Surrogates and Artificial Intelligence: Why AI Trumps Family (with Jake Greenblum) Science and Engineering Ethics (2020)

The increasing accuracy of algorithms to predict values and preferences raises the possibility that artificial intelligence technology will be able to serve as a surrogate decision-maker for incapacitated patients.  Following Camillo Lamanna and Lauren Byrne, we call this technology the autonomy algorithm (AA).  Such an algorithm would mine medical research, health records, and social media data to predict patient treatment preferences.  The possibility of developing the AA raises the ethical question of whether the AA or a relative ought to serve as surrogate decision-maker in cases where the patient has not issued a medical power of attorney.  We argue that in such cases, and against the standard practice of vesting familial surrogates with decision making authority, the AA should have sole decision-making authority.  This is because the AA will likely be better at predicting what treatment option the patient would have chosen.  It would also be better at avoiding bias and, therefore, choosing in a more patient-centered manner.  Furthermore, we argue that these considerations override any moral weight of the patient’s special relationship with their relatives.

On Surrogates’ Moral Authority: A response the Berger (with Jake Greenblum) American Journal of Bioethics (2019)

Jeffrey Berger’s article “Marginally Represented Patients and the Moral Authority of Surrogates” makes an important contribution to the literature on surrogate decision making by raising the important issue of whether merely related, non-intimates should serve as surrogates. In this commentary, we highlight two important claims he makes and raise a number of concerns.

Responding to religious patients: why physicians have no business doing theology (with Jake Greenblum) Journal of Medical Ethics (2019)

A survey of the recent literature suggests that physicians should engage religious patients on religious grounds when the patient cites religious considerations for a medical decision. We offer two arguments that physicians ought to avoid engaging patients in this manner. The first is the Public Reason Argument. We explain why physicians are relevantly akin to public officials. This suggests that it is not the physician’s proper role to engage in religious deliberation. This is because the public character of a physician’s role binds him/her to public reason, which precludes the use of religious considerations. The second argument is the Fiduciary Argument. We show that the patient-physician relationship is a fiduciary relationship, which suggests that the patient has the clinical expectation that physicians limit themselves to medical considerations. Since engaging in religious deliberations lies outside this set of considerations, such engagement undermines trust and therefore damages the patient-physician relationship.

Parental Decision Making: The Best Interest Principle, Child Autonomy, and Reasonableness (with Jake Greenblum) HEC Forum (2019)

On what basis should we judge whether a parent’s medical decision for their child is morally acceptable? In a recent article, Johan Bester attempts to answer this question by defending a version of the Best Interest Standard (BIS) for parental decision making. The purpose of this paper is to identify a number of problems faced by Bester’s version of BIS and to suggest ways to redress these problems. Accordingly, we intend to advance the project of formulating a method for guiding parents’ medical decision making for their children. We argue that Bester’s standard fails to accommodate the autonomy of the child and that his criteria for assessing the reasonableness of the parents’ argument for their decision are too weak. We conclude that properly addressing these worries renders his test otiose and that it ought to be replaced with the three commonly held principles of bioethics—the principles of autonomy, beneficence, non-maleficence—and a standard of reasonableness.

The New Common Rule’s “Reasonable Person” Standard for Informed Consent (with Jake Greenblum) Bioethics (2018)

Laura Odwazny and Benjamin Berkman have raised several challenges regarding the new reasonable person standard in the revised Common Rule, which states that informed consent requires potential research subjects be provided with information a reasonable person would want to know to make an informed decision on whether to participate in a study. Our aim is to offer a response to the challenges Odwazny and Berkman’s raise, which include the need for a reasonable person standard that can be applied consistently across IRBs and that doesn’t stigmatize marginal groups. In response, we argue that the standard ought to be based in an Ordinary rather than Ideal Person conception of reasonable person and that the standard ought to employ what we call a Liberal Constraint. We conclude by suggesting some of the likely consequences our view would have, if adopted.

Toward a Functionalist Account of Blame

In this paper, I argue that blame ought to be understood as a function rather than a mental state or an activity. Any plausible account of blame must satisfy two desiderata. First, it must be consistent with the intension of blame. In other words, it must get the ordinary connotations of blame right. I call this the intensional desideratum. Second, the account must be consistent with the set of instances of what we would ordinarily identify as blaming. I call this the extensional desideratum. After discussing these desiderata in more detail, I offer an overview of different accounts of blame’s nature. I then argue that non-functionalist accounts of blame fail to adequately meet one or both desiderata. Next, I argue that functionalist accounts are better equipped to adequately meet these desiderata. It follows that we ought to explain the nature of blame in terms of its function rather than mental states or activities that putatively constitute blame.

Defending Formal Contractualism 

The purpose of this paper is to (1) defend Darwall’s formal contractualism against some objections raised by Douglas Paletta and (2) to argue that formal contractualism is preferable to substantive contractualism. Moral contractualism is the view that the foundation of morality is the equal dignity of persons. Substantive contractualism attempts to ground a contractualist principle in the ideal of mutual justifiability, while Darwall’s formal contractualism attempts to ground a contractualist principle in the practice of holding accountable. Paletta argues that substantive contractualism is preferable to formal contractualism because the former is better suited to preclude the justification of intuitively unjust authority relations such as slavery. After responding to this objection, I argue, contra Paletta, that formal contractualism rather than substantive contractualism is better equipped to reject objectionable authority relations. This, I argue, is because it has a principled means of rejecting such relations through its establishment of universal second-personal authority.

A Practice-Based Grounding of Universal Dignity

In this paper I attempt to give a practice-based grounding of universal dignity understood as an authority to issue demands for recognition. This is the understanding of dignity Darwall attempts to establish in his book The Second-Person Standpoint.  I establish that all persons share this authority – and so dignity – by showing that universal dignity is a condition for the possibility of the practice of blaming. There are two major steps in my argument. The first is to establish that blaming is a kind of practice that functions to communicate certain demands and appraisals through negative reactive attitudes. Since blaming has a communicative function it is appropriate to examine it under the lens of speech act theory. In the second step, I appeal to Mark Lance and Rebecca Kukla’s framework of formal pragmatics to show that universal authority to issue demands for recognition is a precondition for the practice of blaming. This second step is where my account differs from Darwall’s in that my account appeals directly to speech-act theory rather than second-personal competence. Assuming that the practice of blaming is justified, this establishes that all persons share dignity. I close by offering some considerations for why this account of dignity serves as a better foundation for moral contractualism than Scanlon’s account of contractualism since, unlike Scanlon’s contractualism, it doesn’t require presupposing substantive moral claims.  This makes it a more suitable candidate for answering the normative question, “Why be moral?”.