Genes, embryos, and future people

Testing embryonic cells for genetic abnormalities gives us the capacity to predict whether and to what extent people will exist with disease and disability. Moreover, the freezing of embryos for long periods of time enables us to alter the length of a normal human lifespan. After highlighting the shortcomings of somatic-cell gene therapy and germ-line genetic alteration, I argue that the testing and selective termination of genetically defective embryos is the only medically and morally defensible way to prevent the existence of people with severe disability, pain and suffering that make their lives not worth living for them on the whole. In addition, I consider the possible harmful effects on children born from frozen embryos after the deaths of their biological parents, or when their parents are at an advanced age. I also explore whether embryos have moral status and whether the prospects for disease-preventing genetic alteration can justify long-term cryopreservation of embryos.     

The moral importance of selecting people randomly

This article discusses some ethical principles for distributing pandemic influenza vaccine and other indivisible goods. I argue that a number of principles for distributing pandemic influenza vaccine recently adopted by several national governments are morally unacceptable because they put too much emphasis on utilitarian considerations, such as the ability of the individual to contribute to society. Instead, it would be better to distribute vaccine by setting up a lottery. The argument for this view is based on a purely consequentialist account of morality; i.e. an action is right if and only if its outcome is optimal. However, unlike utilitarians I do not believe that alternatives should be ranked strictly according to the amount of happiness or preference satisfaction they bring about. Even a mere chance to get some vaccine matters morally, even if it is never realized.     

Safety, identity and consent: a limited defense of reproductive human cloning

Some opponents of reproductive human cloning have argued that, because of its experimental nature, any attempt to create a child by way of cloning would risk serious birth defects or genetic abnormalities and would therefore be immoral. Some versions of this argument appeal to the consent of the person to be conceived in this way. In particular, they assume that if an experimental reproductive technology has not yet been shown to be safe, then, before we use it, we are morally obligated to get either the actual consent or the presumed consent of the person to be conceived. In this article, I attempt to explain the appeal of such consent-based arguments as deriving from a mistaken view of personal identity. I then argue that since this view is false, such arguments are unsound. Finally, I argue that even if reproductive cloning is unsafe, it may still be morally permissible in some circumstances.     

Constraints and heroes

A story, perhaps apocryphal, is told about the United States surgical team which pioneered the first artificial heart procedure. It is said that the team received a number of telephone calls from people around the country who, worried about the ailing heart recipient, offered to donate to him their own hearts. When the surgical team, justifiably curious, sent psychiatrists to examine these donors, they found to their surprise that many of the donors were rational, competent, sincere, and fully aware that as a consequence of donating their hearts they would die.... My concerns here will be threefold. First, I want to add some substance to the widely-held intuition that there is something morally objectionable about a physician participating in procedures which put even a willing subject at risk. In so doing, I want to explore the larger question of why such a puzzle arises -- why physicians, and many others, find it morally objectionable to help someone do something which all agree to be heroic. Finally, I will start by examining some ways of framing the issue, widely employed in medical ethics, which I believe are simply wrong. This sort of puzzle is much more interesting than proponents of these standard arguments would have us believe, and it illustrates some larger points about morality which are often overlooked.     

WARNOCK VERSUS POWELL (AND HARRADINE): WHEN DOES POTENTIALITY COUNT?*

Lockwood's essay is one of three in this issue of Bioethics on potentiality and its applicability to research with human embryos. (See also Richard M. Hare's "When does potentiality count? A comment on Lockwood," and Stephen Buckle's "Arguing from potential.") The author critiques the reasoning behind some of the proposals for regulating such research, particularly the recommendations of Britain's Warnock Committee and Enoch Powell's legislative response, the Unborn Children (Protection) Bill. Lockwood attempts to formulate a logically defensible and morally plausible position on potentiality, arguing that it is potential plus identity, which depends on brain development, which generates moral claims. He concludes that, while there may be practical reasons for banning embryo research after the nervous system begins to develop, it may not be morally wrong to experiment with miscarried fetuses whose brain is developing, but who are nonviable.     

Cloning and adoption: a reply to Levy and Lotz

In previous articles I discussed the ethics of human reproductive cloning, focusing on a possible future scenario in which reproductive cloning can be accomplished without an elevated risk of anomalies to the children who are created. I argued that in such a scenario it would be ethically permissible for infertile couples to use cloning as a way to have genetically related children and that such use should not be prohibited. In 'Reproductive Cloning and a (Kind of) Genetic Fallacy', Neil Levy and Mianna Lotz raise objections to my conclusions. They disagree with the view, for which I argued, that some couples can have defensible reasons for desiring genetically related children. They also offer several new arguments against reproductive cloning, including an argument that it would diminish the number of adoptions, thereby adversely affecting the welfare of children who need to be adopted. In this paper I point out that Levy and Lotz's criticisms misconstrue my arguments and that there are serious problems with their arguments for prohibiting infertile couples from using cloning, including their argument from adoption.     

Two puzzles for Marquis's conservative view on abortion

Don Marquis argues that abortion is morally wrong in most cases since it deprives the fetus of the value of its future. I criticize Marquis’s argument for the modified conservative view by adopting an argumentative strategy in which I work within his basic account: if it is granted that his fundamental idea is sound, what follows about the morality of abortion? I conclude that Marquis is faced with a dilemma: either his position must shift towards the extreme conservative view on which abortion is never morally permissible, or he must abandon any recognizably conservative view. This dilemma suggests that Marquis’s view is either deeply implausible or that he cannot use this argument to successfully support his preferred position.     

Tying oneself to the mast: One necessary cost to morally enhancing oneself biomedically

In this article I seek to establish what, if anything, might be morally troubling about morally enhancing oneself through biomedical means. Building on arguments by Harris, while simultaneously acknowledging several valid counter‐arguments that have been put forth by his critics, I argue that taking BMEs necessarily incurs at least one moral cost in the restrictions they impose on our freedom. This does not necessarily entail that the use of BMEs cannot be overall justified, nor that, in certain cases, their costs may not be forestalled. It does show, however, that their use is not morally neutral. There is a cost to such technologies and, as such, the onus will always be on their defenders to show that these costs can compensated for.     

A Critique of Henrik Friberg‐Fernros's Defense of the Substance View

Proponents of the substance view contend that abortion is seriously morally wrong because it is killing something with the same inherent value and right to life as you or I. Rob Lovering offers two innovative criticisms of the anti‐abortion position taken by the substance view – the rescue argument and the problem of spontaneous abortion. Henrik Friberg‐Fernros offers an interesting response to Lovering, but one I argue would be inconsistent with the anti‐abortion stance taken by most substance view theorists.     

Valuing lives

[E]conomists have to assess the value of human lives in order to decide how much ought to be spent on matters like road improvements, safety measures, health costs and pollution controls. These economic measures of the value of a life are the subject of this paper. When I first heard of the attempts of economists to put a monetary price on the value of a life I was sure that such measures would have to be at best hopelessly partial and at worst morally objectionable. I now think I was wrong on both counts and in this paper I shall argue that: (i) it is morally permissible to put a price on a person's life; and (ii) there is a theoretically adequate way of determining such a price.     

Ruse's Darwinian meta-ethics: A critique

Michael Ruse, in Taking Darwin Seriously seeks to establish that taking Darwin seriously requires us to treat morality as subjective and naturalistic. I argue that, if morality is not objective, then we have no good reason for being moral if we can avoid detection and punishment. As a consequence, we will only continue to behave morally as long as we remain ignorant of Ruse's theory, that is, as long as the cat is not let out of the bag. Ruse offers a number of arguments to show that his theory can overcome such problems. I argue that they all fail. Ruse also argues that he can offer a naturalistic account of ethics which steps around the naturalistic fallacy and avoids the confusion of reasons with causes. His principal argument for this view is an analogy between spiritualism and morality. I argue that this analogy fails.     

Beware the curriculum-reform troops

Questions of resource allocation can pose practical and ethical dilemmas for clinicians. In the Aristotelian conception of distributive justice, the unequal allocation of a scarce resource may be justified by morally relevant factors such as need or likelihood of benefit. Even using these criteria, it can be difficult to reconcile completing claims to determine which patients should be given priority. To what extent the physician''s fiduciary duty toward a patient should supersede the interests of other patients and society as a whole is also a matter of controversy. Although the courts have been reluctant to become involved in allocation decisions in health care, they expect physicians to show allegiance to their patients regardless of budgetary concerns. The allocation of resources on the basis of clinically irrelevant factors such as religion or sexual orientation is prohibited. Clear, fair and publicly acceptable institutional and professional policies can help to ensure that resource allocation decisions are transparent and defensible.     

Marquis: A Defense of Abortion?

This is a reply to Don Marquis'Why Abortion is Immoral.' Marquis, who asserts that abortion is morally wrong, bases his argument on the following premise: Killing a being is morally wrong if that being is the sort of being who has a valuable future. I argue that this premise is false. I then assert that if I am correct about this premise being false, Marquis is faced with a dilemma. If he does not alter the premise in a way that makes it true, his argument is unsound. However, if he does make such an alteration, he must also alter a second premise in his argument, and this second change opens him to the charge of question begging. In addition, I conclude that such an alteration requires Marquis to adopt a position much like that taken by Judith J. Thompson in 'A Defense of Abortion,' a position he initially states is indefensible.     

EXISTENCE: WHO NEEDS IT? THE NON‐IDENTITY PROBLEM AND MERELY POSSIBLE PEOPLE

In formulating procreative principles, it makes sense to begin by thinking about whose interests ought to matter to us. Obviously, we care about those who exist. Less obviously, but still uncontroversially, we care about those who will exist. Ought we to care about those who might possibly, but will not actually, exist? Recently, unusual positions have been taken regarding merely possible people and the non‐identity problem. David Velleman argues that what might have happened to you – an existent person – often doesn't merit moral consideration since the alternative person one would have been had what might have happened actually happened is a merely possible person about whom one has no reason to care. He argues that his way of thinking can eliminate the non‐identity problem. Caspar Hare argues that merely possible people have interests and are morally relevant. He argues that we can solve the non‐identity problem by rejecting the view that merely possible people are morally irrelevant. Both Hare and Velleman argue that focusing on one's de dicto rather than on one's de re children can help us avoid the non‐identity problem. I analyze the role that merely possible, nonexistent hypothetical entities ought to play in our moral reasoning, especially with regard to procreation. I refute both Velleman's and Hare's views and demonstrate the difficulties we encounter when we try to apply their views to common non‐identity cases. I conclude with the common‐sense view regarding who matters, morally: only those who do, did, or will exist.     

Killing, letting die and the bare difference argument

I believe that there is no intrinsic moral difference between killing and letting die. That is, there is no difference that depends solely on the distinction between an act and an omission. I also believe that we can reasonably establish this thesis by appeal to the Bare Difference Argument. The form of this argument involves considering two imaginary cases in which there are no morally relevant differences present, save the bare difference that one is a case of killing and one a case of letting die. But in the pair of cases under consideration this bare difference makes no moral difference. Hence it cannot be that the bare difference between killing and letting die is in itself a morally important difference.
Winston Nesbitt has recently argued that the Bare Difference Argument fails because "the examples produced typically possess a feature which makes their use in this context illegitimate, and that when modified to remove this feature, they provide support for the view which they were designed to undermine". I argue that Nesbitt misunderstands the logic of the Bare Difference Argument and that accordingly his objections are mistaken.     

Dodged debts and the submissive predator: perspectives on Amazonian relations of dependence

This article explores the nature of inter‐ethnic asymmetry and the dynamic of long‐term dependence in Amazonia. Drawing on the case of the Sanema and their neighbouring Ye'kwana, it seeks to gain a deeper understanding of submission and indebtedness with a view to rethinking where the power might lie in such relationships. The association between the two groups, I argue, is motivated by the Sanema's pursuit of manufactured items, access to which the Ye'kwana had historically monopolized. The dynamic entered into in order to procure these goods is one of voluntary deference on the part of the Sanema, a demeanour that is actively pursued because it enables morally valued autonomy and a freedom from ongoing reciprocity. I conclude that this ‘submissive extraction’ can offer new perspectives on the relationship between debt, predation, and freedom.     

The negative view of natural selection

An influential argument due to Elliott Sober, subsequently strengthened by Denis Walsh and Joel Pust, moves from plausible premises to the bold conclusion that natural selection cannot explain the traits of individual organisms. If the argument were sound, the explanatory scope of selection would depend, surprisingly, on metaphysical considerations concerning origin essentialism. I show that the Sober-Walsh-Pust argument rests on a flawed counterfactual criterion for explanatory relevance. I further show that a more defensible criterion for explanatory relevance recently proposed by Michael Strevens lends support to the view that natural selection can be relevant to the explanation of individual traits.     

Birds Do It. Bees Do It. So Why Not Single Women and Lesbians?

Infertile couples have come to take assisted reproductive technologies (ART) for granted. An increasing number of single women and lesbian couples also desire to have children and turn to ART, especially donor insemination, to fulfill this desire. While most married couples find that access to ART is limited primarily by the ability to pay, for single women and lesbian couples, the story may be much different. In the United States, they may find that doctors and infertility clinics view their desires as immoral and refuse to accept them as patients, although other doctors and clinics readily accept them. In most other countries, however, it is against the law for single women and lesbian couples to make use of ART, including donor insemination.
In this paper I will argue that marital status and sexual orientation should not serve as a barrier to accessing the world of reproductive medicine. I will base this conclusion on two arguments. First, that justice requires that we treat like cases alike. Just as we would not accept or reject patients for cardiac rehabilitation programs based on factors such as a history of poor eating habits, so too we should not look at nonmedical factors such as marital status when deciding whether to treat infertility. For the second justification for the conclusion of equal access to ART, I will examine the concept of the family. I will argue that it is morally acceptable for single women and lesbian couples to have children and to head families.