Bioethics

Many of the essays we have selected reflect the times in which they were written. Since bioethics often comments on developments in fast‐moving areas of medicine and the biological sciences, the factual content of articles in bioethics can become obsolete quite rapidly. In preparing this 4th edition, we have taken the opportunity to cover some new issues and to include some more recent writings. Part X, on Disability, is new, as are the section in Part VII on Academic Freedom and Research and the essays in Part IX on Doctors’ Duty to Treat. There are new articles in almost every other section as well, on gene editing, the morality of ending the lives of newborns, brain death, the eligibility of mentally ill patients for assisted dying and experiments on humans and on animals, and on public health.

Some authors of articles that have become dated in their facts have kindly updated them especially for this edition. An article may, however, be dated in its facts but make ethical points that are still valid, or worth considering, so we have not excluded older articles for this reason.

Other articles are dated in a different way. During the past few decades we have become more sensitive about the ways in which our language may exclude women, or reflect our prejudices regarding race or sexuality. We see no merit in trying to disguise past practices on such matters (although we have made minor changes to some of the older writings in this anthology, in order to bring the terminology used in line with contemporary usage), so we have not excluded otherwise valuable works in bioethics on these grounds. If they are jarring to the modern reader, that may be a salutary reminder of the extent to which we all are subject to the conventions and prejudices of our times.

Helga Kuhse was a co‐editor of the first three editions of this anthology. She has now retired from academic work, and so decided not to join us in co‐editing this edition. Nevertheless, her influence remains present, in the articles carried over from earlier editions. We thank her for helping to establish Bioethics: An Anthology as a comprehensive and widely used collection of the best articles in the field.

Katherine Carr did a stellar job as the copy‐editor of this volume. The number of errors she spotted in previously published peer‐reviewed (and presumably copy‐edited and proof‐read) journal articles is extraordinary.

Last, but not least, we thank two Graduate Students in the Queen’s University Department of Philosophy who assisted us in sourcing possible materials for inclusion in the 3rd edition of this text (Nikoo Najand) and in this current edition (Chris Zajner).

1 1See Van Rensselaer Potter, Bioethics: Bridge to the Future (Englewood Cliffs, NJ: Prentice‐Hall, 1971).

2 2Fritz Jahr, Bio‐Ethik: Eine Umschau über die ethischen Beziehungen des Menschen zu Tier und Pflanze. Kosmos. Handweiser für Naturfreunde, 1927, 24:2–4.

3 3The Karamazov Brothers, trans. Ignat Avsey (Oxford: Oxford University Press, 1994), vol. I, part 2, bk. 5, ch. 4. First published in 1879.

The view that human life has special value is deeply rooted in most people’s thinking and no serious ethical theory allows a person to be killed without strong moral justification. Abortions terminate the lives of fetuses. Given that these fetuses are human, and of course innocent of any wrongdoing, it is easy to see why some people consider abortion to be unjustifiable homicide. In some respects fetuses are like persons; but in other respects they are very different. Therefore we need to ask whether they have the same moral status as those human beings we think of as persons.

In the first article in this Part, Michael Tooley provides a challenge to the view that fetuses are persons. In his 1972 landmark article “Abortion and Infanticide,” he seeks to articulate and defend an ethically significant criterion that confers personhood and a right to life. To have a right to life, Tooley argues, an entity needs to possess a concept of self, that is, be “capable of desiring to continue existing as a subject of experiences and other mental states.” An entity that has this capability is a person, whereas one that lacks it is not. This view has implications that enable us to defend abortion, but also challenge the moral views of most people who accept abortion; for on this view neither fetuses nor newborn infants are persons, whereas some nonhuman animals, such as chimpanzees and elephants, do seem to be persons.

Tooley thus holds that the potential to become a person is not sufficient to give fetuses a right to life. Here it is important to take a closer look at the notions of potentiality and capacity. Sleeping persons – unable to exercise the capacity to desire their own continued existence while asleep – are, according to Tooley, still persons because they possess the relevant capacity in a sense in which fetuses do not. A person who is asleep was self‐conscious before she went to sleep and will be the same self‐conscious person when she wakes up; a fetus, on the other hand, has never been awake and self‐conscious.

Tooley takes the issue of personhood to be central. Judith Jarvis Thomson, in “A Defense of Abortion” takes a very different approach. For the purposes of her argument, Thomson accepts that the fetus is a person, but argues that even if one grants this premise, the conclusion that every person has a right to life – in the sense that would make abortion wrong – does not follow. She then uses an ingenious analogy to support her view that one person’s right to life does not always outweigh another person’s rights to something less than life. This general view applies, Thomson holds, in the case of pregnancy and abortion. A woman has a right to control her body, and a fetus only has the right to use a woman’s body if she has implicitly given it that right. This would be the case if the woman is responsible, in some sense of the term, for its presence in her body. In many cases – certainly in the case of a pregnancy resulting from rape, and arguably, if more doubtfully, when contraception has failed – the woman bears little or no responsibility for the presence of the fetus in her body and would thus, according to Thomson, be justified in having an abortion. She would not be killing the fetus unjustly.

Thomson reminds us that any complete assessment of the ethics of abortion must focus not only on the purported rights or interests of fetuses, but also on the rights of women. But her argument has been criticized as incomplete. One of the strongest objections focuses on her narrow understanding of the right to life. It has, for example, been argued that a right to life, properly understood, also entails the provision of positive aid. If this is correct, then Thomson’s argument on abortion is inconclusive.

In “The Wrong of Abortion” Patrick Lee and Robert P. George argue that the choice to have an abortion is immoral, in an objective sense. They begin by noting three features of human embryos: their distinctiveness from sperm and egg, their humanness, and their completeness or wholeness. In their view, it follows from this that during an abortion a human being is killed. This human being is at an earlier stage of development than you or I, but is a member of our species nonetheless.

Lee and George reject Tooley’s personhood argument. In their view we are not consciousnesses that inhabit human bodies, rather we are continuing living bodily entities, some of which may take years to develop the capacity to reason. Contra Tooley, they think that the right to life belongs to any being with a rational nature, by which they mean, not that the being is actually capable of reasoning, but that it is a being with “the internal resources and active disposition” to develop the higher mental functions that are typically developed by human beings. This implies, of course, that whole human beings have that right, from the moment of conception. They reject Thomson’s argument by suggesting that while an unwanted pregnancy may lead to significant inconvenience, this inconvenience pales into insignificance considering that abortion leads to the preventable death of a human being.