Science and technology have vastly expanded the realm of medicine. The numbers of and knowledge about diseases has greatly increased, and we can help more people in many more ways than ever before. At the same time, the extensive expansion has also augmented harms, professional responsibility, and ethical concerns. While these challenges have been studied from a wide range of perspectives, the problems prevail. This article adds value to previous analyses by identifying how the moral imperative of medicine has expanded (...) in three ways: (1) from targeting experienced phenomena, such as pain and suffering, to non-experienced phenomena (paraclinical signs and indicators); (2) from addressing present pain to potential future suffering; and (3) from reducing negative wellbeing (pain and suffering) to promoting positive wellbeing. These expansions create and aggravate problems in medicine: medicalization, overdiagnosis, overtreatment, risk aversion, stigmatization, and healthism. Moreover, they threaten to infringe ethical principles, to distract attention and responsibility from other competent agents and institutions, to enhance the power and responsibility of professionals, and to change the professional-beneficiary relationship. In order to find ways to manage the moral expansion of medicine, four traditional ways of setting limits are analyzed and dismissed. However, basic asymmetries in ethics suggest that it is more justified to address people’s negative wellbeing (pain and suffering) than their positive wellbeing. Moreover, differences in epistemology, indicate that it is less uncertain to address present pain and suffering than future wellbeing and happiness. Based on these insights the article concludes that the moral imperative of medicine has a gradient from pain and suffering to wellbeing and happiness, and from the present to the future. Hence, in general present pain and suffering have normative priority over future positive wellbeing. (shrink)

Human enhancement is ontologically, epistemologically, and ethically challenging and has stirred a wide range of scholarly and public debates. This article focuses on some conceptual issues with HE that have important ethical implications. In particular it scrutinizes how the concept of human enhancement relates to and challenges the concept of health. In order to do so, it addresses three specific questions: Q1. What do conceptions of HE say about health? Q2. Does HE challenge traditional conceptions of health? Q3. Do concepts (...) of health set limits to or direct HE? Addressing Q1 reveals that HE tends to frame and form our conception of health. Thereby it challenges traditional conceptions of health. Accordingly, health does not provide strong sources for setting limits to HE. On the contrary HE seems to define and expand the concept of health. Common to the concepts of HE and health is that both depend on vague value concepts, such as happiness, well-being, or goodness. There seems to be a tendency in the HE literature to define the goal of human life in terms of what is bigger, stronger, faster, more intelligent, and more resilient. However, this is confusing “goodness” with “more” and quality with quantity. Until HE more appropriately defines happiness, HE will fail to provide a relevant compass for improving the life of human beings. On the contrary, if we let simplified conceptions of “enhancement” come to define goodness or health, we may do more harm than good. Until doing so, we may well learn from Tithonus, listen to Douglas Adams’ Wowbagger, and pay attention to Virginia Woolf’s Orlando. Enhanced life may not be better. The same goes for health. (shrink)

This paper shows how critical realism can be used to integrate empirical data and philosophical analysis within ‘empirical bioethics’. The term empirical bioethics, whilst appearing oxymoronic, simply refers to an interdisciplinary approach to the resolution of practical ethical issues within the biological and life sciences, integrating social scientific, empirical data with philosophical analysis. It seeks to achieve a balanced form of ethical deliberation that is both logically rigorous and sensitive to context, to generate normative conclusions that are practically applicable to (...) the problem, challenge, or dilemma. Since it incorporates both philosophical and social scientific components, empirical bioethics is a field that is consistent with the use of critical realism as a research methodology. The integration of philosophical and social scientific approaches to ethics has been beset with difficulties, not least because of the irreducibly normative, rather than descriptive, nature of ethical analysis and the contested relation between fact and value. However, given that facts about states of affairs inform potential courses of action and their consequences, there is a need to overcome these difficulties and successfully integrate data with theory. Previous approaches have been formulated to overcome obstacles in combining philosophical and social scientific perspectives in bioethical analysis; however each has shortcomings. As a mature interdisciplinary approach critical realism is well suited to empirical bioethics, although it has hitherto not been widely used. Here I show how it can be applied to this kind of research and explain how it represents an improvement on previous approaches. (shrink)

Moderne teknologi gir fantastiske muligheter for menneskelig formering. Mange som tidligere ikke kunne få barn, eller som fikk syke barn, kan nå hjelpes. Samtidig reiser mulighetene en rekke vanskelige moralske spørsmål, som ikke har enkle svar – ofte fordi de bunner i grunnleggende etiske motsetninger. Denne artikkelen gir en kort oversikt over de mulighetene som tre typer teknologier gir: assisterende, seleksjonsfremmende og egenskapsendrende teknologier. Deretter peker den på noen av de viktige moralske spørsmålene som disse teknologiene reiser i betydningen «Hvordan (...) bør teknologiene brukes»? Så stilles spørsmålet: Hvordan skal vi begrunne bruken? Dette spørsmålet peker på en rekke grunnleggende etiske utfordringer. Det er disse utfordringene som gjør at de moralske spørsmålene sjelden finner solide og stabile svar, men til stadighet blusser opp i til dels heftige offentlige debatter. I tillegg løfter artikkelen frem flere moralske spørsmål som er glemt eller gjemt. Spørsmålene som vi ikke stiller kan ofte fortelle oss like mye om oss selv og våre verdier, som de spørsmålene som drøftes eksplisitt. De moralske spørsmålene – samt de underliggende etiske utfordringene og de glemte spørsmålene – kan forklare hvorfor debattene ofte står på stedet hvil, og hva vi må jobbe med for å komme videre i drøftingene av moderne reproduksjonsteknologi. Vi synes å være teknologiske helter som er fremragende på teknikk, men elendige på etikk. Målet er å forhindre at vi blir tragiske helter som går til grunne på våre beste egenskaper. Nøkkelord: reproduksjonsteknologi, assistert reproduksjon, invitro-fertilisering, fosterdiagnostikk, genredigering, sortering, abortEnglish summary: Ethical challenges with newer reproductive technology Modern technologies provide fascinating opportunities for human reproduction. Many persons previously infertile, or who risked having diseased children, can now have healthy children. At the same time, these technological opportunities also raise a wide range of moral questions, which rarely have easy answers. One reason for this is that they are based on profound ethical challenges. This article sets out to give a short overview of three types of technologies: assisting, selective, and characteristic-changing technologies. It goes on to highlight some of the important moral questions raised by these technologies. The third part addresses the basic ethical challenges lurking behind the moral questions and debates. The fourth part addresses some forgotten or hidden questions, arguing that these are telling and important. The article ends with arguing that many of the basic ethical challenges and the unaddressed questions can explain why debates on reproductive technologies are so heated and static. We appear to have become technological giants, but ethical infants. Accordingly, we should try to avoid becoming tragic heroes succumbing to our very best abilities. (shrink)

Demographical changes in high income counties will increase the need of health care services but reduce the number of people to provide them. Welfare technology is launched as an important measure to meet this challenge. As with all types of technologies we must explore its ethical challenges. A literature review reveals that welfare technology is a generic term for a heterogeneous group of technologies and there are few studies documenting their efficacy, effectiveness and efficiency. Many kinds of welfare technology break (...) with the traditional organization of health care. It introduces technology in new areas, such as in private homes, and it provides new functions, e.g. offering social stimuli and entertainment. At the same time welfare technology is developed for groups that traditionally have not been extensive technology users. This raises a series of ethical questions with regard to the development and use of welfare technologies, which are presented in this review. The main challenges identified are: (1) Alienation when advanced technology is used at home, (2) conflicting goals, as welfare technologies have many stakeholders with several ends, (3) respecting confidentiality and privacy when third-party actors are involved, (4) guaranteeing equal access and just distribution, and (5) handling conflicts between instrumental rationality and care in terms of respecting dignity and vulnerability. Addressing these issues is important for developing and implementing welfare technologies in a morally acceptable manner. (shrink)