Responsibility beyond design: Physicians' requirements for ethical medical AI.

Medical AI is increasingly being developed and tested to improve medical diagnosis, prediction and treatment of a wide array of medical conditions. Despite worries about the explainability and accuracy of such medical AI systems, it is reasonable to assume that they will be increasingly implemented in medical practice. Current ethical debates focus mainly on design requirements and suggest embedding certain values such as transparency, fairness, and explainability in the design of medical AI systems. Aside from concerns about their design, medical AI systems also raise questions with regard to physicians' responsibilities once these technologies are being implemented and used. How do physicians' responsibilities change with the implementation of medical AI? Which set of competencies do physicians have to learn to responsibly interact with medical AI? In the present article, we will introduce the notion of forward-looking responsibility and enumerate through this conceptual lens a number of competencies and duties that physicians ought to employ to responsibly utilize medical AI in practice. Those include amongst others understanding the range of reasonable outputs, being aware of own experience and skill decline, and monitoring potential accuracy decline of the AI systems.

Did Alexander Fleming Deserve the Nobel Prize?

Penicillin is a serendipitous discovery par excellence. But, what does this say about Alexander Fleming's praiseworthiness? Clearly, Fleming would not have received the Nobel Prize, had not a mould accidently entered his laboratory. This seems paradoxical, since it was beyond his control. The present article will first discuss Fleming's discovery of Penicillin as an example of moral luck in science and technology and critically assess some common responses to this problem. Second, the Control Principle that says that people are not responsible for things beyond their control will be defended. An implication of this principle is that Alexander Fleming's desert, which is based on his epistemic skills, remains untouched by luck. Third, by distinguishing different notions of praiseworthiness, a way to resolve the paradox of moral luck will be elaborated. Desert provides only a pro tanto reason to determine whether someone is an appropriate addressee of reward. Here, luck can make a difference. Forth, it will be argued that stimulating the quest for socially beneficial science provides a compelling reason to treat scientists with equal desert differently. Penicillin provides striking evidence for the importance of this quest and showcasing it incentivizes the making of socially beneficial science. Ultimately, it will be justified why Fleming deserved the Nobel Prize in at least one sense of the concept.

After the fact-the case of CRISPR babies.

The world has been startled by the irresponsible experiment of He Jiankui, who used CRISPR to genetically modify human embryos. In this viewpoint, we explore the phenomenon of moral luck in medicine and its bearing on the limits of simple judgements of the kind "everything that ends well is well" or "someone broke the rules, and is therefore blameworthy". The risks involved in scientific and medical experiments are often brushed aside, when they turn out well. The clinical application of CRISPR in the human germline is presently too risky to be used without more preclinical research and unacceptable without broader societal support, which justifies the call for a moratorium by the scientific community. However, such policies do not determine how to assess cases, where someone was willing to take such risks beyond all rules, guidelines and regulation and succeeds. The policies including the proposed moratorium are as unanimous about the undesirability of current applications of clinical germline editing as they are about the potential importance of this research. What if this potential is achieved by breaking the rules? The paradox of moral luck impinges on this debate. In our analysis, we rebut simplified judgments and advocate a more balanced view on the relation between moral responsibility and the societal consequences of medicine.

The usual suspects: why techno-fixing dementia is flawed.

Dementia is highly prevalent and up until now, still incurable. If we may believe the narrative that is currently dominant in dementia research, in the future we will not have to suffer from dementia anymore, as there will be a simple techno-fix solution. It is just a matter of time before we can solve the growing public health problem of dementia. In this paper we take a critical stance towards overly positive narratives of techno-fixes by placing our empirical analysis of dementia research protocols and political statements in a framework of technology assessment. From this perspective, it becomes obvious that a techno-fix is just one of many ways to approach societal problems and more importantly that technologies are way less perfect than they are presented. We will argue that this narrow scope, which focusses on the usual suspects for solving illnesses, reduces dementia to organismic aspects, and may be counterproductive in finding a cure for dementia. We conclude with outlining how the narrow scope can be balanced with other narratives and why we should have a reasonable scepticism towards the usual suspects.