Impact case study database

Changed public understanding of risks posed by AI

Superintelligence has reached over 7,000,000 people. Over 250,000 copies of the book have been sold worldwide, and it has been translated into 31 languages. The book spawned a TED talk with over 4,800,000 views on TED, and over 2,200,000 on YouTube as of October 2020; it was also featured in a profile in the New Yorker, and a BBC Hardtalk interview. [1] The book has been endorsed by numerous public figures, including Bill Gates and Elon Musk, with Musk saying:

“Worth reading Superintelligence. We need to be super careful with AI.” [1]

Superintelligence sparked a worldwide debate about the dangers of unsafe AI, and motivated parts of the public to change its thinking. Dozens of people publicly claimed that Superintelligence has changed their perception of AI risk. Reactions to the book include:

“Bostrom has convinced me that once an AI is developed, there are many ways it

can go wrong, to the detriment and possibly extermination of humanity“; or “Makes

me want to change fields and work on the control problem, given that if this book is correct, it's the single most important problem humankind will ever solve.” [1]

Additionally, the book inspired the creation of art. For example, the author Jude Mace wrote about the creation of her book The Seed of the Violet Tree:

“I had time to read, explore and contemplate the possibilities and risks superintelligence presents to humanity. My interest began after reading Nick Bostrom’s, Superintelligence: Paths. Dangers, Strategies…”. [1]

Changed policy regarding future of AI

Nick Bostrom, with other FHI researchers, have informed policy decisions about AI.

The UK House of Commons Science and Technology Committee recommended a standing Commission on AI be established. On 24 March 2016, Dr Owen Cotton-Barratt’s testimony informed the UK House of Commons Science and Technology Committee’s recommendation that “a standing Commission on Artificial Intelligence be established…”, which “should focus on establishing principles to govern the development and application of AI techniques, as well as advising the Government of any regulation required on limits to its progression.” [2, paragraphs 59, 65/66, 73].

The House of Lords Select Committee on Artificial Intelligence recommended more funding for AI research at universities . Following testimony from Bostrom on 10 October 2017 and written evidence from FHI, the House of Lords Select Committee on Artificial Intelligence recommended a) that “the funding for PhD places in AI and machine learning be further expanded” [3, paras 163, 169], and b) that “universities and research councils providing grants and funding to AI researchers must insist that applications for such money demonstrate an awareness of the implications of the research and how it might be misused.” [3, paragraphs 321, 329].

The All-Party Parliamentary Group on Artificial Intelligence recommended placing more focus on global developments in UK AI policy. The All-Party Parliamentary Group on Artificial Intelligence recommended on 30 October 2017 to “commission research or create a forum mapping out the AI global ecosystem and best practices from other countries and intergovernmental organisations”; and to “apply both a national and international lens when addressing AI issues”, both after citing Allan Dafoe stating that “’AI is both. It is an issue on the national and international domain.’ International collaboration is necessary to address many of its issues, but each government must be held responsible for setting the right policy frameworks within its own borders”. [4, pp 19, 28]

Changes to institutions’ policies on safe and accountable AI

Various researchers at FHI, including Bostrom, Dafoe, and Drexler, have worked closely with commercial and non-commercial partners including staff at Google Deepmind, the G30, the World Intelligence Congress in China, and the Bank of England [5]. This engagement has contributed to these institutions’ emerging policies regarding ethical AI. Among other output, researchers at FHI led by Miles Brundage contributed to a report led by OpenAI, one of the largest private AI labs worldwide working on AI safety. Being produced with industry partners (OpenAI), the document summarises leading advances in the research into AI transparency, and also guides AI policies on verification for regulators and companies, including recommendation of stronger third-party auditing and reporting standards on AI incidences, and software mechanisms like more emphasis on interpretability and privacy-preserving machine learning. [6] OpenAI stated that they will adopt several of the recommendations in their own policies [7].

Deepmind, a Google division working on advanced AI, acknowledged the value of FHI’s work as well. Discussing a joint Deepmind-FHI paper on AI safety [F], the Deepmind co-author said of FHI researcher Stuart Armstrong:

“It was a real pleasure to work with Stuart on this. … This collaboration is one of the first steps toward AI Safety research, and there’s no doubt FHI and Google DeepMind will work again together to make AI safer.” [8]

Development of AI safety as a focus area for philanthropic funding

Superintelligence helped to catalyse a global conversation about advanced Artificial Intelligence, which led to increased funding and interest in the field of technical AI safety, which will in turn give rise to further technological development (and resultant impact) over the long term.

For example, the Open Philanthropy Project (OPP), a U.S.-based grant-making organisation co-founded by Facebook co-founder Dustin Moskovitz, which recommended USD100,000,000 worth of grants in 2018, has committed USD114,813,767 of funding since 2015 for projects relating to potential risks from advanced artificial intelligence'. In their discussion of the reasoning underlying their decision to focus on safe AI as a key area for grant-making, the OPP recommended reading Superintelligence and cited Bostrom’s work throughout. [9] The CEO of OPP also explicitly named Superintelligence as one of the reasons which convinced him of the importance of risk from advanced AI. [10] In a testimonial, OPP referred to FHI as an ‘ invaluable pioneer and thought partner’ for their work, that Bostrom’s work had fed directly into their decision making, and that his work on astronomical waste was an important factor in OPP’s early engagement with arguments about long-run future consequences, where it now concentrates half its funding. [11]

The research influenced policy in the Australian States of Western Australia and Victoria. In those states, Savulescu was invited to participate in the Joint Select Committee (in both parliaments) on End of Life Choices’ investigation into assisted dying. His research (especially 1 and 3 above) was cited and used by the committees to form eventual Governmental assisted dying legislation.

Changing euthanasia legislation in the State of Victoria

In Victoria, Savulescu made a written submission to the Victorian Legislative Council Standing Committee on Legal and Social Issues: Inquiry into End of Life Choices, with Ben White and Lindy Willmott on 3 August 2015 [A]. He also made an oral submission to the Council at Parliament House, Melbourne, Victoria on 19 August 2015 [A]. In addition, his work (3 above) was heavily cited throughout the Parliament of Victoria's final report produced in

2016 [B]. Overall, the state government agreed with Savulescu’s findings and recommendations that there should be appropriate guidelines for the administration of continuous palliative sedation.

Savulescu also presented his work to Victorian Coroners in 2015 [C]. As a result of his presentation, the Coroners concluded that the elderly were committing suicide in circumstances where they would be eligible for assisted dying if the new law was brought in. The Coroners agreed on the basis of this presentation that the data they carry on suicide in the elderly would be useful for the Committee in considering the decisions. This data was repeatedly referred to in the transcript of the discussion around the new law [A], and played a major role in deciding to enact the new law [C].

Introduction of ‘gentle deaths’ in the State of Victoria

In 2017, Victoria legalised assisted dying, and the law came into force in June 2019. [D] The first assisted dying permit was issued in July 2019, and 580 requests had been received by 31^st December 2020 [E], with over 220 assisted deaths recorded. The first person to end their life under the new law passed away in August 2019 supported by her family. Her family, in an interview with BBC Australia, said that the new laws enabled her to have "the empowered death that she wanted". [F, pages 2,3] A retired nurse is another of the early applicants for a permit, who welcomed the option to end her own life. Having provided palliative care throughout her career, she was acutely aware of the suffering experienced by terminal patients. In an interview with The Age, she said "I have such very vivid memories of how terrible a process it was and of people just suffering so greatly"… When she realised landmark voluntary assisted dying laws had passed and would come into effect this year, she said "Emotionally I just feel so much better, It's incredible the comfort it has given me." Cases such as these demonstrate the significant effect that this law change has had on end-of-life care and the autonomy given to terminally ill patients [F, pages 2,3]. The main beneficiaries of the research are Victorian palliative care patients, their families and carers. This enables individuals to take responsibility and plan for their own deaths, and provides much greater clarity and guidance for the physicians involved in their care. As described in the two cases mentioned above, the new law has provided comfort through autonomous decision-making, and the knowledge that individual suffering can be averted.

Changing euthanasia legislation in the State of Western Australia

In Western Australia, Savulescu’s work also changed the recommendations of the Joint Select Committee on End of Life Choices [G]. The parliamentary committee referred to Savulescu’s research 11 times in their report ‘MY LIFE, MY CHOICE’ in August 2018 [G], specifically the paper [5], above. The main conclusion of the report was that “Unnecessary suffering at end of life, and broad community agreement regarding individual autonomy, form the basis for the Committee’s recommendation that the Western Australian Government draft and introduce a Bill for Voluntary Assisted Dying.” [G, page 7] As a result of the report, the West Australian Government initiated a bill to legalise voluntary assisted dying for patients suffering from a terminal illness after a cross-party parliamentary committee recommended the move, saying the law would limit "unnecessary suffering at end of life" [H].

Changing public perception of ‘gentle death’ and facilitating ethical assisted dying

The main beneficiaries of the research are the Western Australian palliative care patients and their families, and those campaigning for assisted dying legislation. One breast cancer patient had campaigned for the legislation, taking the view that watching the slow degeneration of loved ones is unbearably hard for families, as well as for the patient themselves. Speaking to the news channel ABC after the legislation was passed, she said of the opportunity for voluntary assisted dying "And you can make that time a special time rather than them remembering you as somebody that was maybe struggling to breathe, in pain and they can't do anything about it" [F, pages 2,3].

Besides the individual cases of gentle deaths that have gone forward as a result of the new legislation (which, in turn, was explicitly informed by Savulescu’s research), Savulescu’s research has prompted extensive coverage in the mainstream press. This includes articles that cite Savulescu in The Age, The Guardian, and The Conversation (combined monthly readership of over 35,000,000 people), as well as on Twitter and other social media outlets [F, pages 5,6].

The impact of this research falls into two main areas: (1) public policy, law and services; (2) understanding, learning and participation.

Diverting institutional philanthropic resources towards more effective causes

MacAskill’s research on effective altruism between 2015 and 2019 has influenced the work of NGOs and other organisations by directing philanthropic resources towards more effective causes. Key examples of these are listed below:

• MacAskill’s research on effective altruism (especially research item 1) led several philanthropists, including billionaire Ben Delo, to direct their donations towards charities working in the field of effective altruism. [A] Ben Delo has, as a result of MacAskill’s research, joined the Giving Pledge in 2019 and committed to donate the majority of his wealth to long-term oriented effective altruistic causes. [B] Effective Giving UK, who advise Ben Delo, state: “Based on Prof. MacAskill’s research, our advisee and the UK’s youngest self-made billionaire, Ben Delo, pledged to donate the majority of his wealth (over USD500,000,000) to work to safeguard future generations and protect the long-term prospects of humanity. In Mr. Delo’s Giving Letter, he explicitly cites Prof. MacAskill’s work on effective altruism [...] as influential to his giving strategy.” Ben Delo learned about MacAskill’s unpublished work through having personal conversations with him. On the Giving Pledge website, Delo states, “My approach is inspired by philosopher William MacAskill and the effective altruism movement, which promotes the use of reason and evidence when deciding how best to help others [...]. In short, I believe that all lives are valuable, including those of future generations.” [A]

• After MacAskill’s research on effective altruism was featured on the Making Sense Podcast with Sam Harris, [C] Harris decided to pledge 10% of his personal earnings as well as USD3,500 of the organisation’s income to effective charities, by signing the Giving What We Can Pledge. [D, page 348] The podcast has approximately 1,000,000 downloads per episode.

• Based on his research, MacAskill advised the Centre for Effective Altruism in establishing a fund for individual donors, directed to the long-term future. The Centre for Effective Altruism is an Oxford-based charity working in support of the effective altruism community in bringing about positive changes in how we improve the world. MacAskill co-founded the organisation in 2011. The Executive Director of the Centre for Effective Altruism said: “MacAskill’s research was [sic] vital input in establishing the Long-Term Future Fund.” [E] The Long-Term Future Fund has raised more than USD4,800,000, of which over USD4,100,000 was paid out between March 2017 and November 2020 for charitable purposes. [F]

Diverting lay public resources towards more effective causes

MacAskill and Ord’s research has contributed to enhancing understanding of issues in effective charity and decision-making on the benefits of giving to evidence-based charities. He has stimulated public interest and engagement in altruistic decision-making, increased awareness of these areas and challenged norms in the area of effective ways to improve welfare. Below are some of the key examples of how this has been achieved.

• In April 2018, MacAskill argued the moral importance of the long-term future in a TED talk on the concept of effective altruism [A, B, C], released on the TED website. [G]The talk has been watched almost 2,000,000 times and has been picked up by popular news and public intellectuals, including Max Tegmark, famous author, physicist, cosmologist and machine learning researcher on Twitter. Tegmark writes, “This was one of my favorite 2018 TED talks: let's not only do good but pick our battles wisely!” [G]

• MacAskill presented his research on moral uncertainty [research items 4, 5, 6] on popular podcasts over the period 2015-2019, including the 80,000 Hours podcast (circa 26,000 downloads), The Tim Ferriss Show, Very Bad Wizards, and the AI Alignment Podcast.[H] Some of these appearances popularised MacAskill’s research, and led to changes in the audience’s donation behaviours and careers - such as a survey respondent starting an MPhil in a related field after listening to a podcast of MacAskill’s on Moral Uncertainty. [L]

• MacAskill encouraged people to join the effective altruism movement, and to dedicate more of their time and money towards effective charity. In a survey by the Effective Altruism Forum of their members in 2019, respondents were asked how they had first heard of effective altruism, 72 people (63% of 115 open comments) cite MacAskill’s podcast appearances, and 4 people (5% of 76 open comments) cite MacAskill’s TED talk [I]. The mean donation to effective charities per survey respondent was USD6,407 (calculation: USD16,100,000 total donations [J] among 2513 respondents [K].) One of the survey respondents who was influenced by reading MacAskill’s work said “I now donate 10% of my income” to charities and causes “such as the Against Malaria Foundation and efforts to reduce existential risk.” [L]

Each year in the United Kingdom, approximately 40,000 seriously ill infants and children are admitted to intensive care units. Despite advances in medical science and treatment, a proportion of these children do not recover from their illness. The majority of deaths follow decisions to withdraw or withhold potentially life-prolonging treatment. In clarifying ethical questions surrounding these decisions, and in the development of novel ethical frameworks for clinical decision-making, Wilkinson’s research has significantly impacted public understanding and debate, legal rulings, and professional guidance, each discussed below.

Development of a clear ethical framework used in courts for quality of life decisions for children

Wilkinson’s research has examined pre-existing guidance for UK health professionals around decisions for children. There is no statutory law relating to withdrawal of life-sustaining treatment, but professional guidelines had been cited by judges in cases, and consequently incorporated into case law. Wilkinson was part of a working group that revised the ambiguous criteria that were being used, and published new guidelines in 2015 [A]. The guidelines the group developed have subsequently informed decisions on at least 13 cases related to such medical decisions in the UK, specifically quoting the revised criteria in the new guidance [B]. For example, in introducing an expert witness report on the case of Re M (Declaration of Death of a Child) [2020], Sir Andrew McFarlane noted directly that Professor Wilkinson’s “high level of professional expertise” in his involvement in developing the 2015 guideline was of “direct relevance to the issue in these proceedings” [B, page 6]. In another example (the court case of Alder Hey v Evans, 2018), Justice Hayden noted “It is necessary here to root my own conclusions in the framework of the Law and within the available guidance. The Royal College of Paediatrics and Child Health has produced guidance, ...” He then quoted verbatim from the revised guidance [B], [C, page 17].

Influence on decisions relating to extremely premature newborn infants: development/revision of national and international guidelines

Wilkinson’s research into the basis for decisions regarding extremely premature newborn infants has international reach, having influenced professional guidance outside the UK, in Australia and the Philippines. Wilkinson was the lead author on the first South Australian guidance relating to resuscitation decisions for extremely premature newborn infants [D]. This was the first published professional guidance to specifically incorporate prognosis into decisions, drawing on Wilkinson’s novel framework (the PAGE framework – Prognosis Average Gestation Equivalent) [3, above]. He was consulted by a working group developing similar guidance in Queensland, and the PAGE framework was also included in that guideline [E].

In the Philippines, Wilkinson has collaborated with neonatologists and ethicists to address the extremely challenging treatment decisions they faced in a limited-resource setting. There was no existing ethical guidance for such decisions, and in January 2018 he conducted a national survey of specialist neonatologists in the Philippines to assess existing practice, attitudes and understanding [4, above]. In February 2019, he convened a consensus workshop at the Philippine Society of Newborn Medicine national conference [F]. The Vice President of the Philippine Society has noted that Wilkinson was “very effective” in coordinating a large group of professionals to develop consensus and that he completed the first draft the resulting guidelines, which are highly rated by local paediatricians and “very relevant in our practice” [G]. Another participant in the workshop who facilitated Wilkinson’s work in the Philippines wrote, “Prof Dominic [Wilkinson] has been a catalyst of ethical change in the Philippines context of neonatal care.” [H]

In 2018-9, Wilkinson was part of a working group that developed a new national framework for resuscitation of extremely preterm infants for the UK. That framework was published in October 2019 [I]. The ethical principles underpinning that framework were based on Wilkinson’s published research, and he wrote key sections of the framework, particularly relating decision-making to prognosis. The president of the British Association of Perinatal Medicine has acknowledged Wilkinson’s “enormous contribution” to the framework, his “very active role” in developing the guidance [J]. The new guidance endorsed the possibility of providing active stabilisation to a group of extremely preterm infants at 22 weeks gestation – where previous guidance had recommended against active treatment. An editorial in The Lancet noted that “the report provides a practical and thoughtful approach in this very complex area of perinatal medicine” [K].

Improvement of public understanding and contribution to public debate in relation to parent-doctor disagreement concerning medical treatment

Wilkinson’s research into ethics around conflicts between doctors and parents led to wide national and international public attention at the time of high-profile cases (Charlie Gard March-July 2017, Alfie Evans Jan-April 2018, Tafida Raqeeb September-October 2019). Wilkinson’s work with the media around these cases was cited positively by the UK Science Media Centre (who clarify poorly understood science headline stories):

“Without Dominic and a frustratingly small number of other medics, the media would have had no access to impartial, evidence-based expertise whatsoever, and the public would have been woefully misinformed about childhood disease and prognosis.” [L]

These cases attracted a great deal of media attention [M], and Wilkinson gave interviews nationally and internationally, including on the BBC, CNN, Sky Television, The Times, [M]. Social media comments also highlight his role in helping to inform wider understanding about the role of parents and of the courts, with Twitter users who had watched his interview with Good Morning Britain, which had an average daily audience of 640,000 in 2018 [N, page 3]. Comments on social media included a referral to Wilkinson’s “incredibly important point[s]” [M, page 5], commending him as “the voice of reason” [M, page 2], and expressed gratitude to Wilkinson for “publicly giving a much needed, very balanced and empathic presentation” [M, page 6]. He has subsequently been consulted and been involved in working with families and professionals to develop practical ways to improve resolution of such disagreements. He was co-author of a Royal College of Paediatrics and Child Health guideline relating to reducing conflict [N].

Around this time, Wilkinson acted as a script consultant for a BBC television program – Holby City (audience 4,500,000), which ran a story over a recent season exploring conflict between parents and doctors around treatment [N]. Wilkinson provided input to a script workshop and direct feedback on scripts that was termed “invaluable” by the script writers in helping keep the story “grounded in reality” [O]

Floridi’s research on the need to address novel ethical problems thrown up by digital technologies has contributed to the way in which organizations (government and business) should anticipate and cope with the rapid changes in the field of technology. Specifically, his work on the philosophy and ethics of information has "influenced the influencers", that is, the way in which important actors (such as the European Commission and companies such as Microsoft) deal with digital challenges.

Influencing government policy regarding socially responsible Artificial Intelligence

As Chair of the project “AI4People”, the first project on socially good AI in Europe (funded by the Atomium think tank and established in June 2017), Floridi led the first, comparative analysis of international standards and principles about an ethical framework for AI. The research [3] identified 47 different principles and synthesized them into five. Four were very close to standard bioethics principles and a new one was added regarding explicability (requiring that the issues be explained in a way that relevant stakeholders understand). The work then recommended 20 practical policies to the European Commission [A]. The guidance has influenced policy in the UK, for example by changing the thinking of Members of Parliament and policy documents that government in the UK and EU use to audit AI technologies [B]. Lord Clement-Jones of the House of Lords, for example, affirms that Floridi’s work has “had a major impact on the wider government, business, and academic community” [B].

Translating government policy into action in the fight against COVID-19 and beyond

Floridi is a founding board member of the UK Centre for Data Ethics and Innovation (CDEI). This Centre was established in 2018 to provide the UK Government with access to independent, impartial and expert advice on the ethical and innovative deployment of data and artificial intelligence. Floridi has provided key insights to their methodology, including by providing their definition of ‘data ethics’ [C, p.2]. This methodology informs all their work and Floridi has been an active member of all the meetings where a number of changes have been introduced. An interim report on progress notes that the Centre has worked: (i) with the Home Office to reduce bias [D, p.11]; (ii) with the Behavioural Insights Team to research public perceptions of the fairness of credit ratings and improve financial decision-making [D, p.14]; and (iii) with govern-mental recruitment where they are developing bias-mitigating approaches [D, p.15]. Floridi also set up an AI Ethics committee for Digital Catapult in 2018 [E]. The Chair of the CDEI noted that Floridi has also played a role in ensuring that technologies used to combat COVID-19 are ethical:

I would also like to mention his work during the COVID-19 pandemic to help ensure that the UK’s use of digital technologies in combating the disease is subject to ethical challenge and debate. [F]

Specifically Floridi has influenced the ethics of technologies being used in the COVID-19 era serving in 2020 on the ethics advisory board for NHSX during the development of the NHS contact tracing app [G]. In written evidence to the UK Parliament, it was minuted that:

The creation by NHSX of an Ethics Advisory Board, chaired by the previous head of the Nuffield Council on Bioethics Professor Sir Jonathan Montgomery to provide advice and recommendations to the app oversight board is welcomed. Having leading experts such as Professor Luciano Floridi, … is very positive. This is a great example of collaboration between the NHSX and the CDEI. [H, p. 5]

Floridi has also influenced the Vatican’s official position on the ethics of high-tech research. President of the Vatican’s ‘Pontificia Academia Pro Vita’, stated “thanks to [Floridi’s] influential contribution about ethics in hi-tech research, the Academy published an international statement on AI Ethics [known as] Rome Call.” The statement supports an ethical approach to AI and is designed to promote a sense of responsibility among organisations, governments and institutions. Signed by The Pontifical Academy for Life, Microsoft, IBM, FAO and the Italian Government, the President of the Pontifical Academy goes on to state, “…the importance of Prof. Floridi’s support is that this document was approved and signed by the FAO General Director [and] by the President of Microsoft… on February 28th, 2020 and it was officially delivered to the Holy Father Pope Francis.” [I]

Shaping corporate responsibility in AI design and innovation

Floridi has helped some of the most important organisations in the digital industry, advising them about corporate responsibility in the design, development and deployment of AI systems. For example, the Senior Director of European Government Affairs, Rule of Law and Responsible Tech at Microsoft, stated:

It would not be an overstatement to say that Professor Floridi’s research, projects and work have tremendously contributed to our own thinking. [J]

Floridi wrote the foreword to Microsoft’s vision for the future of technology and AI, published in 2018. [K] Floridi has also influenced the way Ernst and Young evaluate critical ethical challenges posed by AI by being a member of a panel which “establishes governance and controls necessary for building and maintaining trust in AI systems”. [L]

With the aim of making his contributions to the ethics of AI and other technologies sustainable into the future, Floridi recently co-founding of the Institute of Artificial Intelligence, whose aim is to help corporations and governments develop ethical regulations surrounding AI [M]. The Institute is new and is already gaining traction. For example, Darren Jones MP, who is a founding member of the Institute, joined legislators from across the world in Paris in February 2020 to take part in the inaugural meeting of the Global Parliamentary Network working group on Artificial Intelligence, which was hosted by the Institute [M, p.5].

Enabled the successful completion of the UK’s 100,000 Genomes Project and the establishment of the NHS Genomic Medicine Service. In December 2012, the Prime Minister, David Cameron announced an aspiration to sequence 100,000 genomes. In December 2012, having read Ethical Problems in Genetics Practice, the Chief Medical Officer, Professor Dame Sally Davies invited Parker to chair a high-level advisory group to make recommendations on the ethical requirements to inform the establishment of the 100,000 Genomes Project.[A] Parker’s published recommendations [B] were accepted by the Chief Medical Officer and the Department of Health in full and informed the subsequent implementation of shape of the 100,000 Genomes Project. [C, especially chapter 16] In 2013, the Secretary of State established Genomics England - a company wholly owned by the UK Government - as the mechanism for the implementation of the 100,000 Genomes Project. [D] Parker was appointed as a non-executive director (with particular responsibility for embedding ethics in the 100,000 Genomes Project). The inaugural board meeting took place on the 13^th August 2013. Parker established and chairs an Ethics Advisory Committee and an in-house ethics advisory team. He led the development of the 100,000 Genomes Project’s approaches to consent, data sharing, feedback of findings, recontact, diversity and equity, and consent for children and young people. The 100,000 Genomes Project – the world’s first genomics initiative at this scale and in the context of a national health service - was successfully completed in 2019. On its completion, the Chief Medical Officer for England, wrote to Parker for his significant level of leadership on relevant ethical issues played by Parker.

“ Thank you for your tremendous contribution to this work. With the successful completion of the 100,000 Genomes Project and the launch of the NHS Genomic Medicine Service the UK is firmly established as the world leader in genomic medicine. It would not be an overstatement to say that this initiative would not have been the success it is and might perhaps not even have been possible without your crucial leadership on ethics.” Chief Medical Officer for England. [A]

The NHS Genetic Medicine Service, which launched in 2018, builds upon on existing NHS clinical genetic services and the 100,000 Genomes Project; it includes a national genomic test directory and the national provision of whole-genome sequencing.[E i] In 2018 the Health Secretary announced that from 2019, all seriously ill children will be offered whole genome sequencing as part of their care, and that adults with certain rare diseases or hard-to-treat cancers will also be offered the same option from 2019.[E ii]

Embedding the analysis of ethical issues into genetics practice to enable high ethical standards in the care of patients and families. Between September 2013 and November 2020, the Genethics forum took place 23 times. Genethics is a national forum for health professionals, patients, and ethicists to discuss practical ethical problems encountered in the working lives of clinical genetics departments in the United Kingdom. The outputs of the Genethics meetings include recommendations to improve ethical decision-making in practice. During this period, the Forum was attended by approximately 1,000 genetics professionals and over 322 cases were presented and discussed. The most important impact of the Forum during the assessment period is that health professionals facing complex ethical challenges in their clinical work have been able to obtain (otherwise unavailable) ethics support and advice in their decision-making involving complex ethical judgements. A Consultant Genetic Counsellor in Manchester highlights: [ “… it has been a particularly invaluable resource for trainees in genetic medicine (both doctors and genetic counsellors). The fact that it has remained active for all these years is testament to how useful we have found it.” During the assessment period, versions of Genethics have been established in the Netherlands, [F] Italy, [G] and Israel [H]. “Forum OncoGenEtica was established in 2014 […]. The idea for the format directly drew from the Genethics Forum, […] Attendees have included cancer geneticists, oncologists and pediatricians and almost 70 cases have been discussed.” [G].

Led and informed public and policy debate on the future ethical shape of the social contract for genomic research. In 2017, together with Professors Anneke Lucassen (Professor of Clinical Genetics at Southampton University) and Jonathan Montgomery (Professor of Medical Law at UCL), Parker contributed the ethics chapter to the Chief Medical Officer’s Annual Report (2017) ‘Generation Genome’ reflecting on the ethical requirements for a future data-driven, genomic medicine service. The CMO’s Annual Report is her most important formal policy statement. [C, especially chapter 16] Drawing upon the 100,000 Genomes Project experience, and looking forward to the future uses of genomics, the chapter introduced the concept of the ‘social contract’ and argued that there is a need for the development – through a national process of deliberation - of a new ‘social contract’ as the basis for well-founded public trust and confidence in data science and genomics.  The concept of ‘social contract’ struck a chord and was picked up by the CMO in her introduction as one of the main recommendations of the report. The importance she placed on this was clear in her evidence (in April 2018) to The Science and Technology Committee on Genomics and Genome Editing in the NHS,

“[In her evidence to us] The CMO […] cited the importance of routine large-scale data sharing as a reason “to rethink—or at the very least reinforce—elements of the current ‘social contract’ as set out in the NHS Constitution, to take account of the advances in genomic medicine”. [At this point a footnote in the Committee’s report includes a direct quotation from our chapter “The report refers to this ‘social contract’ as a “common set of principles and values that bind together patients, the public and [NHS] staff in order to ensure that [the NHS] can be effective and equitable”, as laid out in the NHS Constitution, with each party having rights and responsibilities.” para 68 on page 33 [I]

As a consequence, the concept of the ‘social contract’ became central to policy debate about genomics in the UK. A good example of this influence is that, in 2018-19, Ipsos MORI conducted a national consultation on public and patient views about the ‘social contract’ between medical research and society. This was directly inspired by our chapter and the work on social contract. This is reflected in the fact that when the report was published in April 2019 it included an invited foreword co-authored by the CMO and Parker. [J]

Led changes to policy, practice, and the law regarding the familial uses of genetic information. Parker’s research has identified important ethical considerations in favour of a more familial approach to genetics practice. In his published work – both sole authored and with Professor Anneke Lucassen – he argued such information should be more available for care of family members. [2], [3], [5], [6]. Their recommendations were incorporated into the Royal College of Physicians, Royal College of Pathologists and British Society for Genetic Medicine guidelines on Consent and confidentiality in genomic medicine: Guidance on the use of genetic and genomic information in the clinic (2019), which are the primary source of guidance on these issue for all genetics professionals in the UK. [K] A key paragraph in the guidance states,

“Health professionals can find it difficult to know how to preserve the confidentiality of one patient and at the same time alert a family member of their risk of a particular condition. One way of doing this … relatives can be alerted that they might be at risk of developing a condition because of a family history (they perhaps already know about), or because of other information the clinician does not need to specify. This provides a way of alerting relatives that does not breach the confidence (a footnote here links to his research output [3]). [K, page 10])

In 2018, the Appeal Court decided to allow a genetics case (ABC v St Georges Healthcare Trust) concerning the appropriate limits to patient confidentiality to be heard at the High Court. The case was heard in November 2019 and the High Court’s decision announced in April 2020. Although the decision went against ABC, the case established for the first time that health professionals have a legal duty to balance the interests of genetic relatives with those of a patient who has refused permission for the disclosing of confidential information. This case will significantly change the use of genetic (and possibly other) healthcare information in the United Kingdom. Because of his work in this area, Parker was invited to provide expert ethics input into this case to support the claimant. The contents of this advice are confidential, but his input took the form of meetings with the legal team and the claimant and preparation of a substantial report for her legal team. [L]

Informed and contributed to two clinical trials that improved patient health

Howick’s research has led to a clinical trial designed for and reported in a BBC Horizon documentary on placebos (released 24 October 2018). Howick designed the trial placebo intervention which led to a reduction in pain in almost all of the 117 participants in the trial for at least three weeks [A]. One of the patients in the trial, age 71, had been wheelchair-bound for several years. He reports that the placebo helped him stop taking morphine and go for a boat ride. He notes: “I can’t believe I’ve been taking nothing, yet I feel so wonderful” [B, page 4].

Howick helped design another placebo-controlled trial aimed to improve adherence to statin medication. Some people stop taking statins because they fear getting side effects like muscle pain. One of the causes of apparent mild muscle pain can be the expectation of pain (a nocebo effect). In the trial, patients who had stopped taking statins due to apparent intolerance were asked to alternate between placebos and statins, and report side effects. 33 patients have since resumed taking their statins, reduced their cholesterol and lowered their risk of heart disease [C].

Changed public understanding of placebo and placebo-related effects

The back-pain trial described above was aired as a BBC Horizon documentary that had 1,940,000 viewers on its first night. It was also widely reported in the media, including The Guardian, The Telegraph, The Evening Standard, and The Daily Mail (combined daily viewership of over 5,000,000). Many documentary viewers reported a change in understanding or behaviour. One viewer stated, “I encourage the medical profession to…encourage people away from pills” [B, page 5]. The documentary also provided the basis for a teaching resource on the ‘Teachers Pay Teachers’ website, which has been used by at least one teacher who reports: “As we continue learning about True Experimental Designs, this was a great supplemental resource for distance learning” [B, page 9].

Howick has also contributed to the public understanding of placebos via his bestselling book Doctor You. The book has been published in 8 languages (English, French, Italian, Polish, Romanian, Turkish, Chinese, and Slovenian), and has reached the top sales position on Amazon in the UK, US, and Canada, and was rated by the Evening Standard as a top 5 self-help book in 2017 [D]. It has been featured on The Doctors (US), the BBC news (UK), and it has received almost 100 reviews worldwide, including by some people who report a change in thinking [4]. A review on Amazon UK, for example, states, “I’ve found myself medication free and am self-managing headaches that have plagued me for years. Don’t be fooled - I’m sure they are not totally gone, but they appear under control.” [D, page 5] Doctor You has also been used as a teaching resource and is required reading on the Jagiellonian University psychology course (taught to up to 120 students whose exam includes a question based on it) [E].

More recently, the book generated an invitation to give a TEDx talk (10 July 2020). The talk has been viewed 8,885 times as of January 4^th, 2021. Viewers were surveyed on social media to ask whether the talk improved their knowledge of nocebo effects. 44% of the 4,004 respondents claimed that the TEDx talk introduced them to nocebo effects for the first time [F].

Introduced guidance for reporting placebo controls within clinical trials

Howick led a team of international researchers (3 continents, 5 countries), to develop reporting guidelines to improve the description of placebo/sham controls within clinical trials. The guidelines have been endorsed by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network, which is the leading international body governing reporting standards in clinical trials [G]. Top medical journals including the ** BMJ, The Lancet, and the New England Journal of Medicine require that EQUATOR guidelines be followed** [G.ii], and the guideline has been explicitly endorsed by a number of journal editors [G.iii]. A senior editor at PLOS Medicine writes, “I can confirm that we will be asking authors of relevant papers under consideration at PLOS Medicine…to use TIDieR-Placebo” [G.iii].

Enhancing empathy in medical students, professionals, and healthcare systems

Howick’s research showing that positive empathic communication can benefit patients formed the foundation for an empathy training course and the Oxford Empathy Programme in 2014. He has delivered empathy training to over 50 healthcare practitioners, and to students at Leicester Medical School. These training sessions have led to a change in the Leicester University Medical School curriculum. The Academic Clinical Lecturer in Medical Education at the University of Leicester Medical School writes, “the workshop [has] led to a better understanding of the role of empathy in the doctor-patient relationship and the benefits empathetic practice has on patient outcomes’ and that ‘[Howick’s] work with our students has also catalysed movements afoot to modify the empathy curriculum further.’ [H].

With partners from McGill University, Howick designed and co-facilitated a workshop to develop strategies for embedding empathy within the paediatric unit at the Montreal Children’s Hospital. The workshop led to changes ranging from required empathy training for staff, a buddy system, and better patient satisfaction indicators. The Division Chief, Montreal Children’s Hospital writes: “This invitation [to be honorary collaborator] recognizes your significant efforts in helping to create and foster our program in Healthcare Empathy. You enabled the scholarly aspects of this program in enhancing empathic practice while encouraging original research endeavours” [I].

Finally, preliminary data from a feasibility trial of an empathy intervention for healthcare practitioners (which Howick helped design), has shown that the practitioners report changing their practice. After doing the training, one general practitioner said, “When I looked at my video I could have improved on everything!  Enlightening! Didn't take long…Also a goal not to use the computer as much…[note to self to:] Stop frowning so much” [J, page 11].

Impact of philosophical expertise on the Intergovernmental Panel on Climate Change (IPCC)

The Intergovernmental Panel on Climate Change (IPCC) is an organisation within the United Nations family. Its members are the governments of almost every country in the world. It holds a Nobel Peace Prize. It is not an academic body, so its activities and potential impact lie outside academia; the IPCC express the international community’s awareness of climate change. Broome was a Lead Author of its 2014 report, known as ‘AR5’.

IPCC reports are written cooperatively, so Broome’s contributions are pervasive. He was solely responsible for nearly all of sections 3.4 to 3.6.1 of Working Group 3 (E12, E1 pp. 220-8). These sections are guided by his research: starting from basic principles, they set out the ethical foundations that underlie valuations in economics, including cost-benefit analysis. Some of Broome’s particular research is reflected in Box 3.3 (E1 p. 226) on the value of human life, and Box 3.4 (E1 p. 227) on the idea of responding to climate change using policies that require no sacrifice. Dr Ravendra Pachauri, Chair of the IPCC, wrote:

Whenever I discuss the AR5 and its Synthesis Report . . . it is with great pride that I mention to my audience that the AR5 had the enormous benefit of a distinguished philosopher [Professor John Broome] being part of the Core Writing Team. Also, that your active involvement in that process kept all of us honest and focused on larger issues rather than narrow scientific triviality. (E5)

Broome also contributed to the Summary for Policymakers of Working Group 3, which is explicitly agreed by governments, and widely used by policymakers and others. This work included three days of intense negotiations with government delegates (E2, pp. 4-5; E3); the intensity of this negotiation shows the importance the governments attached to the text. Among Broome’s achievements was that all governments have now agreed that ‘many areas of climate policymaking involve value judgements and ethical considerations’ (E1, p. 5). Previously, some governments had refused to recognise that climate change has ethical aspects. Furthermore, all governments have now also agreed that in economic valuations ‘distributional weights, which take account of the different values of money to different people, should be applied to monetary measures of benefits and harms’ (E1, p. 5). This marks a radical shift in the methods of decision making to be adopted by governments.

Broome was also an author of the IPCC’s Synthesis Report. Broome was able to carry through into section 3.1 (E4, pp. 76-7) much of the material on ethics from the Summary for Policymakers of Working Group 3. He also participated in organising and drafting all the text, as well as negotiating it with government delegates.

Influenced the 2015 Paris Agreement and subsequent policies of governments

The IPCC works in cooperation with the United Nations Framework Convention on Climate Change (UNFCCC). The IPCC’s AR5 was timed to provide the scientific basis of discussions at the UNFCCC’s 2015 meeting in Paris. Christiana Figueres, the UNFCCC’s Executive Secretary, noted that ‘AR5 will inform UNFCCC negotiations by providing objective evidence and options for pathways forward’ (E2, p. 4). UN Secretary-General Ban Ki-Moon said:

This report gives a major push . . . to success at Paris next year. . . Science

has spoken. There is no ambiguity in their message. Leaders must act. (E6)

The government of the UK published in September 2014 a ‘vision document’ setting out its ambition for the Paris meeting. (E7) This document quotes the AR5 frequently. The UK Parliament held a debate on the AR5 on 20 November 2014 (E8). Closing the debate, Amber Rudd, then Parliamentary Under-Secretary for Energy and Climate change, said:

The IPCC’s fifth assessment report provides an unparalleled assessment of

the latest climate science. There is no comparable process in terms of scope,

rigour, transparency or level of Government engagement. . .  Following the

IPCC’s report . . . there is no doubt that we need to take action. . . In the UK,

we are taking action. (E8, column 172WH-173WH)

The Agreement reached at the 2015 meeting set the programme for international climate policy in future decades. Governments agreed to formulate policies for mitigation (nationally determined contributions, NDCs) and national adaptation plans (NAPs). These policies are strongly influenced by the IPCC. Of 183 NDCs registered, 162 refer to the IPCC, including 29 that refer explicitly to AR5. Of the 18 NAPs registered, 16 refer to the IPCC, including 12 that refer explicitly to AR5. (E9) For example, the NDCs of Laos, South Africa and Japan (dated 2020) say respectively:

The Government of Lao PDR intends to implement policies that support the

long term goal of limiting global GHG emissions in line with the objectives of

the UNFCCC and the findings of the IPCC’s 5thAssessment Report. (E10, p.4)

South Africa’s shift from a “deviation from business-as-usual” commitment to

a peak, plateau and decline GHG emissions trajectory range in its NDC fully

aligns with the IPPC AR5 future global carbon budget. (E11, p. 8)

Japan’s INDC [Intended Nationally Determined Contribution] is consistent with

the long-term emission pathways up to 2050 to achieve the 2 degrees Celsius

goal as presented in the Fifth Assessment Report of the Intergovernmental Panel

on Climate Change. (E13)