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Table of Contents
Оглавление1 Cover
8 Introduction 1 Abortion and Infanticide I Abortion and Infanticide II Terminology: “Person” versus “Human Being” III The Basic Issue: When is a Member of the Species Homo sapiens a Person? IV Some Critical Comments on Alternative Proposals V Refutation of the Conservative Position VI Summary and Conclusions 2 A Defense of Abortion 3 The Wrong of Abortion Embryos and Fetuses are Complete (though Immature) Human Beings No‐Person Arguments: The Dualist Version No‐Person Arguments: The Evaluative Version The Argument that Abortion is Justified as Non‐intentional Killing References Further reading 4 Why Abortion is Immoral I II III IV V VI
9 Part II: Issues in Reproduction
10 Introduction
11 Assisted Reproduction 5 The McCaughey Septuplets 6 The Meaning of Synthetic Gametes for Gay and Lesbian People and Bioethics Too Controversial Parenthood Protecting Children from Some Possible Parents Conclusions References 7 Rights, Interests, and Possible People
12 Prenatal Screening, Sex Selection, and Cloning 8 Genetics and Reproductive Risk Huntington’s Disease Possible Children and Potential Parents 9 Sex Selection and Preimplantation Genetic Diagnosis Background The General Ethical Debate Preimplantation Genetic Diagnosis and Sex Selection: Joining the Particular Issues Recommendations 10 Sex Selection and Preimplantation Diagnosis Introduction References 11 Why We Should Not Permit Embryos to Be Selected as Tissue Donors Children as Things What Kind of Ethics Do We Need? 12 The Moral Status of Human Cloning Introduction 1 A Crucial Concept: neo‐Lockean Persons 2 Cloning to Produce Human Organisms that Will Never Become Persons 3 Cloning to Produce Persons Conclusion References
13 Part III: Genetic Manipulation
14 Introduction 13 Questions about Some Uses of Genetic Engineering Avoiding the Debate about Genes and the Environment Methods of Changing the Genetic Composition of Future Generations The Positive–Negative Distinction The View that Overall Improvement is Unlikely or Impossible The Family and Our Descendants Risks and Mistakes Not Playing God The Genetic Supermarket A Mixed System Values 14 The Moral Significance of the Therapy–Enhancement Distinction in Human Genetics Introduction Somatic versus Germline Interventions The Concepts of Health and Disease The Goals of Medicine Our Humanness The Rights of the Unborn Eugenics Conclusion: The Significance of the Distinction 15 In Defense of Posthuman Dignity Transhumanists vs. Bioconservatives Two Fears about the Posthuman Is Human Dignity Incompatible with Posthuman Dignity? Why We Need Posthuman Dignity 16 Statement on NIH Funding of Research Using Gene‐Editing Technologies in Human Embryos 17 Genome Editing and Assisted Reproduction Introduction: Genetic Diseases, Genome Editing and Existing Alternatives CRISPR and Assisted Reproduction Assisted Reproduction and PGD, or Assisted Reproduction and CRISPR? The Case for Genome Editing: Two Sets of Arguments Selection versus Therapy Curing Embryos, Society or Prospective Parents? Conclusions: Context Matters References 18 Who's Afraid of the Big Bad (Germline Editing) Wolf? References 19 An Ethical Pathway for Gene Editing
15 Part IV: Life and Death Issues
16 Introduction 20 The Sanctity of Life 1 Direct Objections and Side‐Effects 2 Stating the Principle of the Sanctity of Life 3 The Boundary between Life and Death 4 ‘Being Alive Is Intrinsically Valuable’ 5 ‘Being Conscious Is Intrinsically Valuable’ 6 ‘Being Human Is Intrinsically Valuable’ 7 The Concept of a ‘Life Worth Living’ 8 Is the Desire to Live the Criterion of a Worthwhile Life? 9 Length of Life 10 The ‘No Trade‐Off’ View 11 The Social Effects of Abandoning the Sanctity of Life References 21 Declaration on Euthanasia I The Value of Human Life II Euthanasia III The Meaning of Suffering for Christians and the Use of Painkillers IV Due Proportion in the Use of Remedies Conclusion
17 Killing and Letting Die 22 Active and Passive Euthanasia Reference 23 The Morality of Killing The Morality of Killing 24 Is Killing No Worse Than Letting Die? 2 3 4 25 Why Killing is Not Always Worse – and Sometimes Better – Than Letting Die I II III 26 Moral Fictions and Medical Ethics The Concept of Moral Fictions Exposing the Moral Fictions The Moral Work of Moral Fictions Abandoning the Moral Fictions
18 Newborns 27 Can a Physician Ever Justifiably Euthanize a Severely Disabled Newborn? The Case of the Ill‐fated Newborn References 28 No to Infant Euthanasia References 29 Physicians Can Justifiably Euthanize Certain Severely Impaired Neonates Discussion Conclusions References 30 You Should Not Have Let Your Baby Die 31 After‐Birth Abortion Introduction Abortion and After‐Birth Abortion The Newborn and the Fetus are Morally Equivalent The Fetus and the Newborn are Potential Persons Adoption as an Alternative to After‐Birth Abortion? Conclusions References 32 Does a Human Being Gain the Right to Live after He or She is Born? References 33 Hard Lessons Parents’ Role In Decision‐Making for Children: We Need to Clarify Harm Decisions for Adults Versus Decisions for Children: Allow Adults to Choose Treatment for Themselves even if Suboptimal Experimental Treatment: We Should Have A Lower Threshold For Allowing Access Where Patients Have No Other Options, And Allow Earlier Innovative Treatment The Role of Resources: We Need to Talk about Limited Resources The Role of the Courts: We Need a Fair, Expedient Way of Resolving Disputes Ethical Decisions versus Clinical Decisions: Allow and Support Reasonable Disagreement Medical Tourism: Allow Families to Travel Unless Illegal or Risks Significant Harm Challenging Normative and Conceptual Issues: Need for Further Ethical Analysis Reflective Equilibrium, Reasons and Evidence: Need for Humility and Transparency References
19 Brain Death 34 A Definition of Irreversible Coma Characteristics of Irreversible Coma Other Procedures Comment Summary Reference 35 The Challenge of Brain Death for the Sanctity of Life Ethic I Introduction II The Origins of the New Definition of Death III Death as the Irreversible Loss of Integrated Organic Functioning IV What do the Standard Tests for Brain Death Show? V President George W. Bush’s Council on Bioethics Enters the Debate VI The significance of irreversible unconsciousness VII The Centrality of Ethics VIII Conclusion References 36 The Philosophical Debate I Position One: There Is No Sound Biological Justification for Today’s Neurological Standard II Position Two: There Is a Sound Biological Justification for Today’s Neurological Standard References 37 An Alternative to Brain Death Some Common but Mistaken Assumptions about Death An Alternative Understanding of Death Reference
20 Advance Directives 38 Life Past Reason Autonomy 39 Dworkin on Dementia Advance Directives and Precedent Autonomy Critical and Experiential Interests: Problems with the Model The State’s Interest in Margo’s Life
21 Voluntary Euthanasia and Medically Assisted Suicide 40 The Note Statement 41 When Self‐Determination Runs Amok Self‐Determination Killing and Allowing to Die Calculating the Consequences Euthanasia and Medical Practice 42 When Abstract Moralizing Runs Amok 43 Physician‐Assisted Death and Severe, Treatment‐Resistant Depression Terminology Terminal Illness Defining and Identifying Treatment‐Resistant Depression Can Patients with Severe Major Depressive Disorder Be Competent to Request Assisted Dying? Role Responsibility Slippery‐Slope Concerns Public Policy Considerations 44 Are Concerns about Irremediableness, Vulnerability, or Competence Sufficient to Justify Excluding All Psychiatric Patients from Medical Aid in Dying? Introduction Irremediableness Vulnerability Assessing Competence The Netherlands Conclusion References
22 Part V: Resource Allocation
23 Introduction 45 In a Pandemic, Should We Save Younger Lives? YES – Peter Singer NO – Lucy Winkett YES NO YES NO 46 The Value of Life I The Moral Significance of Age 47 Bubbles under the Wallpaper Bubbles under the Wallpaper A Rights‐Based Approach? Randomness to the Rescue? Conclusion References 48 Rescuing Lives 49 Should Alcoholics Compete Equally for Liver Transplantation? Should Patients with ARESLD Receive Transplants? Objections to Proposal Reasons Patients with ARESLD Should Have a Lower Priority on Transplant Waiting Lists Should Any Alcoholics Be Considered for Transplantation? Need for Further Research Comment References
25 Introduction 50 Organ Donation and Retrieval 51 The Case for Allowing Kidney Sales References 52 Ethical Issues in the Supply and Demand of Kidneys Brief Background: The Status Quo Systems of Kidney Procurement Anti‐Market Considerations The Integrity of the Body Policy 53 The Survival Lottery
26 Part VII: Ethical Issues in Research
27 Introduction
28 Experimentation with Humans 54 Belmont Report A Boundaries between Practice and Research B Basic Ethical Principles C Applications 55 Scientific Research is a Moral Duty Do No Harm Fairness The Moral Imperative for Research Do Universal Moral Principles Deny This Claim? Is There an Enforceable Obligation to Participate in Research? Mandatory Contribution to Public Goods Benefit Sharing A New Principle of Research Ethics On Whom Does the Obligation to Participate in Research Fall? Me and My Kind Children and the Incompetent Inducements to Participate in Research Conclusion References 56 Participation in Biomedical Research is an Imperfect Moral Duty The Principle of Beneficence The Principle of Fairness Conclusions References 57 Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries Asking the Wrong Research Question Inadequate Analysis of Data from ACTG 076 and Other Sources Defining Placebo as the Standard of Care in Developing Countries Justifying Placebo‐Controlled Trials by Claiming They Are More Rapid Toward a Single International Standard of Ethical Research References 58 We’re Trying to Help Our Sickest People, Not Exploit Them 59 Pandemic EthicsThe Case for Risky Research1 The Principle of Risk Parity References
29 Experimentation with Animals 60 Duties towards Animals 61 A Utilitarian View 62 The Harmful, Nontherapeutic Use of Animals in Research is Morally Wrong Methods Some Distracting Issues not Discussed in Detail Some Objections: “Animal Experimentation is Morally Permissible Because …” A Positive, Cumulative Case in Defense of Animals References 63 The Use of Nonhuman Animals in Biomedical Research Arguments Against the Use of Animals in Scientific Research Ethics of Animal Research The Moral Status of Animals Rejecting the Extremes of the Spectrum Equal Consideration of Equal Interests Human Ability to Challenge Nature and Suffering is Unique Utilitarian Considerations What About Marginal Cases? Human Relationships Are Unique: The Human Family Assuming Responsibility and Stewardship Conclusion References 64 Ethical Issues When Modelling Brain Disorders in Non‐Human Primates Introduction Trends in Disease Modelling Post‐CRISPR Methodological Starting Point Conclusion References
30 Academic Freedom and Research 65 On Liberty Chapter II: Of The Liberty of Thought and Discussion 66 Should Some Knowledge Be Forbidden? 1 Introduction 2 A Case Study: The Right to Equality versus the Right to Freedom of Research 3 Past Precedents 4 The Third Precedent 5 Conclusion References 67 Academic Freedom and RaceYou Ought Not to Believe What You Think May Be True 1 An Intelligible Hypothesis 2 Not Believing What You Think May Be True 3 Not Discussing What Some Think To Be True 4 Not Using Science to Investigate the Truth 5 From Advice to Sanctions 6 The Dead Hand of Ignorance 7 The Appeal to Paradigms of Irrationality 8 Compromises 9 The Bright Light of Knowledge 10 Armageddon 11 Some History and Rhetoric References Further Reading
31 Part VIII: Public Health Issues
32 Introduction 68 Ethics and Infectious Disease I Distribution of Research Resources II The Ethical Importance of Infectious Disease III Why the Neglect? Conclusion 69 XDR‐TB in South Africa The Threat to Regional and Global Health The True Extent of the Problem Factors Fuelling the Outbreak Factors That Could Undermine Efforts to Tackle the Outbreak Is There a Role for Involuntary Detention? Conclusion References 70 Clinical Ethics During the Covid‐19 PandemicMissing the Trees for the Forest Introduction Clinical Ethics Challenges Arising in the Care of Covid‐19 Patients Clinical Ethics Considerations in the Care of “Non‐Covid‐19” Patients Moral Distress of Healthcare Providers References 71 The Moral Obligation to be Vaccinated:Utilitarianism, Contractualism, and Collective Easy Rescue Introduction From Collective to Individual Responsibility The Utilitarian Approach: Group Beneficence and Imperceptible Contributions The Deontological Approach Duty of Easy Rescue and Fairness: A Further Argument for an Individual Moral Obligation to be Vaccinated Conclusion References 72 Taking Responsibility for Responsibility Responsibility for Health The Social Determinants of Health Taking Responsibility for Responsibility References
33 Part IX: Ethical Issues in the Practice of Healthcare
34 Introduction
35 When do Doctors have a Duty to Treat? 73 What Healthcare Professionals Owe Us Introduction What Healthcare Professionals Owe Us Neoliberalism and the Fetishisation of ‘Efficiency’ Implications for Healthcare Professionals’ Obligations Conclusion References 74 Conscientious Objection in Health Care Introduction What is Conscientious Objection? Assessing Approaches to Conscientious Objection in Health Care Conscientious Objection vs. Obstruction Conclusion 75 Conscientious Objection in Medicine Introduction Conscience – What Is It, and Does It Matter? Conscience Claims – Should They be Reasonable and Genuine? Conscience and Professionalism Voluntariness and Monopoly Equality of Opportunity Diversity Equal Citizenship Peaceful Co‐existence Conclusion References
36 Confidentiality 76 Confidentiality in Medicine Two Aspects of Medical Confidentiality The Role of Confidentiality in Medicine Possible Solutions to the Confidentiality Problem Afterthought: Confidentiality and Indiscretion Conclusion 77 A Defense of Unqualified Medical Confidentiality The Case of the Infected Spouse Clearing the Ground: What Professional Obligations Are Not The Concept of a Professional Obligation The Duty to Diminish Risks to Third Parties A Defense of Unqualified Confidentiality Concluding Remarks References
37 Truth-Telling 78 On a Supposed Right to Lie from Altruistic Motives 79 Should Doctors Tell the Truth? 80 On Telling Patients the Truth
38 Informed Consent and Patient Autonomy 81 On Liberty 82 From Schloendorff v. NewYork Hospital 83 Informed Consent The Historical Foundations of Informed Consent The Concept of Informed Consent Current Challenges to Informed Consent Conclusion 84 The Doctor–Patient Relationship in Different Cultures “Physicians Treat Patients Badly” Similarities and Differences Conceptions of Autonomy: East and West Truth‐Telling 85 Transgender Children and the Right to Transition 1 Introduction 2 Gender Dysphoria and Treatment for Transgender Youth 3 Psychological Harm and Epistemic Barriers 4 The Physical Risks 5 Justifying Intervention 6 Spreading the Word and the Role of Schools 7 Objections and How to Answer Them 8 Review and Concluding Remarks References 86 Amputees by Choice 87 Rational Desires and the Limitation of Life‐Sustaining Treatment The President’s Commission Report Part I.What is Autonomy? Part III. Limitations of Treatment of Incompetent Patients Limitation of Treatment of Competent Patients Two Objections Conclusion
40 Introduction 88 Valuing Disability, Causing Disability I The Bad‐Difference/Mere‐Difference Distinction II A Problem for the Mere‐Difference View? III Causing a Nondisabled Person to Become Disabled IV Causing a Nondisabled Person to Become Disabled Without Transition Costs V Causing a Disabled Person to Exist Instead of a Nondisabled Person VI Causing and “Curing” VII Conclusion 89 Is Disability Mere Difference? Introduction Disability and Quality of Life Disability and Society The Indirect Strategy Conclusion References 90 Prenatal Diagnosis and Selective Abortion Contrasting Medical and Social Paradigms of Disability Implications for People with Disabilities Implications for Family Life Implications for Professional Practice References 91 Down Syndrome Screening Isn’t about Public Health 92 I Would’ve Aborted a Fetus with Down Syndrome
42 Introduction 93 Neuroethics The Ethics of Neuroscience Memory Modification and Enhancement References 94 Engineering Love 95 Unrequited Love Hurts Unrequited Love Hurts Two Arguments Against the Medicalization of Unrequited Love Conclusions Acknowledgment 96 Stimulating Brains, Altering Minds Empirical Evidence: Benefits and Risks A Case Study Autonomy and Identity Conclusion References 97 Authenticity or Autonomy? When Deep Brain Stimulation Causes a Dilemma Introduction: Feelings of Authenticity and Alienation under Deep Brain Stimulation A Patient’s Dilemma: Choosing between Mental Competence and Well‐Being Authenticity or Autonomy? A Philosophical Reinterpretation Is ‘Authenticity’ the New ‘Autonomy’ in Neuroethics? Conclusions References 98 On the Necessity of Ethical Guidelines for Novel Neurotechnologies Novel Neurotechnologies and Their Future Use Ethical and Societal Issues Raised by Novel Neurotechnologies Developing Ethical Principles for Neurotechnologies The Importance of Novel Neurotechnology for the Progress of Humankind References
43 Index
