This essay defends the controversial and indeed counterintuitive claim that there is a good argument to be made from a Lockean perspective for government action to guarantee access to health care. The essay maintains that this argument is in some regards more robust than the well-known argument in defense of universal health care spelled out by Norman Daniels, which this essay also examines in some detail. Locke's view that government should protect people's lives, property, and freedom–where freedom is understood as (...) independence and self-determination–justifies government action to ensure access to health care, because (roughly), just as individuals cannot protect themselves from crime and foreign invasion, so individuals are unable to provide for their own health care. Defense from disease is as important as defense from crime, and–although this is arguable–government action to guarantee access to health care does not itself undermine freedom. (shrink)

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...) present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

This article explores the respective roles that medical and technological cognitive enhancements, on the one hand, and the moral and epistemic virtues traditionally understood, on the other, can play in enabling us to lead the good life. It will be shown that neither the virtues nor cognitive enhancements (of the kind we have access to today or in the foreseeable future) on their own are likely to enable most people to lead the good life. While the moral and epistemic virtues (...) quite plausibly are both necessary and sufficient for the good life in theory, virtue ethics is often criticised for being elitist and unachievable in practice for the vast majority. Some cognitive enhancements, on the other hand, might be necessary for the good life but are far from sufficient for such an existence. Here it will be proposed that a combination of virtue and some cognitive enhancements is preferable. (shrink)

Is it fair to leave the next generation a public debt? Is it defensible to impose legal rules on them through constitutional constraints? From combating climate change to ensuring proper funding for future pensions, concerns about ethics between generations are everywhere. In this volume sixteen philosophers explore intergenerational justice. Part One examines the ways in which various theories of justice look at the matter. These include libertarian, Rawlsian, sufficientarian, contractarian, communitarian, Marxian and reciprocity-based approaches. In Part Two, the authors look (...) more specifically at issues relevant to each of these theories, such as motivation to act fairly towards future generations, the population dimension, the formation of preferences through education and how they impact on our intergenerational obligations, and whether it is fair to rely on constitutional devices. (shrink)

Biomedical technologies can increasingly be used not only to combat disease, but also to augment the capacities or traits of normal, healthy people – a practice commonly referred to as biomedical enhancement. Perhaps the best‐established examples of biomedical enhancement are cosmetic surgery and doping in sports. But most recent scientific attention and ethical debate focuses on extending lifespan, lifting mood, and augmenting cognitive capacities.

It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; (...) it constitutes “double jeopardy” or violates Frances Kamm's non-linkage principle; it conflicts with equality of opportunity; it conflicts with fairness, which requires ignoring (some/most) differential impacts of treatment; it wrongly gives lower priority to disabled persons for equally effective treatment; it conflicts with giving all persons an equal chance to reach their full potential; and, it is in conflict with giving priority to the worse off. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 32-33, August 2012.

Staggering advances in biotechnology within the past decade have given rise to pharmacological, surgical and prosthetic techniques capable of enhancing human functioning rather than merely treating or preventing disease. Bioenhancement technologies range from nootropics capable of enhancing cognitive abilities to distraction osteogenesis, a surgical technique capable of increasing height through limb lengthening. This paper examines whether the use of bioenhancements falls inside or outside the proper boundaries of healthcare, and if so, whether clinicians have professional responsibilities to administer bioenhancements to (...) patients. After explicating two theoretical approaches to the concept of health, one objectivist and the other constructivist, I contend that clinicians' corresponding professional responsibilities hinge on which philosophical account of health is endorsed, and illustrate how the lack of analytic clarity with respect to this concept can lead to defective positions on the place of bioenhancements in healthcare. With this conceptual framework in place, an account of health as a cluster concept that incorporates both constructivist and objectivist components is developed and defended. (shrink)

In his book, The New Sociological Imagination, Steve Fuller criticizes what he calls “bioliberalism.” According to him, the social sciences are challenged on two sides: humanistic and biological. In particular, Fuller finds the biological challenge serious. Fuller tries to reinvent sociology as a socialist project to counterattack bioliberalism as the biggest threat to the social sciences. First, the author will examine Fuller's argument against bioliberalism, referring to the so-called “liberal eugenics.” Then the author will criticize him. By reinventing sociology as (...) a socialist project, Fuller seems to ignore the relation between value-freedom and education. One of the reasons Max Weber argued for value-freedom was to prevent sociology teachers from imposing their particular views on their students. We must consider this problem of teaching undergraduates sociology and other subjects in a better way if we are to have better social institutions. (shrink)

: I argue that there is an important analogy between sex selection and selective abortion of fetuses diagnosed with Down syndrome. There are surprising parallels between the social construction of Down syndrome as a disability and the deeply entrenched institutionalization of sexual difference in many societies. Prevailing concepts of gender and mental retardation exert a powerful influence in constructing the sexual identities and life plans of people with Down syndrome, and also affect their families' lives.

I argue that there is an important analogy between sex selection and selective abortion of fetuses diagnosed with Down syndrome. There are surprising parallels between the social construction of Down syndrome as a disability and the deeply entrenched institutionalization of sexual difference in many societies. Prevailing concepts of gender and mental retardation exert a powerful influence in constructing the sexual identities and life plans of people with Down syndrome, and also affect their families' lives.1.

New scientific advances have created previously unheard of possibilities for enhancing combatants' performance. Future war fighters may be smarter, stronger, and braver than ever before. If these technologies are safe, is there any reason to reject their use? In this article, I argue that the use of enhancements is constrained by the importance of maintaining the moral responsibility of military personnel. This is crucial for two reasons: the military's ethical commitments require military personnel to be morally responsible agents, and moral (...) responsibility is necessary for integrity and the moral emotions of guilt and remorse, both of which are important for moral growth and psychological well-being. Enhancements that undermined combatants' moral responsibility would therefore undermine the military's moral standing and would harm combatants' well-being. A genuine commitment to maintaining the military's ethical standards and the well-being of combatants therefore requires a careful analysis of performance-enhancing technologies before they are implemented. (shrink)

According to theories of wrongful life (WL), the imposition upon a child of an existence of poor quality can constitute an act of harming, and a violation of the child’s rights. The idea that there can be WLs may seem intuitively compelling. But, as this paper argues, liberals who commit themselves to WL theories may have to compromise some of their other beliefs. For they will thereby become committed to the claim that some women are under a stringent moral duty (...) to have an abortion: a duty that could, without injustice, at least sometimes be enforced by the state. WL theories in other words imply that some women will lack a right to choose, under which both the decision to abort, and the decision to carry the fetus to term, are protected against interference. The paper exposes a dilemma, then, for liberals who are committed both to (a) the rights of future people not to be subjected to a harmful existence, and (b) the rights of women to refuse an abortion. (shrink)

Philosophers concerned with procreative ethics have long been puzzled by Parfit’s Non-Identity Problem (NIP). Various solutions have been proposed, but I argue that we have not solved the problem on its own narrow person-affecting terms, i.e., in terms of the identified individuals affected by procreative decisions and acts, especially future children. Thus, the core problem remains unsolved. This is a nagging concern for all who hold the common intuition that actions that harm no one are permissible. I argue against Harmon’s (...) and Woodward’s direct, narrow person-affecting solutions, and in favor of a new solution to the NIP. My solution, or, rather, dissolution, is based on the argument that merely possible people, i.e., hypothetical people who could possibly, but will not actually, exist, are morally irrelevant. I show that the NIP only arises when we concern ourselves with merely possible people. Once we are careful to restrict our concerns to only those that do or will exist, the NIP is dissolved. (shrink)

As reproductive genetic technologies advance, families have more options to choose what sort of child they want to have. Using preimplantation genetic diagnosis (PGD), for example, allows parents to evaluate several existing embryos before selecting which to implant via in vitro fertilization (IVF). One of the traits PGD can identify is genetic deafness, and hearing embryos are now preferentially selected around the globe using this method. Importantly, some Deaf families desire a deaf child, and PGD–IVF is also an option for (...) them. Selection for genetic deafness, however, encounters widespread disapproval in the hearing community, including mainstream philosophy and bioethics. In this paper I apply Elizabeth Barnes’ value-neutral model of disability as mere-difference to the case of selecting for deafness. I draw on evidence from Deaf Studies and Disability Studies to build an understanding of deafness, the Deaf community, and the circumstances relevant to reproductive choices that may obtain for some Deaf families. Selection for deafness, with deafness understood as mere-difference and valued for its cultural identity, need not necessitate impermissible moral harms. I thus advocate that it is sometimes morally permissible to select for deafness in one’s child. (shrink)

Volume 19, Issue 7, July 2019, Page 43-45.

The wrongful disability problem arises whenever a disability-causing, and therefore (presumptively) wrongful, procreative act is a necessary condition for the existence of a person whose life is otherwise worth living. It is a problem because it seems to involve no harm, and therefore no wrongful treatment, vis-à-vis that person. This essay defends the nonconsequentialist, rights-based, account of the wrong-making features of wrongful disability. It distinguishes between the person-affecting restriction, roughly the idea that wrongdoing is always the wronging of some person, (...) and the harm principle, the idea that all wrongings are harmings. It argues, first, that the harm principle should be rejected, in light of offending intuitions in salient examples. Rejection of the harm principle is not only independently plausible, but also paves the way for a nonconsequentialist diagnosis of wrongful disability. This diagnosis conceives of wrongdoing as a failure to express adequate respect for the humanity or personhood inherent in the person created. The paper defends a theory of humanity-respecting rights that accommodates plausible intuitions about satisficing and fairness, without resorting to consequentialist premises that lead to well-known impossibility results and paradoxes. (shrink)

No artigo, abordo a ideia de melhoramento humano (MH), visando a contestar três frustrantes tendências dos seus críticos, a saber, as ideias de: (1) que a natureza humana será artificializada, sugerindo que estaremos diante de algo novo e incomparavelmente perigoso, bem como que ainda seja possível preservar uma separação radical entre natureza e técnica; (2) que é possível abordar e criticar o MH a partir de uma singularidade semântica; e, diretamente relacionada à anterior, (3) que há univocidade entre os defensores (...) do MH acerca de como os indivíduos devem lidar com os meios biotecnocientíficos disponibilizados, a saber, como uma ingênua e acrítica obrigação de melhorar. In this paper, I discuss the idea of human enhancement (HE). My goal is to refute three frustrating trends in the HE criticism, namely the ideas that: (1) human nature will become artificial, suggesting that we will be facing something new and uniquely dangerous, and that it is still possible to preserve a radical separation between nature and technique; (2) it is possible to address and criticize HE from a semantic uniqueness, which is directly related to the previous item; and (3) there is an univocity among the HE's defenders on how individuals should handle the available bio-techno-scientific tools made available, namely, as a naive and uncritical obligation to become enhanced. (shrink)

The generic idea that the human should enhance seems uncontroversial. However, there is a great controversy about the meaning of enhance and the means that should be used. The possibilities of enhance humans through the use of biotechnology are a central theme of the current bioethical debate. Human Enhancement is the concept used to translate the idea that a biotransformation would generate a bioenhancement. In this article, we present a proposal for a factual-elementary framework of the generic concept of human (...) enhancement, in order to highlight the differences between a normative terminology and a descriptive terminology. Then, we contest the radical polarization that creates a harmful bias in the debate, arguing that what is at issue is a decision making based on non-universal value judgments. (shrink)

The article investigates the validity of two different versions of the slippery slope argument construed in relation to human gene therapy: the empirical and the conceptual argument. The empirical version holds that our accepting somatic cell therapy will eventually cause our accepting eugenic medical goals. The conceptual version holds that we are logically committed to accepting such goals once we have accepted somatic cell therapy. It is argued that neither the empirical nor the conceptual version of the argument can provide (...) a conclusive moral reason for banning somatic cell therapy. According to a third interpretation, referred to as the arbitrary result argument, the many apparent similarities between somatic cell therapy and eugenic-based human genetic engineering drive us to make principled choices concerning what differences and similarities between the two practices should be regarded as morally (ir)relevant. Decisions of this kind are likely to have unpredictable moral consequences. Thus formulated, the slippery slope argument has much plausibility. One objects to somatic cell therapy not so much because of what is at the bottom of the slope on which it lies, but because it is on a slope of which one does not know what is at the bottom. While the arbitrary result argument does not provide a conclusive reason for prohibiting human gene therapy, it reminds of a very important thing: when making bioethical decisions, we should be as specific and as consistent as possible about our basic moral and medical concepts. (shrink)

Feminists have indicated the inadequacies of bioethical debates about human embryonic stem cell research, which have for the most part revolved around concerns about the moral status of the human embryo. Feminists have argued, for instance, that inquiry concerning the ethics and politics of human embryonic stem cell research should consider the relations of social power in which the research is embedded. My argument is that this feminist work on stem cells is itself inadequate, however, insofar as it has not (...) incorporated an analysis of disability into its considerations of the ethical and political issues that surround the phenomena. Thus, I consider claims that disability theorists and anti-disability activists have made about the research. I conclude by indicating that stem cell research must be situated within a cultural matrix that operates in the service of normalisation. (shrink)

: This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to emerge in (...) the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body. (shrink)

Assume that neuro-doping is safe and efficient. This means that the use of it, and similar future safe methods of enhancement in sport, may help those who are naturally weak to catch up with those who are naturally strong and sometimes even defeat them. The rationale behind anti-doping measures seem to presuppose that this is unfair. But the idea that those who are naturally strong should defeat those who are naturally weak rests on a fascistoid ideology that sport had better (...) leave behind. Neuro-doping may be seen as a means to undermine the fascistoid notion of fairness. The conjecture is that, given that society adopts what will be characterized as a policy of biological egalitarianism, this will happen. Then people will compete in society in general and in sport in particular on more equal biological terms. The fascination with natural strength, and the cheering for the winners, can then go away. Instead we see a liberated sport where we take part in it for the sheer fun of doing so. Neuro-doping, and similar techniques, may be a means that helps to liberate elite sport from its perverse view of fairness. (shrink)

Assume that neuro-doping is safe and efficient. This means that the use of it, and similar future safe methods of enhancement in sport, may help those who are naturally weak to catch up with those who are naturally strong and sometimes even defeat them. The rationale behind anti-doping measures seem to presuppose that this is unfair. But the idea that those who are naturally strong should defeat those who are naturally weak rests on a fascistoid ideology that sport had better (...) leave behind. Neuro-doping may be seen as a means to undermine the fascistoid notion of fairness. The conjecture is that, given that society adopts what will be characterized as a policy of biological egalitarianism, this will happen. Then people will compete in society in general and in sport in particular on more equal biological terms. The fascination with natural strength, and the cheering for the winners, can then go away. Instead we see a liberated sport where we take part in it for the sheer fun of doing so. Neuro-doping, and similar techniques, may be a means that helps to liberate elite sport from its perverse view of fairness. (shrink)

“Genethics” is a neologism probably best kept within scare quotes. Yet now that genethics has a Companion—Companion to Genethics, edited by Justine Burley and John Harris, Oxford, Blackwell, 2002, 489 pages, £65—it would appear that we can no longer keep our gloves on when handling the term. Burley and Harris’s enormous collection contains 34 articles, an introduction and an afterword.*Most of the contributions are short , many are new, a few are lifted from earlier work and some are lightly revised (...) versions of earlier pieces. Topics range from the genetics of old age, to the Darwin wars and biotech patenting. The collection’s length and scope make it impossible to review comprehensively. In brief, many of the contributions are excellent. The pieces towards the end of the volume—Sorrell’s on insurance, Munzer’s on patents and property rights, Steiner’s on self ownership, to mention a few—are especially good at bringing serious philosophical analysis to questions of immediate political concern. A high proportion of the essays are devoted to issues of commercialising the genome and genetic research, and these are all good. The guides to further reading that come at the end of each article are also useful, although it is hard not to grin at an astonishing guide at the end of Dawkins’s piece on genetic determinism that includes all and only books by Richard Dawkins.Rather than arbitrarily selecting an article or two for in depth treatment, or saying something intolerably brief about each of the contributions, let me instead use this essay to offer some reflections on the existence of the volume. What, exactly, is genethics, that it requires a companion? The obvious answer to that question is that genethics is the study of the ethical issues that arise out of the science of …. (shrink)

Informed by a search of the literature about the usage of genetic testing information (GTI) by insurance companies, this paper presents a practical ethical analysis of several distinct public policy options that might be used to govern or constrain GTI usage by insurance providers. As medical research advances and the extension to the Human Genome Project (2016, https://en.wikipedia.org/wiki/human_genome_project_-_write) moves to its fullness over the next decade, such research efforts will allow the full synthesis of human DNA to be connected to (...) predictive health dispositions. As testing costs fall, there will be ever more pressure for citizens to disclose GTI. Genetic testing information is integral to future medical care because it can be used to better assess individually tailored medical therapies as well as to allow a more informed risk analysis by the insurance industry, which in some countries such as the USA underwrites a majority of citizen medical expenses. As discussed in this examination, the revelation of people’s uniquely personal GTI to insurers has enormous societal implications. The major contribution of the paper is to offer policy makers and concerned citizens a nuanced articulation of the basic options to regulate GTI, with a special consideration for ethical fairness and equity. As genetic-based medicine blossoms and pressures to reduce healthcare costs increase, there will be an ever greater impetus for countries to revisit their genetic testing policies. Organizations and policy makers striving to create GTI oversights perceived to be both “fair and effective” need to be aware of the ethical perspectives discussed in this paper. (shrink)

In her recent pamphlet Special Educational Needs: a new look (2005) Mary Warnock has called for a radical review of special needs education and a substantial reconsideration of the assumptions upon which the current educational framework is based. The latter, she maintains, is hindered by a contradiction between the intention to treat all learners as the same and that of responding adequately to the needs arising from their individual differences. The tension highlighted by Warnock, which is central to the debate (...) in special and inclusive education, is also referred to as the ‘dilemma of difference’. This consists in the seemingly unavoidable choice between, on the one hand, identifying children's differences in order to provide for them differentially, with the risk of labelling and dividing, and, on the other, accentuating the ‘sameness’ and offering common provision, with the risk of not making available what is relevant to, and needed by, individual children. In this paper, I argue that the capability approach developed by Amartya Sen provides an innovative and important perspective for re-examining the dilemma of difference in significant ways. In particular, I maintain that reconceptualising disability and special needs through the capability approach makes possible the overcoming of the tension at the core of the dilemma of difference, whilst at the same time inscribing the debate within an ethical, normative framework based upon justice and equality. (shrink)

In this paper, I explore the questions of how and to what extent new antidepressants (selective serotonin-reuptake inhibitors, or SSRIs) could possibly affect the self. I do this by way of a phenomenological approach, using the works of Martin Heidegger and Thomas Fuchs to analyze the roles of attunement and embodiment in normal and abnormal ways of being-in-the-world. The nature of depression and anxiety disorders — the diagnoses for which treatment with antidepressants is most commonly indicated — is also explored (...) by way of this phenomenological approach, as are the basic structures of self-being. Special attention is paid in the analysis to the moods of boredom, anxiety and grief, since they play fundamental roles in depression and anxiety disorders and since their intensity and frequency appear to be modulated by antidepressants. My conclusion is that the effect of these drugs on the self can be thought of in terms of changes in self-feeling, or, more precisely, self-vibration of embodiment. I present the idea of a spectrum of bodily resonance, which extends from the normal resonance of the lived body, in which the body is able to pick up a wide range of different moods; continuing over various kinds of sensitivities, preferences and idiosyncrasies, in which certain moods are favored over others; to cases that we unreservedly label pathologies, in which the body is severely out of tune, or even devoid of tune and thus useless as a tool of resonance. Different cultures and societies favor slightly differently attuned self-styles as paradigmatic of the normal and good life, and the popularity of the SSRIs can therefore be explained, not only by defects of embodiment, but also by the presence of certain cultural norms in our contemporary society. (shrink)

Debates about the legitimacy of embryonic stem-cell research have largely focused on the type of ethical value that should be accorded to the human embryo in␣vitro. In this paper, I try to show that, to broaden the scope of these debates, one needs to articulate an ontology that does not limit itself to biological accounts, but that instead focuses on the embryo’s place in a totality of relevance surrounding and guiding a human practice. Instead of attempting to substantiate the ethical (...) value of the embryo exclusively by pointing out that it has potentiality for personhood, one should examine the types of practices in which the embryo occurs and focus on the ends inherent to these practices. With this emphasis on context, it becomes apparent that the embryo’s ethical significance can only be understood by elucidating the attitudes that are established towards it in the course of specific activities. The distinction between fertilized embryos and cloned embryos proves to be important in this contextual analysis, since, from the point of view of practice, the two types of embryos appear to belong to different human practices: (assisted) procreation and medical research, respectively. In my arguments, I highlight the concepts of practice, technology, and nature, as they have been analyzed in the phenomenological tradition, particularly by Martin Heidegger. I come to the conclusion that therapeutic cloning should be allowed, provided that it turns out to be a project that benefits medical science in its aim to battle diseases. Important precautions have to be taken, however, in order to safeguard the practice of procreation from becoming perverted by the aims and attitudes of medical science when the two practices intersect. The threat in question needs to be taken seriously, since it concerns the structure and goal of practices which are central to our very self understanding as human beings. (shrink)

Background and objectives: Summary measures of overall health inequality are independent of group membership and enable international comparisons of distribution of health. We compare inequality between and within countries over time and identify normative issues underlying such comparisons. Methods: We used a set of modeled historical life tables for 193 World Health Organization member states from the years 1990, 2000 and 2008 and calculated inequality in age at death and inequality-adjusted life expectancy. Results: Our calculations suggest that overall health inequalities (...) in age at death have been decreasing in the period 1990–2008 in most countries of the world. Only 20 countries experienced increasing distribution in age at death. Simultaneously, overall life expectancy has increased in 85 per cent of all countries. Thus, the combined measure IALE has improved globally. The same overall trend of reduced health inequality applies to all groups of countries stratified by income level. Conclusion: Overall health inequalities, in addition to average health outcomes, could be reported regularly to monitor the health status of populations and the performance of health systems. We find, on normative grounds, the combined measure IALE to be preferable to measuring trends in inequality only. Likewise, we find the Absolute GiniH to be preferable to Relative GiniH. (shrink)

This paper argues that luck egalitarianism, especially in the guise of equality of opportunity for welfare, is in tension with the ideal of fair equality of opportunity in three ways. First, equal opportunity for welfare is compatible with a caste system in employment that is inconsistent with open competition for positions. Second, luck egalitarianism does not support hiring on the basis of qualifications. Third, amending luck egalitarianism to repair this problem requires abandoning fair access to qualifications. Insofar as luck egalitarianism (...) cannot support fair equality of opportunity, it cannot do justice to the claims of the disabled. Indeed, in the absence of fair equality of opportunity, disabled people are likely to be marginalized. (shrink)

Developments in Non-Invasive Prenatal Testing (NIPT) and cell-free fetal DNA analysis raise the possibility that antenatal services may soon be able to support couples in non-invasively testing for, and diagnosing, an unprecedented range of genetic disorders and traits coded within their unborn child’s genome. Inevitably, this has prompted debate within the bioethics literature about what screening options should be offered to couples for the purpose of reproductive choice. In relation to this problem, the European Society of Human Genetics (ESHG) and (...) American Society of Human Genetics (ASHG) tentatively recommend that any expansion of this type of screening, as facilitated by NIPT, should be limited to serious congenital and childhood disorders. In support of this recommendation, the ESHG and ASHG cite considerations of distribution justice. Notably, however, an account of justice in the organization and provision of this type of screening which might substantiate this recommendation has yet to be developed. This paper attempts to redress this oversight through an investigation of Norman Daniels’ theory of Just health: meeting health needs fairly. In line with this aim, the paper examines what special moral importance (for Just health) screening for the purpose of reproductive choice might have where concerning serious congenital and childhood disorders in particular. The paper concludes that screening for reproductive choice where concerning serious congenital and childhood disorders may be important for providing women with fair opportunity to protect their health (by either having or not having an affected child). (shrink)

Since the first sex reassignment operations were performed, individual sex has come to be, to some extent at least, a technological artifact. The existence of sperm sorting technology, and of prenatal determination of fetal sex via ultrasound along with the option of termination, means that we now have the power to choose the sex of our children. An influential contemporary line of thought about medical ethics suggests that we should use technology to serve the welfare of individuals and to remove (...) limitations on the opportunities available to them. I argue that, if these are our goals, we may do well to move towards a “post sex” humanity. Until we have the technology to produce genuine hermaphrodites, the most efficient way to do this is to use sex selection technology to ensure that only girl children are born. There are significant restrictions on the opportunities available to men, around gestation, childbirth, and breast-feeding, which will be extremely difficult to overcome via social or technological mechanisms for the foreseeable future. Women also have longer life expectancies than men. Girl babies therefore have a significantly more “open” future than boy babies. Resisting the conclusion that we should ensure that all children are born the same sex will require insisting that sexual difference is natural to human beings and that we should not use technology to reshape humanity beyond certain natural limits. The real concern of my paper, then, is the moral significance of the idea of a normal human body in modern medicine. (shrink)

Disability activists influenced by queer theory and advocates of “human enhancement” have each disputed the idea that what is “normal” is normatively significant, which currently plays a key role in the regulation of pre-implantation genetic diagnosis (PGD). Previously, I have argued that the only way to avoid the implication that parents have strong reasons to select children of one sex (most plausibly, female) over the other is to affirm the moral significance of sexually dimorphic human biological norms. After outlining the (...) logic that generates this conclusion, I investigate the extent to which it might also facilitate an alternative, progressive, opening up of the notion of the normal and of the criteria against which we should evaluate the relative merits of different forms of embodiment. This paper therefore investigates the implications of ideas derived from queer theory for the future of PGD and of PGD for the future of queerness. (shrink)

Some say moral bioenhancements are urgent and necessary; others say they are misguided or simply will not work. I examine a class of arguments claiming that moral bioenhancements are problematic because they are self-subverting. On this view, trying to make oneself or others more moral, at least through certain means, can itself be immoral, or at least worse than the alternatives. The thought here is that moral enhancements might fail not for biological reasons, but for specifically morally self-referential reasons. I (...) argue that moral bioenhancements, in a restricted set of cases, are self-subverting such that they are impermissible. Further, some moral bioenhancements would result in agents who are less admirable than they might have been through other means. (shrink)

Next SectionSome argue that genetic enhancements and environmental enhancements are not importantly different: environmental enhancements such as private schools and chess lessons are simply the old-school way to have a designer baby. I argue that there is an important distinction between the two practices—a distinction that makes state restrictions on genetic enhancements more justifiable than state restrictions on environmental enhancements. The difference is that parents have no settled expectations about genetic enhancements.

RESUMOO presente artigo analisa processos de alterização na biologia humana e na biomedicina. A alterização é entendida aqui como o processo cultural de produção de alteridades por meio da delimitação, rotulação e categorização das formas possíveis de ser outro, desde um determinado marco de referência sócio-histórico. Ainda que a alterização faça parte de qualquer processo de delimitação de categorias de identidade no seio de uma cultura - e, nesse sentido, possa apresentar visões do outro tanto positivas quanto negativas -, aqui (...) nos interessamos especificamente na alterização como fator de marginalização e exclusão social de diferentes grupos humanos. São analisados diversos processos de alterização operantes nos discursos e nas práticas das ciências biomédicas ao longo de sua história recente, os quais têm conduzido à exclusão social de diferentes categorias de outros, ou a tratá-los como inferiores, em pretendidas bases científicas, ou em função de determinadas práticas institucionalizadas dentro da comunidade científica. Exemplos típicos de grupos marginalizados pelas ciências ocidentais ao longo de sua história incluem as raças não europeias, as mulheres, os homossexuais e os "pobres". O principal objetivo do presente artigo é analisar, na história recente das ciências biomédicas, esses processos de alterização que têm conduzido à marginalização de tais grupos e a considerá-los como inferiores. ABSTRACTThis article analyzes processes of "othering" in human biology and biomedicine. Othering is understood here as the cultural process of production of otherness by means of the delimitation, tagging, and categorization of the possible ways of being "other" within a given socio-historical context. Although othering can be considered as a constitutive aspect of any process of delimitation of identities within a given culture - and in this sense it can present both positive and negative views of the "other" -, in the present article we are specifically interested in processes of othering that lead to the marginalization and social exclusion of different human groups. We will analyze processes of othering, which have operated in the discourses and practices of biomedical sciences throughout their recent history, that have led to the social exclusion of different categories of "others", or to treating them as inferior, and that have supposedly scientific bases or as a consequence of the institutionalization of certain practices within the scientific community. Typical examples of these "others", marginalized by the Western sciences throughout their history, are the non-European "races", women, gay and lesbian people, and the "poor". The main objective of this article is to analyze, in the recent history of the biomedical technosciences, these different processes of othering that have led to the marginalization of such "others" and to treating them as inferior. (shrink)

(2001). A Neutral Ethical Framework for Understanding the Role of Disability in the Life Cycle. The American Journal of Bioethics: Vol. 1, No. 3, pp. 57-58.

Until now, philosophical debate about human embryonic stem cell (hESC) research has largely been limited to its ethical dimensions and implications. Although the importance and urgency of these ethical debates should not be underestimated, the almost undivided attention that mainstream and feminist philosophers have paid to the ethical dimensions of hESC research suggests that the only philosophically interesting questions and concerns about it are by and large ethical in nature. My argument goes some distance to challenge the assumption that ethical (...) considerations alone must be foregrounded in philosophical discussions about hESC research by introducing a critical stance on the epistemological and ontological assumptions that underlie and condition it. A central aim of the paper is to show how Foucault's insights into knowledge-power, taken in combination with Hacking's claims about styles of reasoning, can make these assumptions evident, as well as cast light on their potentially deleterious implications for disabled people. Arguing in this way also enables me to draw out constitutive effects of research on stem cells, that is, to indicate how the discursive practices surrounding research on stem cells, as well as the technology itself, contribute to the constitution of impairment. (shrink)

The aim of this paper is to scrutinize a contemporary standoff in the American debate over the moral permissibility of human reproductive cloning in its prospective use as a eugenic enhancement technology. I shall argue that there is some significant and under-appreciated common ground between the defenders and opponents of human cloning. Champions of the moral and legal permissibility of cloning support the technology based on the right to procreative liberty provided it were to become as safe as in vitro (...) fertilization and that it be used only by adults who seek to rear their clone children. However, even champions of procreative liberty oppose the commodification of cloned embryos, and, by extension, the resulting commodification of the cloned children who would be produced via such embryos. I suggest that a Kantian moral argument against the use of cloning as an enhancement technology can be shown to be already implicitly accepted to some extent by champions of procreative liberty on the matter of commodification of cloned embryos. It is in this argument against commodification that the most vocal critics of cloning such as Leon Kass and defenders of cloning such as John Robertson can find greater common ground. Thus, I endeavor to advance the debate by revealing a greater degree of moral agreement on some fundamental premises than hitherto recognized. (shrink)

The rapid development of assisted reproduction technologies for the treatment of infertility appears to empower women through expanding their individual choice, but it is also creating new forms of suffering for them and their collaborators, especially in the context of transnational third-party reproduction. This paper explores the possibility of framing the ethical discourse around third-party reproduction by bringing attention to concerns of altruistic empathy for women who collaborate in the reproductive process, in addition to those of individualistic choice. This would (...) entail moving beyond an ethic of liberty that is based on self-interest and the language of rights, to an alternative ethic of care that is based on self-restraint and the language of responsibilities. An ethic of care and responsibility would cultivate the empathetic self-reflection of the autonomous actor in relation to those others who are part of the enterprise of bringing a child into the world. (shrink)

Though the reputation of eugenics has been tarnished by history, eugenics per se is not necessarily a bad thing. Many advocate a liberal new eugenics—where individuals are free to choose whether or not to employ genetic technologies for reproductive purposes. Though genetic interventions aimed at the prevention of severe genetic disorders may be morally and socially acceptable, reproductive liberty in the context of enhancement may conflict with equality. Enhancement could also have adverse effects on utility. The enhancement debate requires a (...) shift in focus. What the equality and/or utility costs of enhancement will be is an empirical question. Rather than philosophical speculation, more social science research is needed to address it. Philosophers, meanwhile, should address head-on the question of how to strike a balance between liberty, equality, and utility in cases of conflict (in the context of genetics). (shrink)

Suppose we accept prenatal diagnosis and the selective abortion of fetuses that test positive for severe genetic disorders to be both morally and socially acceptable. Should we consider prenatal diagnosis and selective abortion (or other genetic interventions such as preimplantation diagnosis, genetic therapy, cloning, etc.) for nontherapeutic purposes to be acceptable as well? On the one hand, the social aims to promote liberty in general, and reproductive liberty in particular, provide reason for thinking that individuals should be free to make (...) their own decisions about whether or not to employ whatever genetic services might be developed and offered by private enterprise. On the other hand, interventions aimed at enhancement would (in many cases) presumably only be available to those who are financially fortunate. A worry is that unequal access to enhancements that provide competitive advantages to offspring will further and more permanently increase existing unjust disparities between the haves and have-nots. The aim to promote liberty might thus conflict with the social aim of equality. An additional worry is that the development and provision of nontherapeutic genetic interventions would drain limited medical resources away from therapeutic purposes which would ultimately be more fruitful. The promotion of liberty might also thus conflict with the aim to promote aggregate utility. Assuming there is no reason to think that the promotion of liberty should be given absolute priority over both equality and aggregate utility, we need to think more about how to make trade-offs between these three legitimate social aims. (shrink)

In this paper, I want to scrutinise the value of utilising the concept of disease for a theory of distributive justice in health care. Although many people believe that the presence of a disease-related condition is a prerequisite of a justified claim on health care resources, the impact of the philosophical debate on the concept of disease is still relatively minor. This is surprising, because how we conceive of disease determines the amount of justified claims on health care resources. Therefore, (...) the severity of scarcity depends on our interpretation of the concept of disease. I want to defend a specific combination of a theory of disease with a theory of distributive justice. A naturalist account of disease, together with sufficientarianism, is able to perform a gate-keeping function regarding entitlements to medical treatment. Although this combination cannot solve all problems of justice in health care, it may inform rationing decisions as well. (shrink)