I am grateful to the authors who commented on my article (Piotrowska 2014) for their careful examination of my argument. They have presented a variety of stimulating ideas and suggestions, with which I largely agree and which I would like to discuss further, but in the interest of brevity, I shall try to concentrate only on points of contention.

This article introduces a non-human version of the non-identity problem and suggests that such a variation exposes weaknesses in several proposed person-focused solutions to the classic version of the problem. It suggests first that person-affecting solutions fail when applied to non-human animals and, second, that many common moral arguments against climate change should be called into question. We argue that a more inclusive version of the person-affecting principle, which we call the ‘patient-affecting principle’, captures more accurately the moral challenge posed (...) by the non-identity problem. We argue further that the failure of person-affecting solutions to solve non-human versions of the problem lend support to impersonal solutions to the problem which avoid issues of personhood or species identity. Finally, we conclude that some environmental arguments against climate change that rely on the notion of personal harm should be recast in impersonal terms. (shrink)

Madison Kilbride recently argued that insurance ) should cover in vitro fertilisation with preimplantation genetic testing services for couples at high risk of having a child affected with a genetic condition. She argues that IVF-PGT meets CMS’s definition of ‘medically necessary care’, where such care includes ‘services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms’. Kilbride argues that IVF-PGT satisfies this definition in two ways: as a diagnostic tool and as a treatment. Contradicting (...) Kilbride, however, I argue that IVF-PGT provides neither diagnosis nor treatment under CMS’s definition. Thus, as long as we accept CMS’s definition of medically necessary care—which Kilbride does, explicitly—it follows that IVF-PGT does not count as medically necessary care. Still, there may be other reasons to conclude that IVF-Preimplantation genetic testing should be covered, and so, it would be a mistake to reject Kilbride’s conclusion altogether. The problem is simply that Kilbride’s argument—that the procedure should be covered because it is medically necessary per CMS’s definition—is not sound. I conclude by discussing a number of other genetic services that are not currently being covered despite the fact that they do seem to satisfy CMS’s definition of ‘medically necessary diagnosis or treatment’. These services, I argue, should be provided under CMS before we consider expanding coverage to include elective procedures such as IVF-PGT. (shrink)

I respond to Monika Piotrowska's argument against anthropocentric theories of moral status that they yield disparate moral verdicts about parallel cases of embryonic stem cell transplantation. I argue that anthropocentric theories of moral status may not fall prey to this problem because embryonic stem cell transplantation may constitute creation rather than mere enhancement.