According to what we call the Principle of Procreative Beneficence, couples who decide to have a child have a significant moral reason to select the child who, given his or her genetic endowment, can be expected to enjoy the most well-being. In the first part of this paper, we introduce PB, explain its content, grounds, and implications, and defend it against various objections. In the second part, we argue that PB is superior to competing principles of procreative selection such as (...) that of procreative autonomy. In the third part of the paper, we consider the relation between PB and disability. We develop a revisionary account of disability, in which disability is a species of instrumental badness that is context- and person-relative. Although PB instructs us to aim to reduce disability in future children whenever possible, it does not privilege the normal. What matters is not whether future children meet certain biological or statistical norms, but what level of well-being they can be expected to have. (shrink)

In a contribution to The Journal of Medicine and Philosophy , Professor Rosamond Rhodes argues that individuals sometimes have an obligation to know about their genetic disorders, because this is required by their status as autonomous persons. Her analysis, which is based on Kant's concept of autonomy and Aristotle's notion of friendship, is extended here to consequentialist concerns. These are of paramount importance if, as we believe and Professor Rhodes herself implies, the Kantian and Aristotelian doctrines can be helpful only (...) in the sphere of private morality, not in the public realm. Better tools for assessing the right to genetic ignorance as an issue of public policy can, we contend, be found in Mill's ideas concerning liberty and the prevention of harm. Our own conclusion, based on the Millian way of thinking, is that individuals probably do have the right to remain in ignorance in the cases Professor Rhodes presents as examples of a duty to know. (shrink)

This beautifully written book by one of the world's leading moral philosophers argues that the key to a fulfilled life is to pursue wholeheartedly what one cares about, that love is the most authoritative form of caring, and that the purest form of love is, in a complicated way, self-love. Harry Frankfurt writes that it is through caring that we infuse the world with meaning. Caring provides us with stable ambitions and concerns; it shapes the framework of aims and interests (...) within which we lead our lives. The most basic and essential question for a person to raise about the conduct of his or her life is not what he or she should care about but what, in fact, he or she cannot help caring about. The most important form of caring, Frankfurt writes, is love, a nonvoluntary, disinterested concern for the flourishing of what is loved. Love is so important because meaningful practical reasoning must be grounded in ends that we do not seek only to attain other ends, and because it is in loving that we become bound to final ends desired for their own sakes. Frankfurt argues that the purest form of love is self-love. This sounds perverse, but self-love--as distinct from self-indulgence--is at heart a disinterested concern for whatever it is that the person loves. The most elementary form of self-love is nothing more than the desire of a person to love. Insofar as this is true, self-love is simply a commitment to finding meaning in our lives. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

The author argues that the key to a fulfilled life is to pursue what one cares about, that love is the most authoritative form of caring, and that the purest form of love is, in a complicated way, self-love.

The emerging international biomedical law tends to recognise the right not to know one’s genetic status. However, the basis and conditions for the exercise of this right remain unclear in domestic laws. In addition to this, such a right has been criticised at the theoretical level as being in contradiction with patient’s autonomy, with doctors’ duty to inform patients, and with solidarity with family members. This happens especially when non-disclosure poses a risk of serious harm to the patient’s relatives who, (...) without that vital information, could be deprived of preventive or therapeutic measures. This paper argues, firstly, that individuals may have a legitimate interest in not knowing their genetic make up to avoid serious psychological consequences; secondly, that this interest, far from being contrary to autonomy, may constitute an enhancement of autonomy; thirdly, that the right not to know cannot be presumed, but must be “activated” by the individual’s explicit choice, and fourthly, that this is not an absolute right, in the sense that it may be restricted when disclosure to the patient is necessary in order to avoid a risk of serious harm to third persons. (shrink)

A defence of the idea that there are sui generis duties of love: duties, that is, that we owe to people in virtue of standing in loving relationships with them. I contrast this non‐reductionist position with the widespread reductionist view that our duties to those we love all derive from more generic moral principles. The paper mounts a cumulative argument in favour of the non‐reductionist position, adducing a variety of considerations that together speak strongly in favour of adopting it. The (...) concluding section connects this debate with larger issues in moral theory concerning the general idea of obligation. (shrink)

Embryonic stem cell research is morally and politically controversial because the process of deriving the embryonic stem cells kills embryos. If embryos are, as some would claim, human beings like you and me, then ES cell research is clearly impermissible. If, on the other hand, the blastocysts from which embryonic stem cells are derived are not yet human beings, but rather microscopic balls of undifferentiated cells, as others maintain, then ES cell research is probably morally permissible. Whether the research can (...) be justified depends on such issues as its cost, chance of success, and numbers likely to benefit. But this is an issue for any research project, not just ES cell research. What makes the debate over ES cell research controversial is that it, like the debate over abortion, raises “questions that politicians cannot settle: when does human life begin, and what is the moral status of the human embryo?” This paper looks at several theories of moral status and their implications for embryo research. (shrink)

Termination of pregnancy after a certain gestational age and following prenatal diagnosis, in many nations seem to be granted with a special status to the extent that they by law have to be discussed within a predominantly medical context and have physicians as third parties involved in the decision-making process (‘indication-based’ approach). The existing legal frameworks for indication-based approaches, however, do frequently fail to provide clear guidance for the involved physicians. Critics, therefore, asked for professional ethics and professional institutions in (...) order to provide normative guidance for the physicians in termination of pregnancy on medical grounds. After outlining the clinical pathway in an indication-based approach and the involved types of (clinical) judgements, this paper draws upon different understandings of professional ethics in order to explore their potential to provide normative guidance in termination of pregnancy on medical grounds. The analysis reveals that professional ethics will not suffice—neither as a set of established norms nor as internal morality—in order to determine the normative framework of indication-based approaches on termination of pregnancy. In addition, there seem to be considerable inconsistencies regarding the target and outcome between prenatal testing on the one hand and following termination of pregnancy on the other hand. A source of morality external to medicine has to be the basis of evaluation if a consistent and workable normative framework for termination of pregnancy and prenatal testing should be established. (shrink)

This paper explores the significative structure and normative quality of the child wish by focusing on the concepts that are used when people speak about it. Does having children belong to the category of human needs, or is it rather something that people desire? The Principle of Precedence holds that needs tend to have a substantially greater moral impact than desires. In order to do justice both to people’s profound happiness that goes with fulfilment of the child wish and to (...) the great distress that goes with involuntary childlessness it seems to be right then to argue that having children belongs to the category of human needs; and to use the term from Harry Frankfurt, to the category of constrained volitional needs. Accordingly, it might be argued that society has a rights-based duty to prevent involuntary childlessness. Contrary to this, I defend the thesis that an ethics of desire, which conceives the child wish as rooted in a symbolic desire, leads to a more adequate understanding of the child wish in all its various phenomenological aspects. (shrink)

New dimensions in different ethical scenarios following genetic information require new medical-ethical Action Guides for physician-patient interaction. This paper discusses the ambiguity in moral choice between a “right not to know” and “a duty to know”, regarding parental decisionmaking pro or contra selective abortion following prenatal screening for autosomal dominant polycystic kidney disease (Potter III) and related public policy issues.

A defence of the idea that there are sui generis duties of love: duties, that is, that we owe to people in virtue of standing in loving relationships with them. I contrast this non-reductionist position with the widespread reductionist view that our duties to those we love all derive from more generic moral principles. The paper mounts a cumulative argument in favour of the non-reductionist position, adducing a variety of considerations that together speak strongly in favour of adopting it. The (...) concluding section connects this debate with larger issues in moral theory concerning the general idea of obligation. (shrink)

An Indian Court recently awarded 50,000 rupees damages to a couple who gave birth to their fourth daughter. The couple were mistakenly told they were carrying a male fetus. The doctor mistook a section of the umbilical cord for a penis. The husband said: “We are already struggling to raise three children. This was a big sacrifice for us to have a fourth child. We would have had an abortion if we had known it was a girl”. The cost of (...) damages amounted to the dowry they would have to pay at the time of their daughter's marriage.This is a fictional case. But the cases of Nicholas Perruche and Lionel1 are not fictional. According to reports, damages were paid to these children on the basis of what the media has described as a “right not to be born”. Is there a “right not to be born?” Was it right to compensate Nicholas Perruche for being born with congenital rubella and Lionel for being born with Down's syndrome?HARM TO THE CHILDWhat constitutes a right is a complex question. On one interpretation, rights protect interests. This implies that a right not to be born would exist if a child had an interest in not being born. Is it ever in a child's interests not to have been born? If it were, this might imply the child is better off dead than alive, as the Collective against Handiphobia claim. Is it better to be dead than have Down's syndrome?Some people do believe that Down's syndrome constitutes a life not worth living.2 But this view seems false. Children with Down's syndrome can and often do lead happy and worthwhile lives. After all, we do not suggest that other animals have a right not to be born or a life not worth …. (shrink)