Toleration is one of the fundamental principles that inform the design of a democratic and liberal society. Unfortunately, its adoption seems inconsistent with the adoption of paternalistically benevolent policies, which represent a valuable mechanism to improve individuals’ well-being. In this paper, I refer to this tension as the dilemma of toleration. The dilemma is not new. It arises when an agent A would like to be tolerant and respectful towards another agent B’s choices but, at the same time, A is (...) altruistically concerned that a particular course of action would harm, or at least not improve, B’s well-being, so A would also like to be helpful and seeks to ensure that B does not pursue such course of action, for B’s sake and even against B’s consent. In the article, I clarify the specific nature of the dilemma and show that several forms of paternalism, including those based on ethics by design and structural nudging, may not be suitable to resolve it. I then argue that one form of paternalism, based on pro-ethical design, can be compatible with toleration and hence with the respect for B’s choices, by operating only at the informational and not at the structural level of a choice architecture. This provides a successful resolution of the dilemma, showing that tolerant paternalism is not an oxymoron but a viable approach to the design of a democratic and liberal society. (shrink)

The authors interpret the data to mean that patients think that their physicians should make relevant decisions in Learning Health System based trials, and label that as being of 'utmost importance'. However, the patients themselves (in the excerpts provided) emphasize that trust in physicians is instrumental for obtaining protection of patient's bests interests (which seems to be of utmost importance for patients). Furthermore, the perceived bias regarding outcome certainty deserves more discussion. Namely, the decision to defer to physician's opinion is (...) linked to perceived certainty of best clinical outcomes and instrumental for protection of best interest, while it lacks appreciation of the level of uncertainty that exists in clinical decision-making. Finally, a discussion on what are the implications of patient perspectives for individual, vs. relational autonomy is something the authors don't pursue, but instead use "physician-patient autonomy" throughout the paper. (shrink)

What is the ethical impact of artificial intelligence assistants on human lives, and specifically how much do they threaten our individual autonomy? Recently, as part of forming an ethical framework for thinking about the impact of AI assistants on our lives, John Danaher claims that if the external automaticity generated by the use of AI assistants threatens our autonomy and is therefore ethically problematic, then the internal automaticity we already live with should be viewed in the same way. He takes (...) advantage of this paradox of internal automaticity to downplay the threats of external automaticity to our autonomy. We respond in this paper by challenging the legitimacy of the paradox. While Danaher assumes that internal and external automaticity are roughly equivalent, we argue that there are reasons why we should accept a large degree of internal automaticity, that it is actually essential to our sense of autonomy, and as such it is ethically good; however, the same does not go for external automaticity. Therefore, the similarity between the two is not as powerful as the paradox presumes. In conclusion, we make practical recommendations for how to better manage the integration of AI assistants into society. (shrink)