The use of the concept of moral status is commonplace today in debates about the moral consideration of entities lacking certain special capacities, such as nonhuman animals. This concept has been typically used to defend the view that adult human beings have a status higher than all those entities. However, even those who disagree with this claim have often accepted the idea of moral status as if it were part of an undisputed received way of thinking in ethics. This paper (...) argues that the use of this concept, however common, distorts our understanding of how to behave towards different individuals in different circumstances. When moral status is identified with the interest in living or the capacity for well-being, it becomes an arbitrary and irrelevant criterion. When it is used as a synonym of moral consideration or considerability, in a way that is compatible with the principle of equal consideration, it becomes trivial and confusing. When used, instead, to defend the unequal moral consideration of interests of equal weight, it has several implausible implications. In particular, the claim that unequal status is justified because of the value of cognitive capacities implausibly entails that our exercising those capacities should have priority over the promotion of our wellbeing. The idea of full moral status is also problematic as it implies the possibility of status monsters. In addition, its use is based in a misconceived way of what it would really entail to have a full status by virtue of having rational capacities. The paper concludes that we have strong reasons to abandon the concept of moral status altogether. (shrink)

Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a “high‐stakes endeavor” that can acutely affect patient (...) care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues?To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician‐gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine. (shrink)

It is commonly thought that neo-Hobbesian contractarianism cannot yield direct moral standing for marginal humans and animals. However, it has been argued that marginal humans and animals can have a form of direct moral standing under neo-Hobbesian contractarianism: secondary moral standing. I will argue that, even if such standing is direct, this account is unsatisfactory because it is counterintuitive and fragile.

Our ambivalent attitudes toward the notion of ‘a life worth living’ present a philosophical puzzle: Why are we of two minds about the birth of a severely disabled child? Is the child’s life worth living or not worth living? Between these two apparently incompatible evaluative judgments, which is true? If one judgment is true and the other false, what makes us continue to find both evaluations appealing? Indeed, how can we manage to hold these inconsistent judgments simultaneously at all? I (...) critically examine two solutions to this puzzle: the hidden-indexical account and Velleman’s anti-realist account. I propose an alternative explanation which appeals to (a) state-given, as opposed to object-given, reasons for belief and (b) the distinction between belief and acceptance. I argue that (1) the fact that a severely disabled life is not worth living provides object-given reason to believe that that life is not worth living, but (2) after the birth of a severely disabled child, the psychological utility of positive evaluation gives us a state-given reason to believe that that child’s life is worth living, and a reason to accept that, in our relation with the child, her life is worth living. I conclude by drawing a practical lesson about wrongful life suits. (shrink)

Preimplantation genetic diagnosis is a new method of prenatal diagnosis that is developing from a union of in vitro fertilization technology and molecular biology. Briefly stated, PGD involves the creation of several embryos in vitro from the eggs and sperm of an interested couple. The embryos are permitted to develop to a 6-to-10-cell stage, at which point one of the embryonic cells is removed from each embryo and the cellular DNA is analyzed for chromosomal abnormalities or genetic mutations. An embryo (...) or several embryos found to be free of genetic abnormalities are subsequently transferred to the woman's uterus for gestation. Embryos found to carry a genetic abnormality are discarded or frozen. Extra normal embryos may be frozen for future transfer or donation to another couple. (shrink)

Preterm birth is defined as any birth that occurs prior to 37 weeks gestation, and is a leading cause of infant mortality, neurological disabilities, breathing, feeding and vision problems, and hea...

The aim of this paper is to critically examine David Shaw, Wybo Dondorp, and Guido de Wert’s arguments in favour of the procurement of human organs from human/nonhuman-primate chimeras, specifically from great-ape/human chimeras. My main claim is that their arguments fail and are in need of substantial revision. To prove this I first introduce the topic, and then reconstruct Shaw et al.’s position and arguments. Next, I show that Shaw et al.: (1) failed to properly apply the subsidiarity and proportionality (...) principles; (2) neglected species overlapping cases in their ethical assessment; (3) ignored the ethics literature on borderline persons; and (4) misunderstood McMahan’s two-tiered moral theory. These mistakes render an important part of their conclusions either false or problematic to the point that they would no longer endorse them. Finally I will briefly mention a possible multipolar solution to the human organ shortage problem that would reduce the need for chimeras’ organs. (shrink)

The doctrine that it is wrong to end the existence of something because it is a human life I call “the standard view.” I argue that attempts by proponents of abortion choice to avoid the implications of the standard view by suggesting that we don't know when life begins or by suggesting that fetuses are only potential lives fail. Nevertheless, opponents of abortion choice should not base their arguments on the standard view, for the standard view is false. I propose (...) a substitute for the standard view that avoids the difficulties with it, that explains why most people believe that the standard view is true and that also underwrites opposition to abortion choice. (shrink)

International guidelines recommend that prenatal screening for fetal abnormalities should only be offered within a non-directive framework aimed at enabling women in making meaningful reproductive choices. Whilst this position is widely endorsed, developments in cell-free fetal DNA based Non-Invasive Prenatal Testing are now raising questions about its continued suitability for guiding screening policy and practice. This issue is most apparent within debates on the scope of the screening offer. Implied by the aim of enabling meaningful reproductive choices is the idea (...) that screening services should support women in accessing prenatal tests that best enable them to realize the types of reproductive choice that they find important. However, beyond whatever options meet the quality standards required for facilitating an informed decision, the remaining criteria of facilitating autonomous choice is strictly non-directive. As a result, policy makers receive little indication prior to consultation with each individual woman, about what conditions should be prioritized during the offer of screening. In this paper we try to address this issue by using the capabilities approach to further specify the non-directive aim of enabling meaningful reproductive choice. The resulting framework is then used to assess the relative importance of offering prenatal screening where concerning different types of genetic condition. We conclude that greater priority may be ascribed to offering prenatal screening for conditions that more significantly diminish a woman’s central capabilities. It follows that serious congenital and earlier-onset conditions are more likely to fulfill these criteria. (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)

Biobanks are an international phenomenon today and promise solutions to hitherto unanswered questions in biomedical research. However, though India may benefit from biobanking activities and output, the regulatory landscape for biobanks remains woefully inadequate. The Guidelines of the Indian Council of Medical Research, which prescribe the conditions for the operation of biobanks, do not adequately address the concerns that emerge in view of the socio-politico-economic backdrop peculiar to the Indian situation. The lack of awareness and understanding of the implications of (...) bioethical issues and requirements on the part of research participants, and inadequate engagement with these issues and requirements on the part of interested personnel could exacerbate growing concerns over effective scientific and ethical management of biobanks, especially commercial ones that have emerged. The role of the State is to be highlighted here as facilitator of such research, mindful of the developmental and health-related needs of the Indian people, regulator of such research, ensuring ethical and regulatory requirements are met, and enabler of access to the productive outcomes of such research, keeping in mind the principles of egalitarian distribution of common resources for the good of all. (shrink)

In the near future developments in non-invasive prenatal testing may soon provide couples with the opportunity to test for and diagnose a much broader range of heritable and congenital conditions than has previously been possible. Inevitably, this has prompted much ethical debate on the possible implications of NIPT for providing couples with opportunities for reproductive choice by way of routine prenatal screening. In view of the possibility to test for a significantly broader range of genetic conditions with NIPT, the European (...) Society of Human Genetics and American Society of Human Genetics recommend that, pending further debate, prenatal screening for reproductive choice should only be offered where concerning serious congenital conditions and childhood disorders. In support of this recommendation, the ESHG and ASHG discuss a number of ethical issues on which they prompt further debate: the informational privacy of the future child, the trivialization of abortion, the risk of information overload, and issues of distributive justice. This paper responds to this call with further reflection on each ethical issue and how it relates to the moral justification of providing couples with opportunities for meaningful reproductive choice. The paper concludes that whilst there may be good reasons for qualifying the scope of any unsolicited prenatal screening offer to serious congenital conditions and childhood disorders, if prenatal screening is justified for providing couples with opportunities for meaningful reproductive choice, then health services may have obligations to empower couples with the same opportunity where concerning other conditions. (shrink)

The possibility of a human head transplant poses unprecedented philosophical and neuroethical questions. Principal among them are the personal identity of the resultant individual, her metaphysical and social status: Who will she be and how should the “new” person be treated - morally, legally and socially - given that she incorporates characteristics of two distinct, previously unrelated individuals, and possess both old and new physical, psychological, and social experiences that would not have been available without the transplant? We contend that (...) this situation challenges linguistic conventions and conceptual binaries, and calls into question the major philosophical approaches to personal identity: animalism and reductionism. We examine these views critically vis-a-vis head transplantation and conclude that they fail to provide an adequate account of the identity of the resultant individual because both neglect the key role of embodiment for personal identity. We maintain that embodiment is central to personal identity and a radical alteration of the body will also radically alter that person, making her a different person. Consequently, a human head transplant will result in an individual partly continuous with the head/brain, and partly continuous with the body donor. We conclude that the resultant person would be different from both the individual whose head was transplanted and the one to whose body the “new” head is attached. (shrink)

Opponents of human embryonic stem cell (hESC) research claim that such research is incompatible with the moral principle that it is always wrong intentionally to end a human life. In this essay, I discuss how that principle might be revised so that it is subject to as few difficulties as possible. I then argue that even the most defensible version of the principle is compatible with the moral permissibility of hESC research.

Non-Identity arguments have a pervasive but sometimes counter-intuitive grip on certain key areas in ethics. As a result, there has been limited success in supporting the alternative view that our choices concerning future generations can be considered harmful on any sort of person-affecting principle. However, as the Non-Identity Problem relies overtly on certain metaphysical assumptions, plausible alternatives to these foundations can substantially undermine the Non-Identity argument itself. In this paper, I show how the pervasive force and nature of Non-Identity arguments (...) rely upon a specific adoption of a theory of modality and identity and how adopting an alternative account of modality can be used to reject many conclusions formed through Non-Identity type arguments. By using Lewis’s counterpart-theoretic account to understand ways we might have been, I outline the basis of a modal account of harm that incorporates a person-affecting aspect. This, in turn, has significant implications for ethical decision-making in areas such as reproductive choice and the welfare of future generations. (shrink)

The central importance of reproduction in all human cultures has given rise to many methods and techniques of assisting reproduction or overcoming infertility. Such methods and techniques have achieved spectacular successes in the Western world, where processes like in vitro fertilization (IVF) constitute a remarkable breakthrough. In this paper, the author attempts to reflect critically on assisted reproduction technologies (ART) from the background and perspective of African culture, a culture within which human reproduction is given the highest priority but which (...) also exhibits a highly ambivalent attitude to modern technology-assisted methods of reproduction. The author considers the ethical crux of reproductive technologies to be linked to the issue of the moral status of the human embryo and argues that a morally significant line of demarcation cannot be drawn between embryos and other categories of humans. (shrink)

Many theories of moral status that are intended to ground pro-choice views on abortion tie full moral status to advanced cognitive capabilities. Extant accounts of this kind are inconsistent with the intuition that the profoundly cognitively disabled have full moral status. This paper improves upon these extant accounts by combining an anti-luck condition with Steinbock’s stratification of moral status into two levels. On the resulting view, a being has full moral status if and only if she has moral status and (...) has had advanced cognitive capacities, has the potential to develop such capacities, or would have had such capacities were it not for luck. I argue that modal accounts of luck provide a non-speciesist basis for attributing the lack of advanced cognitive capacities in humans to luck without doing the same for non-human animals. (shrink)

Margaret Mohrmann, Paul Lauritzen, and Sumner Twiss raise questions about my account of basic interests, liberal theory, and the challenges of multiculturalism as developed in "Children, Ethics, and Modern Medicine." Their questions point to foundational issues regarding the justification and limitation of parental authority to make decisions on behalf of children in medical and other contexts. One of the central questions in that regard is whether adults' decisions deserve to be respected, especially when they seem contrary to a child's or (...) adolescent's basic interests. Questions about respect, in turn, focus attention on others' decisions about what seems good for families and children, decisions that may be paternalistic or utilitarian. Such decisions are further complicated by a child's or adolescent's budding autonomy and need for respect and recognition. Pediatric bioethics grounded in an account of a child's basic interests produces a theory of negative and positive rights for assessing adults' actions in relation to children, especially (but not only) when adults demand respect in their expressions of care. (shrink)

Health policy frameworks usually construe environmental protection and human health as harmonious values. Policies that protect the environment, such as pollution control and pesticide regulation, also benefit human health. In recent years, however, it has become apparent that promoting human health sometimes undermines environmental protection. Some actions, policies, or technologies that reduce human morbidity, mortality, and disease can have detrimental effects on the environment. Since human health and environmental protection are sometimes at odds, political leaders, citizens, and government officials need (...) a way to mediate and resolve conflicts between these values. Unfortunately, few approaches to applied bioethics have the conceptual tools to do accomplish this task. Theories of health care ethics have little to say about the environment, and theories of environmental ethics don’t say much about human health. In this essay, I defend an approach to ethical decision-making that gives policy-makers some tools for balancing promotion of human health and protection of the environment. (shrink)

Two contemporary strategies in cadaver organ transplantation, both with the potential to affect significantly expanding organ transplant waiting list sizes, have evolved: elective ventilation and use of nonheart-beating donors. Both are undergoing a period of critical review. It is not clear how widely EV is practiced around the world. In Great Britain, the Royal Devon and Exeter Hospital was the first hospital to develop an EV protocol, in 1988, after which other British hospitals followed suit. In the 1980s, new NHBD (...) protocols of two distinct types were implemented worldwide, although both rely on death confirmed by traditional cardiopulmonary criteria. The first type involves the removal of organs immediately after death, the preeminent example being the University of Pittsburgh Medical Center Protocol. The second involves the perfusion and cooling of kidneys immediately following death and subsequent organ removal. Protocols of this type have sprung up in Holland, Great Britain, Italy, France, Spain, Japan, and the United States. (shrink)

Two contemporary strategies in cadaver organ transplantation, both with the potential to affect significantly expanding organ transplant waiting list sizes, have evolved: elective ventilation and use of nonheart-beating donors. Both are undergoing a period of critical review. It is not clear how widely EV is practiced around the world. In Great Britain, the Royal Devon and Exeter Hospital was the first hospital to develop an EV protocol, in 1988, after which other British hospitals followed suit. In the 1980s, new NHBD (...) protocols of two distinct types were implemented worldwide, although both rely on death confirmed by traditional cardiopulmonary criteria. The first type involves the removal of organs immediately after death, the preeminent example being the University of Pittsburgh Medical Center Protocol. The second involves the perfusion and cooling of kidneys immediately following death and subsequent organ removal. Protocols of this type have sprung up in Holland, Great Britain, Italy, France, Spain, Japan, and the United States. (shrink)

Community discourse about the moral status of animals is critical to the future of bioethics and, indeed, to the future of modern society. Thomasma and Loewy are to be commended for sharing thoughts and trying to attain some common ground. I am grateful to them for fostering discussion and allowing me to respond. I cannot endorse the negative tone of the end of their conversation, however. They end with serious concerns about the possibility of any agreement between themselves. Even though (...) I perceive some moral differences between them, I do not believe that they are moral strangers. In this commentary I review the ways in which I agree and disagree with Thomasma and Loewy and conclude with some thoughts about the kind of broad ethical thinking we need to do to address our moral relationship to nonhuman, living creatures. (shrink)

Many who believe that human embryos have moral status are convinced that their use in human embryonic stem cell (hESC) research can be morally justified as long as they are discarded embryos left over from fertility treatments. This is one reason why this view about discarded embryos has played such a prominent role in the debate over publicly funding hESC research in the United States and other countries. Many believe that this view offers the best chance of a compromise between (...) the different sides in this debate. This paper focuses on what seems to be the most plausible argument for this view about discarded embryos. It shows that this argument is unsound regardless of how one understands the claim that embryos have moral status. It also discusses the implications of this conclusion for attempts to use this argument as a basis for public policy. (shrink)

How can the abortion issue be resolved? Many believe that the issue can be resolved if, and only if, we can determine when human life begins. Those opposed to abortion choice typically say that human life begins at conception. Many who favor abortion choice say that we will never know when human life begins. The importance of the when-does-human-life-begin issue is not so much argued for as it is taken to be self-evident. Furthermore, belief that this issue is fundamental is (...) taken for granted – at least outside of philosophy – by many of the people who seem to disagree about almost everything else concerning abortion. It has been my experience that – with rare exceptions – even those who insist that the issue of abortion should focus on the interests of pregnant women believe that this focus is warranted because fetuses are either not yet fully alive or not yet fully human. (shrink)

Many medical‐ethics advisory boards have concluded that human embryonic stem cell research can be conducted in an ethical manner. Yet, almost all the recommendations of the ethics advisory boards have included a rather obscure requirement: the embryos that are to be destroyed for stem cell research must be treated with profound respect. In none of these recommendations, however, do we see an adequate explanation of what proper respect for human embryos actually entails. In this essay I argue that showing proper (...) respect for human embryos, on the one hand, and simultaneously destroying them for stem cell research, on the other hand, are not mutually exclusive. In addition, I maintain that given current U.S. in vitro fertilization practices, which deliberately produce more embryos than will be implanted, proper respect for surplus embryos requires their use in embryonic stem cell research. (shrink)

L’objet de cette étude est de montrer les enjeux que posent aux droits de l’homme les lois bioéthiques de juillet 1994 en ce qui concerne l’application des biotechnologies à la reproduction. À cette fin, sont analysés des dispositifs juridiques mis en place dans la loi pour sélectionner des embryons et pour transformer leurs caractères génétiques. Ces résultats sont ensuite comparés aux procédés eugéniques employés en Occident dans la première moitié duxx e siècle. Cela conduit à récuser la catégorie d’eugénique pour (...) rendre compte du projet biopolitique des lois bioéthiques. En conclusion, il s’avère que les enjeux posés par cette législation aux droits de l’homme concernent le sort qu’elle a réservé à la notion d’homme et de sujet de droit. (shrink)

This article addresses whether cardiopulmonary resuscitation and sustained physiological support should ever be permitted in individuals who are diagnosed as brain dead and who had held previously expressed moral or religious objections to the currently accepted criteria for such a determination. It contrasts how requests for care would normally be treated in cases involving a brain-dead individual with previously expressed wishes to donate and a similarly diagnosed individual with previously expressed beliefs that did not conform to a brain-based conception of (...) death. The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor's requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society. (shrink)

Preimplantation genetic diagnosis is a new method of prenatal diagnosis that is developing from a union of in vitro fertilization technology and molecular biology. Briefly stated, PGD involves the creation of several embryos in vitro from the eggs and sperm of an interested couple. The embryos are permitted to develop to a 6-to-10-cell stage, at which point one of the embryonic cells is removed from each embryo and the cellular DNA is analyzed for chromosomal abnormalities or genetic mutations. An embryo (...) or several embryos found to be free of genetic abnormalities are subsequently transferred to the woman's uterus for gestation. Embryos found to carry a genetic abnormality are discarded or frozen. Extra normal embryos may be frozen for future transfer or donation to another couple. (shrink)