13.1 - Moral Bioenhancement and why we still need virtues with Dr. Fabrice Jotterand

Is coffee moral bioenchancement? What does it mean to enhance our moral actions and what is medicine's role in that? Are the virtues still relevant in a world of enhancement? Join us as with discuss these questions and much more with Dr. Fabrice Jotterand, a leading bioethicist at Oregon Health and Science University.

49 minutes • Published Apr 27, 2026 • Download • Transcript

Recommended readings

The Routledge Handbook of the Ethics of Human Enhancement (Routledge, 2023).

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[Intro music]

Hi and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast, we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Thank you for joining us and we look forward to engaging with you through this podcast.

Hi and welcome back to the Hippocratic Society Podcast. Today we are joined by Dr. Fabrice Jotterand.

Fabrice is the Director for the center for Ethics in Healthcare and professor of Medical Ethics at Oregon Health and Science University.

He has a secondary appointment as Senior Researcher at the Institute for Biomedical Ethics in the Faculty of Medicine at the University of Basel, Switzerland.

He is originally from Switzerland and he moved to the United States back in 1995 to pursue his education and academic career. Dr. Jotterand has published more than 90 articles,

book chapters and reviews in leading academic journals, as well as nine books, including his latest monograph entitled the Unfit Brain and the Limits of Moral Bioenhancement,

which is a very fitting title because today we want to discuss with Dr. Jotterand moral bioenhancement and why we still need the virtues.

So Dr. Jotterand, we'd love to start off just with the simple question of what is moral bioenhancement?

Fabrice Jotterand

Well, thank you for the invitation and thank you for having me on the podcast.

Fabrice Jotterand

So the simple definition is the control and manipulation of human conduct through brain interventions that enhance more abilities such as empathy, solidarity, altruism and gratitude.

Fabrice Jotterand

So it's a very simple definition.

Could you give some examples of what those might be?

Fabrice Jotterand

So in terms of the technologies that are available,

Fabrice Jotterand

you can do interventions through neuro, pharmaceutical neuropharmaceutical interventions,

Fabrice Jotterand

such as increasing the level of oxytocin,

Fabrice Jotterand

the use of SSRIs,

Fabrice Jotterand

or you can use neurotechnological interventions,

Fabrice Jotterand

deep brain stimulation,

Fabrice Jotterand

vagus nerve stimulation to treat depression,

Fabrice Jotterand

but it has also an ability to reset the brain.

Fabrice Jotterand

So if you look at neuropharmaceutical interventions in terms of oxytocin level,

Fabrice Jotterand

people will be more trusting.

Fabrice Jotterand

And then in terms of ssri,

Fabrice Jotterand

it will reduce aggressivity.

Fabrice Jotterand

And then you can also,

Fabrice Jotterand

and this is more speculative, but you could have genetic interventions,

Fabrice Jotterand

but this is mostly theoretical at this point. So we don't know if we're going to be able to do so.

Fabrice Jotterand

But as you can see, you can use drugs, you can use neurotechnologies,

Fabrice Jotterand

there is genetic manipulations.

Fabrice Jotterand

So There are different ways to manipulate the brain and human behavior.

Fabrice Jotterand

Yeah.

And so with these technologies, is there,

where does moral bioenhancement start? Or where do these neurotechnologies start and regular everyday things like coffee end? Because, you know, coffee, I'd say maybe makes. Makes me more or less aggressive or just more happy, maybe even kinder.

But how is that? Is that different in kind or is it more of a difference in degree for a drug that would do the same?

Fabrice Jotterand

Well, I mean, it's a little both. But it's a tricky question because,

Fabrice Jotterand

you know, we know the effect of coffee, as you pointed out.

Fabrice Jotterand

So you might be drinking now coffee.

Fabrice Jotterand

Would I call it, you know, a. More bioenhancement?

Fabrice Jotterand

No.

Fabrice Jotterand

So this is why when we have different drugs impacting human behavior,

Fabrice Jotterand

You know, we know caffeine will improve attention and focus,

Fabrice Jotterand

it will enhance self regulation,

Fabrice Jotterand

it has those effects. Right.

Fabrice Jotterand

Do we call it moral bioenhancement? No.

Fabrice Jotterand

But why when we use different drugs or different technologies, neurotechnologies,

Fabrice Jotterand

we call them moral bioenhancement.

Fabrice Jotterand

And as you will see, depending on where the discussion goes, in my view, it's a misnomer when people talk about the whole debate about moral bioenhancement.

Fabrice Jotterand

Because when we say moral,

Fabrice Jotterand

what do we mean? And this is really the question, right?

Fabrice Jotterand

You can manipulate the behavior the same way I gave you two, three, four glasses of wine.

Fabrice Jotterand

Your behavior will change.

Fabrice Jotterand

You might become even more compliant. And we know stories about that, you know, when people drink and then they become more compliant and then they do things that they shouldn't do.

Fabrice Jotterand

So when we say more bioenhancement and we tweak the brain,

Fabrice Jotterand

what are we really tweaking?

Fabrice Jotterand

What, what kind of influence, what kind of control are we trying to have?

Fabrice Jotterand

So this is why I make the distinction between moral content and moral capacity.

Fabrice Jotterand

What people, the proponent of moral bioenhancement, what they want to do is to enhance our capacities to respond morally to different situations.

Fabrice Jotterand

But if we have a kind of a broader perspective on what moral behavior is,

Fabrice Jotterand

we know you need to have a sense of what the good is, what the right is, what the just is.

Fabrice Jotterand

So you have to have a sense of meaning and purpose.

Fabrice Jotterand

You have to have a telos towards some good end, some moral end.

Fabrice Jotterand

So what these people, the proponent, like person in Savulescu, what they want to do is just control your behavior,

Fabrice Jotterand

but they're not really interested in adding content,

Fabrice Jotterand

developing a sense of the good.

Fabrice Jotterand

And so I think this is why moral bioenhancement in my view, it's a misnomer. It's more about bioenhancement toward controlling behavior.

Fabrice Jotterand

But it's not moral.

Fabrice Jotterand

And behavior,

Fabrice Jotterand

it's not only moral. It has also certain other aspects in terms of motivation, in terms of emotion,

Fabrice Jotterand

response to situations.

Fabrice Jotterand

So they don't have the people,

Fabrice Jotterand

the proponent of moral bioenhancement,

Fabrice Jotterand

in my view, they don't have a full psychological picture or a moral psychology that will allow them to say, yeah, this is really moral bioenhancement.

Yeah, I think that that's a really interesting point that we also,

as you're familiar with our work in the Hippocratic Society, that we talk a lot about this idea of how we define what morality is or the idea of what.

What we mean by when we say that medicine is a moral practice.

Do you think you could define for us how we should be thinking about defining what it means to practice medicine within this moral context?

Fabrice Jotterand

Yes. So this is a very important question because it goes back to the question of agency. So the question we need to ask is, what does it mean to be a moral agent?

Fabrice Jotterand

And so to be a moral agent is not just to understand a moral theory,

Fabrice Jotterand

but it's really how you embody some notion of the good.

Fabrice Jotterand

And here I'm referring to virtues.

Fabrice Jotterand

So I think this is why the traditional way of teaching bioethics,

Fabrice Jotterand

in my view, is problematic, because we ask, for instance, medical students to understand the four principles and then apply them to a case.

Fabrice Jotterand

But agencies totally absent in the discussion.

Fabrice Jotterand

So when we say,

Fabrice Jotterand

you know, that we talk about the internal morality of medicine to refer to Pellegrino, I think it has to be more than just a sense of,

Fabrice Jotterand

well, we have principles, we apply them. It has to be about how do I internalize these notions of the good and how do they become habits.

Fabrice Jotterand

So once I'm leaving medical school, they're a part of who I am. They are shaping my intellect,

Fabrice Jotterand

my emotions,

Fabrice Jotterand

my motivations.

Fabrice Jotterand

And so I think this is how, when I understand.

Fabrice Jotterand

I mean, to answer your question, this is how I would understand this idea of practicing medicine within a moral context. And it's very interesting to see that when bioethics was emerging,

Fabrice Jotterand

Edmund Pellegrino, for instance, understood that you need to locate bioethics within a broader context.

Fabrice Jotterand

And I think this is why his work in the philosophy of medicine and virtue ethics is so relevant to the discussions we have now in terms of agency, in terms of flourishing, in terms of how we understand the relevance of practical wisdom, for instance, in the Clinical context and in moral formation.

Yeah,

I think that's also been a key part of the work we've been doing, which is just the idea of the fact that cultivation of virtue, we're not just thinking about it in terms of in the healthcare environment,

but how we practice virtue and try to pursue the good in our life. There's a continuity there between outside the hospital and inside the hospital. And therefore this idea of developing the sense of what the good is in all aspects of our life also affects how we practice patient care.

Fabrice Jotterand

Yeah, no, I totally agree. And so this is why sometimes in my discussion with medical students,

Fabrice Jotterand

they're frustrated because suddenly they don't have agency anymore because we try to placate this professional identity and we forget that there is also a human being, there is an agent, a moral agent.

Fabrice Jotterand

So the question is, how do we take these and allow them to make a smooth transition so they understand who they are as a more agent, and then we have this professional identity that is part of who they are.

Fabrice Jotterand

And sometimes we see this separation that is problematic because at the end, what this leads is to moral distress and burnout, because you're stretching your identity to a point where,

Fabrice Jotterand

listen, I cannot do this.

Fabrice Jotterand

This is who I am. And when I'm in a clinical context or when I'm in the educational setting, I'm asked to do X, but it doesn't reflect who I am.

Fabrice Jotterand

And so I think this is important work to do in terms of starting with agency.

Fabrice Jotterand

So they have a good understanding who they are,

Fabrice Jotterand

and then you progress progressively to professional identity.

Yeah, and on that,

on that note, with. With the topic of moral distress, which I think is a really fascinating one, and for example, conscientious objection, which I think relates a lot to this idea of moral bioenhancement.

And what is the good that we're seeking in medicine?

How does moral bioenhancement, and I know you were talking about this a little bit earlier, but how might this play a part in a pluralistic society where sometimes we don't agree on what the good is or what the ends of medicine are?

And there are different accounts of the ends of medicine, which,

you know, as we know, Pellegrino is very in favor of the internal account of medicine, that it has its own morality in telos,

which I think we tend to agree with. But hey, how do we understand pushing towards the moral or a pursuit of the moral in a society where that's not necessarily the same for everybody?

Fabrice Jotterand

But. But this is the problem. This is why I Said moral bioenhancement is a misnomer because there is no one morality, right? We a sense of what is good based on some assumptions,

Fabrice Jotterand

based on a worldview, some metaphysical assumptions. So it's a metaphysical question.

Fabrice Jotterand

And so what you see, at least in my,

Fabrice Jotterand

when I was working on the book, and I realized the proponents of moral bioenhancement, they have a particular understanding of what a good society is.

Fabrice Jotterand

And so they tend to promote certain ideas.

Fabrice Jotterand

But if you step outside this model, then what does it mean for you?

Fabrice Jotterand

So you see the danger here that you could abuse,

Fabrice Jotterand

hypothetically, if we had the technology,

Fabrice Jotterand

you could abuse that technology and you could manipulate people. Let's say we put in water, whatever it is,

Fabrice Jotterand

whatever component it is,

Fabrice Jotterand

then you expect that people will behave a certain way.

Fabrice Jotterand

But this is the problem with technology in general.

Fabrice Jotterand

It tends to make people uniform.

Fabrice Jotterand

And so this is why I see a real danger. Even if we had the technology,

Fabrice Jotterand

I would be opposed to it.

Fabrice Jotterand

And when I was the book I wrote the Unfit Brain and the Limits of Moral Bioenhancement. I started with the idea of, say, okay, it's a bad idea to use these technologies in the social context.

Fabrice Jotterand

What about in a clinical context? And we cannot treat psychopaths? What about if we could use that technology to treat psychopathy?

Fabrice Jotterand

And I started with this idea, it might be a good idea. Right. And then I ended up saying, oh, it's a very bad idea because there is a humanity that we need to protect.

Fabrice Jotterand

There's a sense of self.

Fabrice Jotterand

I mean, it's more complex than simply say, oh, we're going to manipulate the brain and then you're going to behave a certain way because it requires, when we talk about morality is required again,

Fabrice Jotterand

to have a concept of the good and flourishing that will need to be developed as a human being and not just imposed from outside using technology.

Fabrice Jotterand

Yeah.

Just to clarify there,

what you're saying is, for example, in somebody who's experiencing psychosis,

that you would still,

I mean, as would be assumed, treat the pathology involved with their hallucinations or agitation,

but that the specific aspect of moral development has to be not something that's based on some pharmacology or some other,

I guess, thing that would manipulate the, perhaps agency or intentions of the person.

Fabrice Jotterand

Yes. So if you look at the argument of the proponents of moral bioenhancement, basically what they do, they pathologize human behavior.

Fabrice Jotterand

Their argument is, well, traditional ways of moral formation, education, for instance, what they call moral doctrines have failed.

Fabrice Jotterand

So now we're Going to use technology.

Fabrice Jotterand

It will help us to make better people.

Fabrice Jotterand

But this is problematic because it's the pathologizing that is problematic, because morality is not a pathology. It's something that you develop.

Fabrice Jotterand

Now, you might have a pathology like you described, but the moral component should be separate.

Fabrice Jotterand

And so this is where we need to distinguish what they do.

Fabrice Jotterand

Pearson and Savulescu, they just combine the two.

Fabrice Jotterand

They even go,

Fabrice Jotterand

you know, examples.

Fabrice Jotterand

Well, we have a high level of divorces in society,

Fabrice Jotterand

and I don't think it's Savulescu. It might be.

Fabrice Jotterand

I can't remember, but yeah, I think it's Savulescu. But there's an article,

Fabrice Jotterand

well, we have a high level of divorces in society.

Fabrice Jotterand

What about if we could have a pill that will allow people to stick together and people would be faithful,

Fabrice Jotterand

but if people are not faithful to each other,

Fabrice Jotterand

it might be a moral problem. Right.

Fabrice Jotterand

So again, we try to address human existential problems, moral problems, using technology,

Fabrice Jotterand

instead of stepping back and say,

Fabrice Jotterand

what is missing? What is the part that is missing in how we develop as human beings? So it relates to moral formation.

Fabrice Jotterand

It's really about the components of moral formation. And it starts in the home and then in school,

Fabrice Jotterand

high school,

Fabrice Jotterand

university,

Fabrice Jotterand

et cetera.

Yeah.

On that note,

in terms of the ends of medicine and moral formation, and John, maybe you can talk about this as well as both neurologist and palliative care physician.

What.

What would you say is the scope of medicine in terms of moral formation? For example, if there is a patient, especially in psychiatry, I think this might be most relevant.

There's a patient whose pathology seems to. Yeah, as we were talking about, very much overlap with seemingly lack of moral formation, or to put it harshly, maybe a lack of virtue.

Obviously, there's pathology involved,

but I guess what is the role of the physician? Or on what is the onus of the physician, on addressing that moral part, even if it isn't through moral bioenhancement, but more traditional means of moral formation?

Is that the physician's role at all or medicine's role at all? Or is it we have to leave that to another part of society, like the family or education?

Fabrice Jotterand

Is this a question for me or for John?

I'd love to hear both perspectives on it.

Fabrice Jotterand

John, you're a physician. Maybe you should start.

Yeah,

it's a great question, Michael. I think that there's oftentimes perhaps we think too much about totally separating out what we do as physicians from what we do as human beings.

And I think in some sense it's not possible to do that. There isn't just only one domain, especially when it has to do with the existential questions that a patient brings to the clinic visit,

that there isn't really a way to separate out the experience of illness from the illness itself.

And there is always going to be an existential and moral dimension to an illness.

And so I think it wouldn't be good for a physician to only focus on the illness and not address aspects of the illness that the patient is experiencing,

including,

like, why is this happening? What does it mean for me? And how is this affecting me in the context of my relationships and how I see life? And so I often feel as a physician that I am addressing those things.

And,

you know, even the other day, actually, I had a patient come in to see me, it was only a couple days ago,

where basically this patient was worried about the fact that there was this recent experience of some change in dosage of a type of treatment that led to a side effect.

And while this patient was experiencing the side effect,

felt that this person didn't have enough communication with their clinical team in order to address the side effect.

But in the end, when I was trying to understand the core of the issue,

what really came out was there was a fear that if there was ever a time where this patient couldn't communicate anymore,

that this particular thing that was really distressing as a side effect would not be addressed.

And so at the core of the visit actually was about addressing the fear,

the fear of the future, the fear of what this means for this patient's identity, the fear of what may happen in different contexts. Right. And so,

in some sense, it wouldn't actually have been a fruitful visit had that fear at the core of the visit been addressed. Because in the end, we actually didn't change any medication dosages,

and there was, in some sense, a plan already in place. And so I think it gives an example of how,

again, the experience of the illness is not able to be separated out. And in that sense,

oftentimes when somebody is coming in this state of distress, that there is this existential component that the patient also hopes that the doctor will address to the degree that the doctor is able to.

Fabrice Jotterand

And I would add to that medicine is a humanistic endeavor.

Fabrice Jotterand

So there is this human component that is part of clinical practice. Of course,

Fabrice Jotterand

these days we emphasize knowledge and skills and technology,

Fabrice Jotterand

but if,

Fabrice Jotterand

you know, we talk about medicine as a triad,

Fabrice Jotterand

to refer back to Pellegrino in terms of science,

Fabrice Jotterand

in terms of skills, and then the humanistic side the virtues.

Fabrice Jotterand

And he says, if you remove one component, then it's not medicine.

Fabrice Jotterand

So in the clinical encounter, if you remove that humane dimension,

Fabrice Jotterand

then it's not really medicine in the traditional way.

Fabrice Jotterand

It's some types of medicine.

Fabrice Jotterand

But you are simply addressing a disease.

Fabrice Jotterand

You're looking at an illness.

Fabrice Jotterand

But I think,

Fabrice Jotterand

you know, Osler said the good physician is the one who treat the disease.

Fabrice Jotterand

The great physician is the one who treats the disease. And I mean the person holistically and the environment.

Fabrice Jotterand

And so good medicine is where you try to understand every aspect,

Fabrice Jotterand

as John mentioned, every aspect of the.

Fabrice Jotterand

What's going on in the life of the patient.

Fabrice Jotterand

So it would be very difficult to separate them if you do good medicine, to separate the kind of personal moral versus the clinical.

Fabrice Jotterand

So I would say we need to go back to a kind of holistic approach to medicine.

One thing that I'm wondering, Fabrice, if you could talk more about is as we talk about this idea of moral bioenhancement,

we also touched on this idea of formation of that sense of agency that you were talking about in medical students.

If you could talk a bit more about how best we could enhance that sense of agency and sense of importance, of the weight of development of the interior moral sense of each of the medical students.

Fabrice Jotterand

That's an excellent question. I think there are, I would say, two elements.

Fabrice Jotterand

One is to ask specific questions about themselves.

Fabrice Jotterand

They have to be reflective and ask them,

Fabrice Jotterand

who are you as a moral agent?

Fabrice Jotterand

What are your values?

Fabrice Jotterand

What is your worldview?

Fabrice Jotterand

What is your understanding of the good in general?

Fabrice Jotterand

And then try to attach that worldview in relation to medicine and ask them to say, well,

Fabrice Jotterand

what is medicine?

Fabrice Jotterand

If medicine is inherently a moral practice, then what does it mean for me to enter that profession as an agent?

Fabrice Jotterand

So I think there is this kind of reflective element in how you train future physicians.

Fabrice Jotterand

And of course, it requires to go deep. And I know that not every medical student is interested in doing this type of work, but I think it is essential because you see a tension between agency and the system.

Fabrice Jotterand

And when we say, well, the system is broken, it's because we don't have the right people.

Fabrice Jotterand

And then. Or you say, well,

Fabrice Jotterand

we're not training the people correctly. And so you see these two poles, and it's a real tension.

Fabrice Jotterand

So what we need to do is to prepare future physicians to develop certain mental habits.

Fabrice Jotterand

I would say the virtues to understand the complexity of the system,

Fabrice Jotterand

but also how to navigate that complexity and not reduce everything to a checklist, but rather for them to develop A sense of,

Fabrice Jotterand

okay, I have to embrace distress, moral distress.

Fabrice Jotterand

Some moral distress is good because it allows you to grow as a person and it allows you to understand complexity.

Fabrice Jotterand

But you're not asking them to just go into that world of complexity without equipping them.

Fabrice Jotterand

And so what you have to do, you have to equip them in a way that will allow them to make right choices, to have the right habits.

Fabrice Jotterand

For instance, practical wisdom.

Fabrice Jotterand

I'm always emphasizing practical wisdom because this is what allow a student to say, oh, here I have to step back. Here I have to be courageous. Here I'm pushing too hard.

Fabrice Jotterand

And then understand what's going on in the world.

Fabrice Jotterand

You need to have a sense of who you are, right? It's not say, well, this is what I'm being told,

Fabrice Jotterand

but maybe this is not for me.

Fabrice Jotterand

So it's always a question of situating yourself in a particular context,

Fabrice Jotterand

making the right choice, developing the right habits, and finding good mentorship.

Fabrice Jotterand

Mentoring is key.

Fabrice Jotterand

What are the models? You might have models as clinicians,

Fabrice Jotterand

but you might have people outside medicine who can train you to think critically about what you're experiencing, what you see in the clinical world.

Fabrice Jotterand

So all this is,

Fabrice Jotterand

I would say, part of this kind of development.

Fabrice Jotterand

And there is no, you know,

Fabrice Jotterand

it's not just go through these 10 steps and it's going to work.

Fabrice Jotterand

Each individual is different.

That's music to my ear since that's like the model that we have in the Hippocratic Society, this idea of mentorship and community in the practice and realization of the virtues and having a model to model after.

I'm also wondering if you could talk a bit more about a topic that maybe our listeners are thinking about, because when we think about moral bioenhancement, we think we,

you know, you mentioned things like SSRIs or antipsychotics or things that might like, calm people, vagus nerve stimulation.

But, you know, there's another type of technology that, like, people are rapidly using these days, which are perhaps not implantable or directly affecting the brain, but I think is affecting our sense of some of these questions that you're asking.

And what I mean by that is the large language models, right? And so with these models like ChatGPT,

people are starting to use them for things like asking moral questions or asking ethical questions or even using them for counseling around certain emotional distress or even existential questions. And I think that that does blur in some sense this idea of what does it mean to be a moral agent and how are we interacting with other moral Agents and wondering if you could comment a bit about that and your thoughts that especially since it's so,

I think, relevant to probably what a lot of people are also thinking about or wrestling in that space.

Fabrice Jotterand

This is an excellent question.

Fabrice Jotterand

Absolutely.

Fabrice Jotterand

It's reshaping our notion or understanding of agency because suddenly you have a dilemma. Instead of thinking, being a critical thinker,

Fabrice Jotterand

what you do, you ask ChatGPT, give me the answer.

Fabrice Jotterand

I have a problem,

Fabrice Jotterand

a moral dilemma in the clinical context. I could have my phone. I have a problem.

Fabrice Jotterand

I can give you a particular case in Belgium. There was a young man,

Fabrice Jotterand

he was distressed because of the economy, the environment. I don't know if you heard about this case,

Fabrice Jotterand

but he was depressed.

Fabrice Jotterand

So then he started a conversation with a chatbot and he committed suicide. Because at the end the chatbot said, well, you know, there's no solution. The best way is to commit suicide.

Fabrice Jotterand

And the gentleman just committed suicide. So the problem is a chatbot will not have a sense of, you know,

Fabrice Jotterand

agency the way we have.

Fabrice Jotterand

It doesn't have any sense of agency, actually. It's just words, right? It answers to something, a question to some symbols.

Fabrice Jotterand

So it's all about syntax and it's not about meaning and purpose.

Fabrice Jotterand

So when we talk about AI the problem, or if we introduce AI in our conversations, it will undermine our creativity,

Fabrice Jotterand

our critical thinking, our sense of agency,

Fabrice Jotterand

our sense of responsibility,

Fabrice Jotterand

and then it undermines our human relationships. Instead of living in communities and asking advice to peers and say, hey, this is my dilemma. What do you think about this?

Fabrice Jotterand

How should I move forward? And AI will never understand.

Fabrice Jotterand

When people say to me, say, well, we're going to have robots that will be empathic in a clinical setting, I said, absolutely not.

Fabrice Jotterand

A robot will not be empathic. Empathy is not something that you just communicate. It's something that you have to understand.

Fabrice Jotterand

And so robot will never understand the limitations of our bodies,

Fabrice Jotterand

will never understand what it means to confront death,

Fabrice Jotterand

to be sick, and all these questions.

Fabrice Jotterand

So I think this will reshape our mind in ways that it's not going to be an enhancement, actually. It's going to be the opposite, I think,

Fabrice Jotterand

because it will undermine our agency, critical thinking, creativity.

Fabrice Jotterand

And now I see, for instance,

Fabrice Jotterand

copilot. You're familiar with copilot, right?

Fabrice Jotterand

It's embedded in our email system.

Fabrice Jotterand

I mean, it's so easy. Write an email about this.

Fabrice Jotterand

It looks fantastic.

Fabrice Jotterand

But instead of me wrestling a little bit and try to communicate what I really want to communicate,

Fabrice Jotterand

my muscle, my intellectual muscle or muscles will just become weaker and Weaker.

Fabrice Jotterand

So I think I see a lot of problems with this integration of artificial intelligence and our ability to converse with these machines.

Yeah, I wonder that bringing this back to mentorship,

one thing that I've been thinking about a lot with the ideas of virtue as well and mentorship and virtue development is what is it specifically about the person to person relationship that makes it sort of a seedbed for virtue more than AI could be?

Because,

I mean, I've heard people say that AI can do a lot of good for,

I guess, you know,

reframing things or, you know, asking it a question or just helping you be more encouraged. But yeah, the way you talk. And from what I've heard, it seems like virtue itself cannot really be instilled by AI in the same way as a mentor.

So I wonder, experientially or anthropologically,

what do you have sort of, I guess a better explanation of what the mechanism of virtue across mentorship or person to person virtue development is.

Fabrice Jotterand

I mean, true mentorship is not only to say good things about the other person.

Fabrice Jotterand

True mentorship is sometimes to say, you need to stop now. You're on the wrong way,

Fabrice Jotterand

on the wrong path.

Fabrice Jotterand

An AI will always be compliant to a certain extent.

Fabrice Jotterand

It will always say good things about you.

Fabrice Jotterand

It will not understand why it's not good to do X.

Fabrice Jotterand

So for that particular reason,

Fabrice Jotterand

I'm not sure an AI will be able to really shape your person in a way that a human being can,

Fabrice Jotterand

because a human being knows what it means. Let's say I'm 60 and I'm mentoring a medical student who is 25.

Fabrice Jotterand

I know what it means to be 25. A robot will never understand what it means to be 25. It's only data that is given to.

Fabrice Jotterand

It's just input. Right.

Fabrice Jotterand

So for that particular reason,

Fabrice Jotterand

in terms of developing virtues,

Fabrice Jotterand

if we talk about a virtue like courage,

Fabrice Jotterand

well, you know, I can explain why when I was 25, I was not very courageous because X, Y, and Z and I can talk about my failures.

Fabrice Jotterand

An AI will never talk about failure.

Fabrice Jotterand

Failure is so important in terms of growth, in terms of personal development.

Fabrice Jotterand

So for that particular reason, I don't think an AI is very helpful. It can give you a sense of what a virtue is, but existentially,

Fabrice Jotterand

it will not explain what it means to develop a particular virtue like courage or practical wisdom,

Fabrice Jotterand

et cetera, et cetera.

Yeah, I also wonder, coming back to one of the things that you mentioned earlier, Fabrice, is,

or alluded to earlier in the discussion, is just this idea of how important the body is.

Or this idea that the body is so important for the understanding of the moral experience.

Because, as you mentioned,

AI can't understand what it means to die because it doesn't have a body.

And I've been thinking a lot about this idea of how the body is therefore also just so important in virtue development. Because there are many things that just arise,

you know, in the body in terms of trying to grow in temperance or fortitude and that we're wrestling with and in some sense even encourage to say something that needs to be said in a particular moment.

They're like your heart is racing. There's all these things that happen also to your physiology as you're confronting moral questions.

And I think that there's something about,

therefore, that not being able to be shared by an AI Chatbot in terms of how it understands truly, that sense of.

Because it doesn't have a body,

that it is unable to therefore experience in the same way that another human being does.

And I wonder what you think also about. Because it's one. One aspect I've been wondering is this idea of, like, how is virtue shared?

Because I think that we sometimes think about this idea of how perhaps the more kind of the idea of perhaps one of the theological virtues, love as being shared between two persons, but also the will then being activated to love another.

And it seems like in that setting, like, virtues can be shared.

But I guess in classical virtue, it's about how one is trying to grow in one's individual sense of virtue through that sense of intention, agency, et cetera. But could you talk a little bit about this idea of.

Well, yeah, bodies. And then also if virtues can be conceptualized in that way of somehow being shared.

Fabrice Jotterand

Yeah.

Fabrice Jotterand

I think we live in a society where the body is not important. So this is why you have.

Fabrice Jotterand

The transhumanist movement is very popular. And they don't need the body.

Fabrice Jotterand

Right.

Fabrice Jotterand

Because our identity is only in the brain.

Fabrice Jotterand

This type of. Kind of what we call neuroessentialism.

Fabrice Jotterand

We are the brain,

Fabrice Jotterand

but the body, in terms of shaping our identity or giving us an identity is not part of the discussion. But the problem is we engage with the world with our bodies.

Fabrice Jotterand

I'm six four,

Fabrice Jotterand

I'm Caucasian, et cetera, et cetera.

Fabrice Jotterand

And then you will recognize me as a Fabrice because of my characteristics.

Fabrice Jotterand

And this is important to give us a sense of identity.

Fabrice Jotterand

And then in terms of how we demonstrate virtues.

Fabrice Jotterand

Well, body language is important.

Fabrice Jotterand

If you look at the clinical context.

Fabrice Jotterand

If you put your hand on the shoulder of a Patient in terms of communicating compassion, empathy and love,

Fabrice Jotterand

you can just do that. And you know why you do it.

Fabrice Jotterand

So I think the two go together. If you don't have a body, then it's like, you know,

Fabrice Jotterand

if we talk about wisdom, right, you have Sophia, which is purely intellectual versus practical, wisdom, which is embodied.

Fabrice Jotterand

It's something that you have to be able to communicate with your body, the whole.

Fabrice Jotterand

With your whole being.

Fabrice Jotterand

You have to be able to,

Fabrice Jotterand

well, to communicate love,

Fabrice Jotterand

courage,

Fabrice Jotterand

et cetera.

Fabrice Jotterand

So I think this is a very important point in terms of how we develop these technology now, these virtues, is because we need to live in communities,

Fabrice Jotterand

and this is how we're going to develop.

Fabrice Jotterand

And the role of communities is to help people see virtues in others, how they are embodied.

Fabrice Jotterand

And then you have this modeling,

Fabrice Jotterand

and then you say, I want to be like him,

Fabrice Jotterand

like her.

Fabrice Jotterand

And then you say, hey, how do I develop these virtues?

Fabrice Jotterand

And then once you have these virtues,

Fabrice Jotterand

then you do the same for the next generation.

Fabrice Jotterand

So this is why communities,

Fabrice Jotterand

institutions are key to society in general and to medicine in particular,

Fabrice Jotterand

where you bring these individuals, you bring medical students into this community of practice,

Fabrice Jotterand

communities of practice,

Fabrice Jotterand

and you embody these virtues and you talk about there is a cognitive dimension, there's an emotional dimension, but there is an experiential dimension.

Fabrice Jotterand

So, and this is. It reflects what it means to be a human being. And we lost that ability because it's either purely intellectual, it's virtual.

Fabrice Jotterand

And all these meetings that we have,

Fabrice Jotterand

you know,

Fabrice Jotterand

for work, virtual meetings,

Fabrice Jotterand

you can hide behind the screen,

Fabrice Jotterand

but you're not totally immersed, you're not totally engaged with the community, with your colleagues, with patients,

Fabrice Jotterand

whatever the context of the meeting.

Fabrice Jotterand

So I think the two go together where you need to be able to express these virtues. And so it becomes a model for others, but you're also confronted to the reality of other people maybe challenging you.

Yeah,

I love those points, and I think it's a wonderful place to maybe start to wrap up on these lived virtues. Embodiment. What?

And I guess both of your experiences maybe are some practical tips to bring this embodiment and virtue into our lives. Like, how can we continue to foster these mentorships? How can we approach technologies, both ones that are arising and AI in a way that continues to foster our virtue development.

Just any sort of final tips to keep it practical? I guess

Fabrice Jotterand

you're not going to like my answer, but I try to stay away as much as possible of these certain technologies.

Fabrice Jotterand

It's just because I want to be engaged with human beings.

Fabrice Jotterand

I'M interested with.

Fabrice Jotterand

I do work on AI and do work from an ethical and philosophical standpoint on the integration of AI in a clinical setting. And I always say we need to have a human centered approach to the implementation of AI in a clinical setting because we might lose ourselves in the sea of technology.

Fabrice Jotterand

And this is the problem.

Fabrice Jotterand

Heidegger, he wrote this essay on technology in the 50s in German and then was translated in English in the 60s. But already at that time he saw the shift that technology was turning against us.

Fabrice Jotterand

And now we are the point where technology is basically dictating how we should behave.

Fabrice Jotterand

If you don't have an iPhone now at work,

Fabrice Jotterand

you cannot work. You're totally cut off from work.

Fabrice Jotterand

And so this is why in terms of being practical,

Fabrice Jotterand

I would say use it in a responsible way. Don't panic. Morally,

Fabrice Jotterand

be wise,

Fabrice Jotterand

but maybe also take a break,

Fabrice Jotterand

maybe, you know,

Fabrice Jotterand

take a Sabbath,

Fabrice Jotterand

it's Sunday. I mean, if you're a Christian, say, well, today I'm going to minimize the use of technology,

Fabrice Jotterand

or I'm at home, I'm with my kids,

Fabrice Jotterand

with my wife,

Fabrice Jotterand

I don't do emails.

Fabrice Jotterand

Things like that I think will help us being,

Fabrice Jotterand

I would say,

Fabrice Jotterand

virtuous about technology.

Fabrice Jotterand

We can do a lot of good things with technology.

Fabrice Jotterand

But I come to a point where I'm seriously concerned about how technology is dictating our way of life,

Fabrice Jotterand

how we think, it's formatting the way we think,

Fabrice Jotterand

what we do.

Fabrice Jotterand

It's everywhere. And John, I would be curious your perspective as a physician. And I don't know if you use AI these days, but what I hear,

Fabrice Jotterand

it's everywhere.

Fabrice Jotterand

So for that particular reason I would say,

Fabrice Jotterand

well,

Fabrice Jotterand

let's be wise, but also let's be careful before we are totally mastered by technology.

Yeah,

I totally agree with the idea of making sure that all of our technology starts and ends with the human person.

And I think the question ends up being how does that look practically and how does one do that in practice?

And have been thinking more and more about the way in which we sometimes too rapidly integrate certain technologies without thinking about the intention in which even the technologies were created by companies that may want you to use it more.

In fact, there was actually just a news article yesterday about how the courts are bringing against certain social media companies because they neglected the addictive potential of what they were doing in children.

And in some sense there was maybe even an intentionality of trying to get children addicted to the social media. And so there's a large court case going on right now about that.

That which I thought was interesting too,

so how we're thinking about also that they're not just oftentimes neutral in the sense of how they're being played out or trying to be incorporated into our lives and being intentional about that.

And I think the only other thing that I would mention in terms of embodiment is I had a lunch with a friend recently, and we were just discussing this idea of how in different situations,

being aware of that which arises in our heart. I think that's also something that happens in medicine. You kind of recognize things by this countertransference, which, you know, maybe if you're very materialist, you could just say, oh, it's just brain processes.

But perhaps one could say that there's something deep inside in terms of an awareness or a mindful awareness of the heart of the other, or the intention of the other, or something that you're sensing beyond perhaps just the intellect in which how you respond to the other.

And I think that that is like an important part of the body is being able to see those things rise from one's heart and recognize them,

also take a step back from it sometimes. Also, like, recognize whether something that's arising in us can just be an emotion that we just feel nervous about something or whether it's something that we should be aware of and pay more attention to.

And this kind of reflective approach to how our body responds to things, I think is really important and comes back to this idea of, I think, mindfulness of seeing things taking that step back,

being aware of, like, what our body is telling us,

and also then being able to discern whether that's coming from somewhere that we have to, like, pay more deeply, deeper attention to, or whether it's also something that we can allow to pass.

Recognizing that this is. Is at times something that happens physiologically that we don't have to, like, be,

like, upset at every time we feel a little nervous about something as well, you know.

And this coming in touch more deeply with that which is happening in our body, I think only helps us be more integrated fully into who we are and our sense of identity as we've been talking about.

Yeah, yeah. I think both amazing tips. And I'm noticing a theme here of being,

I guess, very just aware and present in the moment, both of yourself and of others, and not letting technology or even just emotions sort of bring you out of that,

which I think to me seems to be core to growing in virtue.

Well, great. Thank you both so much. This was a very fruitful conversation. I know. Certainly helpful for me. I hope helpful for our listeners. And thank you, Fabrice, again for joining us.

We're really glad to have you.

You.

Fabrice Jotterand

It was my pleasure. Thank you for the invitation.

Absolutely. We'll see you all next time on the Hippocratic Society Podcast.

Thank you very much for joining and reflecting with us today.

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