Kennedy Institute of Ethics Journal

This issue of the Kennedy Institute of Ethics Journal contains two essays and one dialogue, all of which concern ethical and epistemological issues that arise at the meeting point of our cognitive and mental lives and technology.

In the first piece, two leading bioethicists with expertise in neurotechnology, James Giordano and Joseph J. Fins, discuss a wide range of complex problems surrounding people with disorders of consciousness that make their mental states opaque to observers. It is especially difficult to know how to respectfully care for and interact with such people, since we cannot directly communicate with them and our technological methods for discerning whether and how they are conscious are nascent and unreliable. People with these disorders challenge our norms for decision-making and patient care, including end of life care. It is easy for doctors, who may only sporadically have contact with people with these disorders, to be unaware of their consciousness altogether. Because caring for people with these sorts of consciousness disorders is typically technologically intense, such care also raises difficult questions concerning resource allocation. Giordano and Fins discuss these and a wide range of other issues in depth. Their discussion of how the tools of disability studies and disability rights advocacy can and should be applied when it comes to people with whom we cannot communicate is particularly powerful. As Fins points out, the important principle, “Nothing about us without us,” cannot be honored in the case of people whose voices and experiences we cannot discern; this slogan presupposes communicative abilities. Fins and Giordano challenge us to revisit our concepts of accessibility and inclusion in ways that might let them be adapted to the needs of people with consciousness disorders.

Phoebe Friesen and Anna Swartz—in “The First Smart Pill: Digital Revolution or Last Gasp?”—offer a critical social history of Abilify MyCite, a version of the popular antipsychotic drug Abilify, which contains a small sensor that digitally tracks when patients take the medication, thereby enabling compliance information to be shared with health care professionals. Friesen and Swartz show in detail the ways in which the story [End Page ix] of this drug’s use and uptake were fundamentally shaped by marketing pressures and financial incentives. Even though we do not actually have good evidence that the drug provides benefits that normal Abilify does not provide, nor that it increases compliance, Abilify MyCite was marketed as a success story. Bioethicists who were paid consultants for Otsuka, the maker of the drug, offered shallow analyses that justified the drug’s existence, focusing primarily on compliance and safety while skimming over deep ethical issues concerning privacy, surveillance, and the targeting of minority populations. Friesen and Swartz conclude that “MyCite was merely another move made in order to capitalize on the enormous success of Abilify that was slipping away from an increasingly desperate company.” Their discussion provides a fascinating case study in the production of medical knowledge and the complex ways it is controlled and shaped by financial interests, as well as driven by an optimistic enthusiasm for technological fixes in the medical and bioethical communities.

Finally, Zohar Lederman and Nancy Jecker—in their essay, “Social Robots to Fend Off Loneliness?”—take up the ethically and existentially fascinating question of when and whether robots can and should be used to mitigate human loneliness. As they point out, loneliness is an urgent public health concern, particularly among older people and other vulnerable groups, but it has received very little bioethical attention. They show that one cannot give a fine-grained answer to the question of what role robots might play in helping with loneliness unless one dives into the nature and varieties of loneliness. This is a deep philosophical project, and the essay argues that loneliness comes in different varieties, many of which essentially concern deficiencies in human-human interactions that serve a wide variety of purposes for us, only some of which can be fulfilled by nonhuman robots. Lederman and Jecker raise fascinating questions about whether deception is integral to the kind of help that robots can in fact offer for fending off loneliness, and whether that would in turn...