Where Are the Medical Ethics?

This transcript has been edited for clarity.

Hi. I’m Art Caplan, and I’m at the Division of Medical Ethics at New York University’s Grossman School of Medicine.

Some of you know that Mark Zuckerberg has spun out a bigger entity of his Facebook company called Meta; what he’s talking about is a company that’s going to try to create an artificial world using the internet in the future – the so-called metaverse.

Think of situations where you see games now, where people are wearing headsets and involved in video games. Something like what’s called the Oculus, where you basically have images transmitted directly into your eyes by wearing a kind of goggle system, and it seems absolutely real. You can go on a safari. You could take a hike up a tall mountain. You could travel to outer space. You can do almost anything within that still somewhat primitive metaverse.

There are also people working on trying to create sensations in the metaverse. A Japanese company has recently reported that it has found ways to attach sensors to people so they can feel their skin tingle or other sensations as part of this idea of ​​being immersed in an artificial environment. For those of you who are Star Trek fans, it’s the holodeck. You basically walk into an artificially created video, sound, and sensation world.

Although it sounds like science fiction, elements of it are already here. When we use the internet to do this kind of communication, I’m reaching out to you over an electronic means. Even though we’re far apart, I still can be a presence and talk to you and we can set off a discussion and a debate. That would have seemed unbelievable to our great-grandparents, for example.

If you put that on steroids, you have a world in which your patient someday may come to you and say, “I feel anxious and depressed. I’m overwhelmed with anxiety.” The remedy might be to say, “Okay, wear this goggle system and go into a universe where we can expose you to things that make you nervous and try to reduce your phobias, play techniques with you that might help you be less anxious, or do things with you that might be stress relieving. “

At the far end, what if you had urges and desires that are weird, aberrant, or dangerous? Can you indulge them in this new world in the metaverse?

We need rules, as this technology begins to appear, governing what can be done, what can’t be done, what’s acceptable to do, and who can watch what’s going on if you’re in one of these spaces. You may say that you do not need to worry about that or that you will worry about it when it happens – it’s happening. It’s coming very fast. Today’s little toys that are sold to kids include the Oculus and so on, to play games and have adventures.

I think that very soon, we’re going to wind up in the doctor’s office or in the hospital for people to be able to do much more intensive mental health interventions, do things that allow people to get rid of bad impulses, or do things that we would never permit them to do in the “real world.”

We probably may see people say, “Well, you go in there and I’ll observe you and I’ll see whether you’re taking your medicines or doing things to be compliant or following instructions.”

How much observation? How much privacy? What’s going to be appropriate? I don’t have the answers yet for how to do the medical ethics of the metaverse but I do know that world is coming. I do know that it’s going to become a key part of how medicine and healthcare operate.

I think it’s exciting. I think it gives us tools and powerful weapons in the battle against illness and disease but I also think that the possibility is there for abuse.

I think our concepts of issues like confidentiality and privacy are going to have to be rethought when you’re starting to see the patient somewhere out in the electronically created world rather than in your office.

I’m Art Caplan. Thanks for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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