This Is Bioethics

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Udo Schüklenk. This Is Bioethics

Table of Contents

Guide

Pages

THIS IS PHILOSOPHY

THIS IS BIOETHICS: AN INTRODUCTION

ABOUT THE AUTHORS

PREFACE AND ACKNOWLEDGMENTS

1 INTRODUCTION TO ETHICS

1.1 Religion and Ethics

1.2 Law and Ethics

1.2.1 Legal and Moral Rights

1.3 Ethical Relativism

1.4 Why be Ethical?

Questions

Website Links

2 ETHICAL THEORY

2.1 Virtue Ethics

2.2 Feminist Ethics

2.3 Utilitarian Ethics

2.4 Rule‐Based Ethics

2.5 ‘Georgetown Mantra’

2.5.1 Non‐Maleficence

2.5.2 Beneficence

2.5.3 Respect for Autonomy

2.5.4 Justice

2.6 Contract Theory

Questions

Website Links

3 BASICS OF BIOETHICS

3.1 History and Scope of Bioethics

3.2 Who Can Claim to be a Bioethicist?

3.3 Organizations and Journals

3.4 Policy Advice

3.5 Common Arguments in Bioethics

3.6 Playing God

3.7 Unnatural and Abnormal

3.8 Dignity

3.9 Nazi Arguments in Bioethics

3.10 Slippery‐Slope Arguments

3.11 Treating Someone as a Means

Questions

Website Links

4 MORAL STANDING: WHAT MATTERS

4.1 Moral Standing and Moral Status

4.2 Species Membership

4.3 Sentientism

4.4 Capabilities

4.5 Biocentrism

4.6 Holism

4.7 The Future

Questions

Website Links

5 BEGINNING OF LIFE. 5.1 Introduction

5.2 Ethical Arguments about Reproductive Rights and Responsibilities. 5.2.1 Reproductive Autonomy and the Right to Reproduce

5.2.2 Consequentialism and Procreative Beneficence

5.2.3 ‘Do No Harm’ and the Person‐Affecting Restriction

5.2.4 The Non‐Identity Problem

5.2.5 Virtue Ethics

5.2.6 Feminist Bioethics

5.3 Issues in Assisted Reproduction

5.3.1 Genetic Relatedness: How Important Is It?

5.3.2 Issues of Selection in Reproduction

5.4 Embryos, Fetuses and Abortion

5.4.1 Fetuses

5.4.2 Judith Jarvis Thomson and the Violinist

5.4.3 The ‘Future‐Like‐Ours’ Argument

5.4.4 The Impairment Argument Against Abortion

5.4.5 Women’s Character

5.4.6 Abortion and Fetal Transplants

5.4.7 Savior Siblings

5.4.8 Infants and Infanticide

5.4.9 Severely Disabled Infants

5.4.10 Acts and Omissions

5.4.11 Newborn Screening

Questions

Website Links

6 HEALTH CARE PROFESSIONAL‐PATIENT RELATIONSHIP

6.1 Informed Consent

6.2 Paternalism

6.3 Deciding for Others

6.3.1 Deciding for Others: Advance Directives

6.3.2 Deciding for Others: Patients Who Never Had Capacity

6.3.3 Deciding for Others: Incapacitated Patients without Advance Directives

6.4 Truth Telling

6.5 Confidentiality

6.6 Conscience Matters

6.7 Duty to Treat

Questions

Website Links

7 RESEARCH ETHICS

7.1 Elements of Ethical Research

7.2 Clinical Research: The Basics

7.3 Animal Experiments

7.4 Informed Consent

7.5 Trial‐Related Injuries

7.6 Benefits

7.7 Benefiting from Evil

7.8 Ethical Issues Affecting Clinical Research Involving the Catastrophically Ill

Question

7.9 Developing World. 7.9.1 Utility of Research Question

7.9.2 Standards of Care

Questions

Website Links

8 GENETICS. 8.1 Genetics and Genomics. 8.1.1 Introduction – Genetics, Genomics and Bioethics: Is Genetics Special?

8.1.2 Issues in Clinical Genetics: Genetic Testing and Counseling

8.1.2.1 Non‐Directiveness

8.1.2.2 Children

8.1.2.3 Genetic Screening

8.1.2.4 Direct‐to‐Consumer Testing

8.2 Gene Therapy: Somatic and Germline

8.2.1 Is There a Need for Germline Gene Therapy?

8.2.2 Risks and Irreversible Consequences

8.2.3 Future Generations and Lack of Consent

8.2.4 The Iconic Significance of the Germline

8.2.5 Gene Editing

8.3 Genomic Research. 8.3.1 The Human Genome Project

8.3.2 Biobanks

8.3.3 Feedback of Findings

8.4 Personalized Medicine

8.4.1 Human Cloning – Therapeutic Cloning

8.4.2 Reproductive Cloning

8.5 Other Issues in Genetics and Genomics

Questions

Website Links

9 ENHANCEMENT. 9.1 Introduction

9.2 Enhancement and Superhumans

9.3 The Meaning of Enhancement

9.3.1 Enhancement and Improvement

9.4 Alternatives to the ‘Improvement’ Account. 9.4.1 Therapy–Enhancement Distinction

9.4.2 Species‐Normal Functioning

9.4.2.1 Quantitative Account of Enhancement

9.4.3 Enhancement: The Umbrella View

9.5 Ethical Issues

9.5.1 Is Enhancement Necessary?

9.5.2 Enhancement is Inevitable

9.5.3 A Compromise Position?

9.5.4 Autonomy

9.5.5 The Habermasian Concern

9.6 Social Inequalities and Social Justice

9.6.1 Consequences for the Future of Humans

9.7 Moral Enhancement

9.8 Cognitive Enhancement

Questions

Website Links

10 MENTAL HEALTH

10.1 Mental Illness

10.2 Diagnosis

10.3 Autonomy and Capacity

10.4 Least Restrictive Option

10.5 Best Interests

10.6 Treatment and Detention

10.6.1 Detention for the Good of the Service User

10.6.2 Detention for the Protection of Others

Questions

Website Links

11 END OF LIFE

11.1 Do You Want to Live Forever?

11.2 Terminology

11.3 Case for the Decriminalization of Assisted Dying

11.4 The Case Against the Decriminalization of Assisted Dying

11.4.1 In‐Principle Reasons Against Assistance in Dying

11.4.2 Slippery‐Slope Reasons Against Assistance in Dying

11.4.2.1 Pereira v. Downie

11.5 Violation of Health Care Professional Values and Traditions

Questions

Website Links

12 JUSTICE AND HEALTH CARE. 12.1 Introduction

12.2 Types of Justice. 12.2.1 Justice and Discrimination

12.2.2 Justice in Distribution

12.2.3 Procedural Justice

12.2.4 Justice and Exploitation

12.3 The Concept of Justice and its Connection With Equality

12.3.1 Justice and Equality: Equal Treatment and Equal Consideration

12.3.2 Justice, ‘Deserving’, and Personal Responsibility

12.3.3 Justice is Giving People What They Need

12.4 Theories of Justice. 12.4.1 Utility and Well‐Being

12.4.2 Respect for Persons: Rights to Health and Health Care

12.4.3 John Rawls and Norman Daniels

12.4.4 The Capabilities Approach

12.5 Special Cases

12.5.1 Personalized Medicine and Justice

Questions

Website Links

13 POPULATION HEALTH. 13.1 Global Health Issues

13.2 Health Aid Obligations

13.2.1 Allocation Priorities

13.3 Population Health and Public Health

13.4 Communicable Disease Control Challenges

13.4.1 Take One: Michael Johnson is Not Culpable

13.4.2 Take Two: Michael Johnson is Culpable

13.4.3 Take Three: Shared Responsibility

13.4.4 Deterrence

13.4.5 Private Acts and Social Consequences

13.4.6 Novel Coronavirus Pandemic

13.4.7 Vaccines

13.5 Public Health Promotion

13.5.1 Communicable Disease: HIV

13.5.2 Non‐Communicable Disease: Obesity

Questions

Note

Website Links

BIBLIOGRAPHY. Chapter 1: Introduction to Ethics

Chapter 2: Ethical Theory

Chapter 3: Basics of Bioethics

Chapter 4: Moral Standing: What Matters

Chapter 5: Beginning of Life

Chapter 6: Health Care Professional Patient Relationship

Chapter 7: Research Ethics

Chapter 8: Genetics

Chapter 9: Enhancement

Chapter 10: Mental Health

Chapter 11: End‐of‐Life Issues

Chapter 12: Justice

Chapter 13: Population Health

FURTHER READING. Chapter 1: Introduction to Ethics

Chapter 2: Ethical Theory

Chapter 3: Basics of Bioethics. History and Scope

Fallacious Arguments

Chapter 4: Moral Standing: What Matters

Chapter 5: Beginning of Life

Chapter 6: Health Care Professional Patient Relationship

Chapter 7: Research Ethics

Chapter 8: Genetics

Chapter 9: Enhancement

Chapter 10: Mental Health

Chapter 11: End‐of‐Life Issues

Chapter 12: Justice

Chapter 13: Population Health

INDEX

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Series editor: Steven D. Hales

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1.33 What can be said with regard to these claims? For starters, it might well be true that we have no ethical proof comparable to the kind of proof you would come across in logic or physics. However, consider this: Even in the sciences, scientific paradigms (i.e. scientific truths that have been taken for granted, sometimes for centuries) are replaced radically or evolutionarily by other paradigms. After all, that is the story of science! Scientific truth then seems a more relative matter than most people are willing to concede. However, demonstrably progress is made. Change usually occurs when the old paradigm can be proven faulty and a new paradigm is better able to explain and predict the phenomenon in question. There is arguably no equivalent to this in ethics. However, progress in ethics undoubtedly occurs, too. Today we pretty much agree that slavery is unethical, and we even agree by and large on the reasons for this conclusion. In some ways progress in ethics is not dissimilar to progress that occurs in other Humanities’ disciplines. For instance, do we have incontrovertible proof of the causes that ultimately led to Hitler’s ascendancy to Chancellor in the dying days of the Republic of Weimar? Historians speak much to the causes, but truth be told, their idea of causation is very different to that of a physicist. And yet, we will still find most historians agreeing on some of the fundamental causes that led to Hitler’s coming to power. We encounter similar situations with regard to research conducted by researchers working in other disciplines, such as anthropologists, geographers, and even lawyers, yet the charge that they are unable to prove their conclusions objectively ‘right’ isn’t usually leveled against them. Perhaps progress should be measured taking into account the peculiarities and idiosyncrasies of particular disciplines.

1.34 Gordon Graham, a Scottish philosopher and ordained Anglican priest, seems to have hit the nail on its head when he writes, ‘Provided we accept that our conclusions will in all likelihood fall short of absolute proof or incontrovertible demonstration, the most plausible and intelligent approach to moral questions and disagreements is just to see how far clear and cogent reasoning – assembly of the relevant facts, analysis of the relevant concepts and adherence to the rules of logic – can take us’ (Graham 2004, 13). He goes on to say that a point of view that he describes as ‘soft objectivism’ holds ‘that for any moral matter reason may be able to point us to a resolution that (…) is clearer and more cogent than any other and which it would be logically possible but unreasonable to dispute’ (14).

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