When Two Become One: Singular Duos and the Neuroethical Frontiers of Brain-to-Brain Interfaces.

Advances in brain-brain interface technologies raise the possibility that two or more individuals could directly link their minds, sharing thoughts, emotions, and sensory experiences. This paper explores conceptual and ethical issues posed by such mind-merging technologies in the context of clinical neuroethics. Using hypothetical examples along a spectrum from loosely connected pairs to fully merged minds, the authors sketch out a range of factors relevant to identifying the degree of a merger. They then consider potential new harms like loss of identity, psychological domination, loss of mental privacy, and challenges for notions of autonomy and patient benefit when applied to merged minds. While radical technologies may seem to necessitate new ethical paradigms, the authors suggest the individual-focus underpinning clinical ethics can largely accommodate varying degrees of mind mergers so long as individual patient interests remain identifiable. However, advanced decisionmaking and directives may have limitations in addressing the dilemmas posed. Overall, mind-merging possibilities amplify existing challenges around loss of identity, relating to others, autonomy, privacy, and the delineation of patient interests. This paper lays the groundwork for developing resources to address the novel issues raised, while suggesting the technologies reveal continuity with current healthcare ethics tensions.

Does attitude importance moderate the effects of person-first language? A registered report.

Previous research has demonstrated that exposure to outgroup descriptions that use person-first, as compared to identity-first, language can attenuate negative stereotypes or prejudice and enhance support for policies that seek to advance outgroup rights. However, those benefits of person-first language may not apply to all social groups equally. The present study examines a boundary condition of the effects of person-first language. Specifically, we postulate that person-first language reduces the stigmatization of outgroups to a lesser degree if individuals hold more important negative attitudes towards the respective communities. We will test this hypothesis in a two-factorial 2 (target group) x 2 (descriptor) online experiment that includes a control group and for which we will recruit a general-population sample (N = 681). Stereotyping, dehumanization, as well as negative affect and behavioral intentions towards two outgroups will be compared: people with a physical disability/the physically disabled (i.e., negative attitudes are expected to be less important) and people who have committed a violent crime/violent criminals (i.e., negative attitudes are expected to be more important). Our findings will bear implications for understanding when language use could influence public opinion of different social groups. Additionally, the research can inform the development of more effective communication policies to promote inclusion and reduce stigma.

Flourishing, Mental Health Professionals and the Role of Normative Dialogue.

This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental health and flourishing, and how professionals should respond to patients with controversial views on what is good for them. We discuss the relationship dynamics between healthcare providers and patients, proposing that 'liberal' approaches can provide a pragmatic framework to address disagreements about well-being in the context of flourishing-oriented mental healthcare. We acknowledge the criticisms of these approaches, including the potential for unintended paternalism and distrust. To mitigate these risks, we conclude by suggesting a mechanism to minimize the likelihood of unintended paternalism and foster patient trust.

The Mystery of Mental Integrity: Clarifying Its Relevance to Neurotechnologies.

The concept of mental integrity is currently a significant topic in discussions concerning the regulation of neurotechnologies. Technologies such as deep brain stimulation and brain-computer interfaces are believed to pose a unique threat to mental integrity, and some authors have advocated for a legal right to protect it. Despite this, there remains uncertainty about what mental integrity entails and why it is important. Various interpretations of the concept have been proposed, but the literature on the subject is inconclusive. Here we consider a number of possible interpretations and argue that the most plausible one concerns neurotechnologies that bypass one's reasoning capacities, and do so specifically in ways that reliably lead to alienation from one's mental states. This narrows the scope of what constitutes a threat to mental integrity and offers a more precise role for the concept to play in the ethical evaluation of neurotechnologies.

Merging Minds: The Conceptual and Ethical Impacts of Emerging Technologies for Collective Minds.

A growing number of technologies are currently being developed to improve and distribute thinking and decision-making. Rapid progress in brain-to-brain interfacing and swarming technologies promises to transform how we think about collective and collaborative cognitive tasks across domains, ranging from research to entertainment, and from therapeutics to military applications. As these tools continue to improve, we are prompted to monitor how they may affect our society on a broader level, but also how they may reshape our fundamental understanding of agency, responsibility, and other key concepts of our moral landscape. In this paper we take a closer look at this class of technologies - Technologies for Collective Minds - to see not only how their implementation may react with commonly held moral values, but also how they challenge our underlying concepts of what constitutes collective or individual agency. We argue that prominent contemporary frameworks for understanding collective agency and responsibility are insufficient in terms of accurately describing the relationships enabled by Technologies for Collective Minds, and that they therefore risk obstructing ethical analysis of the implementation of these technologies in society. We propose a more multidimensional approach to better understand this set of technologies, and to facilitate future research on the ethics of Technologies for Collective Minds.

Race and resource allocation: an online survey of US and UK adults' attitudes toward COVID-19 ventilator and vaccine distribution.

OBJECTIVE: This study aimed to assess US/UK adults' attitudes towards COVID-19 ventilator and vaccine allocation. DESIGN: Online survey including US and UK adults, sampled to be representative for sex, age, race, household income and employment. A total of 2580 participated (women=1289, age range=18 to 85 years, Black American=114, BAME=138). INTERVENTIONS: Participants were asked to allocate ventilators or vaccines in scenarios involving individuals or groups with different medical risk and additional risk factors. RESULTS: Participant race did not impact vaccine or ventilator allocation decisions in the USA, but did impact ventilator allocation attitudes in the UK (F(4,602)=6.95, p<0.001). When a racial minority or white patient had identical chances of survival, 14.8% allocated a ventilator to the minority patient (UK BAME participants: 24.4%) and 68.9% chose to toss a coin. When the racial minority patient had a 10% lower chance of survival, 12.4% participants allocated them the ventilator (UK BAME participants: 22.1%). For patients with identical risk of severe COVID-19, 43.6% allocated a vaccine to a minority patient, 7.2% chose a white patient and 49.2% chose a coin toss. When the racial minority patient had a 10% lower risk of severe COVID-19, 23.7% participants allocated the vaccine to the minority patient. Similar results were seen for obesity or male sex as additional risk factors. In both countries, responses on the Modern Racism Scale were strongly associated with attitudes toward race-based ventilator and vaccine allocations (p<0.0001). CONCLUSIONS: Although living in countries with high racial inequality during a pandemic, most US and UK adults in our survey allocated ventilators and vaccines preferentially to those with the highest chance of survival or highest chance of severe illness. Race of recipient led to vaccine prioritisation in cases where risk of illness was similar.

Affirmative action in healthcare resource allocation: Vaccines, ventilators and race.

This article is about the potential justification for deploying some form of affirmative action (AA) in the context of healthcare, and in particular in relation to the pandemic. We call this Affirmative Action in healthcare Resource Allocation (AARA). Specifically, we aim to investigate whether the rationale and justifications for using prioritization policies based on race in education and employment apply in a healthcare setting, and in particular to the COVID-19 pandemic. We concentrate in this article on vaccines and ventilators because these are both highly scarce resources in the pandemic, and there has been a need to develop policies for allocating them. However, as will become clear, the ethical considerations relating to them may diverge. We first set out two rationales for AAs and what they might entail in a healthcare setting. We then consider some disanalogies between AA and AARA, as well as the different implications of AARA for allocating ventilators as opposed to vaccines. Finally, we consider some of the practical ways in which AARA could be implemented, and conclude by responding to some key objections.

Which features of patients are morally relevant in ventilator triage? A survey of the UK public.

BACKGROUND: In the early stages of the COVID-19 pandemic, many health systems, including those in the UK, developed triage guidelines to manage severe shortages of ventilators. At present, there is an insufficient understanding of how the public views these guidelines, and little evidence on which features of a patient the public believe should and should not be considered in ventilator triage. METHODS: Two surveys were conducted with representative UK samples. In the first survey, 525 participants were asked in an open-ended format to provide features they thought should and should not be considered in allocating ventilators for COVID-19 patients when not enough ventilators are available. In the second survey, 505 participants were presented with 30 features identified from the first study, and were asked if these features should count in favour of a patient with the feature getting a ventilator, count against the patient, or neither. Statistical tests were conducted to determine if a feature was generally considered by participants as morally relevant and whether its mean was non-neutral. RESULTS: In Survey 1, the features of a patient most frequently cited as being morally relevant to determining who would receive access to ventilators were age, general health, prospect of recovery, having dependents, and the severity of COVID symptoms. The features most frequently cited as being morally irrelevant to determining who would receive access to ventilators are race, gender, economic status, religion, social status, age, sexual orientation, and career. In Survey 2, the top three features that participants thought should count in favour of receiving a ventilator were pregnancy, having a chance of dying soon, and having waited for a long time. The top three features that participants thought should count against a patient receiving a ventilator were having committed violent crimes in the past, having unnecessarily engaged in activities with a high risk of COVID-19 infection, and a low chance of survival. CONCLUSIONS: The public generally agreed with existing UK guidelines that allocate ventilators according to medical benefits and that aim to avoid discrimination based on demographic features such as race and gender. However, many participants expressed potentially non-utilitarian concerns, such as inclining to deprioritise ventilator allocation to those who had a criminal history or who contracted the virus by needlessly engaging in high-risk activities.

Enhancing Gender.

Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state-something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue that developments from the human enhancement debate can help clarify or resolve some of the conceptual and ethical entanglements arising from the apparent conflict between seeking medicine while not necessarily suffering from a pathology or disorder. Specifically, we focus on the welfarist account of human enhancement and argue it can provide a useful conceptual framework for thinking about some of the more contentious disagreements about access to transgender healthcare services.

Animal researchers shoulder a psychological burden that animal ethics committees ought to address.

Animal ethics committees (AECs) typically focus on the welfare of animals used in experiments, neglecting the potential welfare impact of that animal use on the animal laboratory personnel. Some of this work, particularly the killing of animals, can impose significant psychological burdens that can diminish the well-being of laboratory animal personnel, as well as their capacity to care for animals. We propose that AECs, which regulate animal research in part on the basis of reducing harm, can and ought to require that these harms to researchers are reduced as well. The paper starts by presenting evidence of these burdens and their harm, giving some examples showing how they may be mitigated. We then argue that AECs are well placed to account for these harms to personnel and ought to use their power to reduce their occurrence. We conclude by responding to four potential objections: (1) that this problem should be addressed through health and safety administration, not research ethics administration; (2) that the proposal is unjustifiably paternalistic; (3) that these harms to laboratory animal personnel ought to occur, given their treatment of animals; and (4) that mitigating them may lead to worse treatment of research animals.

Which factors should be included in triage? An online survey of the attitudes of the UK general public to pandemic triage dilemmas.

OBJECTIVE: As cases of COVID-19 infections surge, concerns have renewed about intensive care units (ICUs) being overwhelmed and the need for specific triage protocols over winter. This study aimed to help inform triage guidance by exploring the views of lay people about factors to include in triage decisions. DESIGN, SETTING AND PARTICIPANTS: Online survey between 29th of May and 22nd of June 2020 based on hypothetical triage dilemmas. Participants recruited from existing market research panels, representative of the UK general population. Scenarios were presented in which a single ventilator is available, and two patients require ICU admission and ventilation. Patients differed in one of: chance of survival, life expectancy, age, expected length of treatment, disability and degree of frailty. Respondents were given the option of choosing one patient to treat or tossing a coin to decide. RESULTS: Seven hundred and sixty-three participated. A majority of respondents prioritised patients who would have a higher chance of survival (72%-93%), longer life expectancy (78%-83%), required shorter duration of treatment (88%-94%), were younger (71%-79%) or had a lesser degree of frailty (60%-69%, all p<0.001). Where there was a small difference between two patients, a larger proportion elected to toss a coin to decide which patient to treat. A majority (58%-86%) were prepared to withdraw treatment from a patient in intensive care who had a lower chance of survival than another patient currently presenting with COVID-19. Respondents also indicated a willingness to give higher priority to healthcare workers and to patients with young children. CONCLUSION: Members of the UK general public potentially support a broadly utilitarian approach to ICU triage in the face of overwhelming need. Survey respondents endorsed the relevance of patient factors currently included in triage guidance, but also factors not currently included. They supported the permissibility of reallocating treatment in a pandemic.

Biomarkers for the Rich and Dangerous: Why We Ought to Extend Bioprediction and Bioprevention to White-Collar Crime.

There is a burgeoning scientific and ethical literature on the use of biomarkers-such as genes or brain scan results-and biological interventions to predict and prevent crime. This literature on biopredicting and biopreventing crime focuses almost exclusively on crimes that are physical, violent, and/or sexual in nature-often called blue-collar crimes-while giving little attention to less conventional crimes such as economic and environmental offences, also known as white-collar crimes. We argue here that this skewed focus is unjustified: white-collar crime is likely far costlier than blue-collar crime in money, health, and lives lost. Moreover, attempts to biopredict and bioprevent blue-collar crime may entail adopting potentially unfair measures that target individuals who are already socio-economically disadvantaged, thus compounding pre-existing unfairness. We argue, therefore, that we ought to extend the study of bioprediction and bioprevention to white-collar crime as a means of more efficiently and fairly responding to crime. We suggest that identifying biomarkers for certain psychopathic traits, which appear to be over-represented among senior positions in corporate and perhaps political organisations, is one avenue through which this research can be broadened to include white-collar crime.

Moral enhancement and the good life.

One approach to defining enhancement is in the form of bodily or mental changes that tend to improve a person's well-being. Such a "welfarist account", however, seems to conflict with moral enhancement: consider an intervention that improves someone's moral motives but which ultimately diminishes their well-being. According to the welfarist account, this would not be an instance of enhancement-in fact, as I argue, it would count as a disability. This seems to pose a serious limitation for the account. Here, I elaborate on this limitation and argue that, despite it, there is a crucial role for such a welfarist account to play in our practical deliberations about moral enhancement. I do this by exploring four scenarios where a person's motives are improved at the cost of their well-being. A framework emerges from these scenarios which can clarify disagreements about moral enhancement and help sharpen arguments for and against it.

Enhancement, disability and the riddle of the relevant circumstances.

The welfarist account of enhancement and disability holds enhanced and disabled states on a spectrum: the former are biological or psychological states that increase the chances of a person leading a good life in the relevant set of circumstances, while the latter decrease those chances. Here, I focus on a particular issue raised by this account: what should we count as part of an individual's relevant set of circumstances when thinking about enhanced and disabled states? Specifically, is social prejudice relevant to an individual's circumstances in regards to how disabled or enhanced they are? For instance, if an individual is discriminated against on the basis of their skin colour, and this leads to a reduction in their well-being, the welfarist account suggests that their skin colour is a disability. To avoid such a seeming mislabel, Savulescu and Kahane have argued for excluding social prejudice from counting as a relevant circumstance to their welfarist definition of disability. I argue, however, that this exclusion of social prejudice is unsatisfactory and incompatible with the goals of this account.