential of enhancing academic prose and idea generation by fine-tuning a large language model (here, GPT-3) on one's own previously published writings: AUTOGEN ("AI Unique Tailored Output GENerator"). We develop, test, and describe three distinct AUTOGEN models trained on the prior scholarly output of three of the current authors (SBM, BDE, JS), with a fourth model trained on the combined works of all three. Our AUTOGEN models demonstrate greater variance in quality than the base GPT-3 model, with many outputs outperforming the base model in format, style, overall quality, and novel idea generation. As proof of principle, we present and discuss examples of AUTOGEN-written sections of existing and hypothetical research papers. We further discuss ethical opportunities, concerns, and open questions associated with personalized academic prose and idea generators. Ethical opportunities for personalized LLMs such as AUTOGEN include increased productivity, preservation of writing styles and cultural traditions, and aiding consensus building. However, ethical concerns arise due to the potential for personalized LLMs to reduce output diversity, violate privacy and intellectual property rights, and facilitate plagiarism or fraud. The use of coauthored or multiple-source trained models further complicates issues surrounding ownership and attribution. Open questions concern a potential credit-blame asymmetry for LLM outputs, the legitimacy of licensing agreements in authorship ascription, and the ethical implications of coauthorship attribution for data contributors. Ensuring the output is sufficiently distinct from the source material is crucial to maintaining ethical standards in academic writing. These opportunities, risks, and open issues highlight the intricate ethical landscape surrounding the use of personalized LLMs in academia. We also discuss open technical questions concerning the integration of AUTOGEN-style personalized LLMs with other LLMs, such as GPT-4, for iterative refinement and improvement of generated text. In conclusion, we argue that AUTOGEN-style personalized LLMs offer significant potential benefits in terms of both prose generation and, to a lesser extent, idea generation. If associated ethical issues are appropriately addressed, AUTOGEN alone or in combination with other LLMs can be seen as a potent form of academic enhancement.

Why do evaluative judgments affect emotion attributions? The roles of judgments about fittingness and the true self.

Past research has found that the value of a person's activities can affect observers' judgments about whether that person is experiencing certain emotions (e.g., people consider morally good agents happier than morally bad agents). One proposed explanation for this effect is that emotion attributions are influenced by judgments about fittingness (whether the emotion is merited). Another hypothesis is that emotion attributions are influenced by judgments about the agent's true self (whether the emotion reflects how the agent feels "deep down"). We tested these hypotheses in six studies. After finding that people think a wide range of emotions can be fitting and reflect a person's true self (Study 1), we tested the predictions of these two hypotheses for attributions of happiness, love, sadness, and hatred. We manipulated the emotions' fittingness (Studies 2a-b and 4) and whether the emotions reflected an agent's true self (Studies 3 and 5), measuring emotion attributions as well as fittingness judgments and true self judgments. The fittingness manipulation only impacted emotion attributions in the cases where it also impacted true self judgments, whereas the true self manipulation impacted emotion attribution in all cases, including those where it did not impact fittingness judgments. These results cast serious doubt on the fittingness hypothesis and offer some support for the true self hypothesis, which could be developed further in future work.

Psychedelics, Meaningfulness, and the "Proper Scope" of Medicine: Continuing the Conversation.

Psychedelics such as psilocybin reliably produce significantly altered states of consciousness with a variety of subjectively experienced effects. These include certain changes to perception, cognition, and affect,1 which we refer to here as the acute subjective effects of psychedelics. In recent years, psychedelics such as psilocybin have also shown considerable promise as therapeutic agents when combined with talk therapy, for example, in the treatment of major depression or substance use disorder.2 However, it is currently unclear whether the aforementioned acute subjective effects are necessary to bring about the observed therapeutic effects of psilocybin and other psychedelics. This uncertainty has sparked a lively-though still largely hypothetical-debate on whether psychedelics without subjective effects ("nonsubjective psychedelics" or "non-hallucinogenic psychedelics") could still have the same therapeutic impact, or whether the acute subjective effects are in fact necessary for this impact to be fully realized.3,4,5.