Bioethics

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The new edition of the classic collection of key readings in bioethics, fully updated to reflect the latest developments and main issues in the field
 
For more than two decades,
has been widely regarded as the definitive single-volume compendium of seminal readings on both traditional and cutting-edge ethical issues in biology and medicine. Acclaimed for its scope and depth of coverage, this landmark work brings together compelling writings by internationally-renowned bioethicist to help readers develop a thorough understanding of the central ideas, critical issues, and current debate in the field.
Now fully revised and updated, the fourth edition contains a wealth of new content on ethical questions and controversies related to the COVID-19 pandemic, advances in CRISPR gene editing technology, physician-assisted death, public health and vaccinations, transgender children, medical aid in dying, the morality of ending the lives of newborns, and much more. Throughout the new edition, carefully selected essays explore a wide range of topics and offer diverse perspectives that underscore the interdisciplinary nature of bioethical study. Edited by two of the field’s most respected scholars,  Covers an unparalleled range of thematically-organized topics in a single volume Discusses recent high-profile cases, debates, and ethical issues Features three brand-new sections: Conscientious Objection, Academic Freedom and Research, and Disability Contains new essays on topics such as brain death, life and death decisions for the critically ill, experiments on humans and animals, neuroethics, and the use of drugs to ease the pain of unrequited love Includes a detailed index that allows the reader to easily find terms and topics of interest
 remains a must-have resource for all students, lecturers, and researchers studying the ethical implications of the health-related life sciences, and an invaluable reference for doctors, nurses, and other professionals working in health care and the biomedical sciences.

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The assumption that inheritable genetic modifications or other human enhancement technologies would lead to two distinct and separate species should also be questioned. It seems much more likely that there would be a continuum of differently modified or enhanced individuals, which would overlap with the continuum of as‐yet unenhanced humans. The scenario in which ‘the enhanced’ form a pact and then attack ‘the naturals’ makes for exciting science fiction, but is not necessarily the most plausible outcome. Even today, the segment containing the tallest ninety percent of the population could, in principle, get together and kill or enslave the shorter decile. That this does not happen suggests that a well‐organized society can hold together even if it contains many possible coalitions of people sharing some attribute such that, if they ganged up, they would be capable of exterminating the rest.

To note that the extreme case of a war between humans and posthumans is not the most likely scenario is not to say that there are no legitimate social concerns about the steps that may take us closer to posthumanity. Inequity, discrimination, and stigmatization – against, or on behalf of, modified people – could become serious issues. Transhumanists would argue that these (potential) social problems call for social remedies. One example of how contemporary technology can change important aspects of someone’s identity is sex reassignment. The experiences of transsexuals show that Western culture still has work to do in becoming more accepting of diversity. This is a task that we can begin to tackle today by fostering a climate of tolerance and acceptance towards those who are different from ourselves. Painting alarmist pictures of the threat from future technologically modified people, or hurling preemptive condemnations of their necessarily debased nature, is not the best way to go about it.

What about the hypothetical case in which someone intends to create, or turn themselves into, a being of such radically enhanced capacities that a single one or a small group of such individuals would be capable of taking over the planet? This is clearly not a situation that is likely to arise in the imminent future, but one can imagine that, perhaps in a few decades, the prospective creation of superintelligent machines could raise this kind of concern. The would‐be creator of a new life form with such surpassing capabilities would have an obligation to ensure that the proposed being is free from psychopathic tendencies and, more generally, that it has humane inclinations. For example, a future artificial intelligence programmer should be required to make a strong case that launching a purportedly human‐friendly superintelligence would be safer than the alternative. Again, however, this (currently) science fiction scenario must be clearly distinguished from our present situation and our more immediate concern with taking effective steps towards incrementally improving human capacities and health‐span.

Is Human Dignity Incompatible with Posthuman Dignity?

Human dignity is sometimes invoked as a polemical substitute for clear ideas. This is not to say that there are no important moral issues relating to dignity, but it does mean that there is a need to define what one has in mind when one uses the term. Here, we shall consider two different senses of dignity:

1 Dignity as moral status, in particular the inalienable right to be treated with a basic level of respect.

2 Dignity as the quality of being worthy or honorable; worthiness, worth, nobleness, excellence. 7

On both these definitions, dignity is something that a posthuman could possess. Francis Fukuyama, however, seems to deny this and warns that giving up on the idea that dignity is unique to human beings – defined as those possessing a mysterious essential human quality he calls ‘Factor X’ 8 – would invite disaster:

Denial of the concept of human dignity – that is, of the idea that there is something unique about the human race that entitles every member of the species to a higher moral status than the rest of the natural world – leads us down a very perilous path. We may be compelled ultimately to take this path, but we should do so only with our eyes open. Nietzsche is a much better guide to what lies down that road than the legions of bioethicists and casual academic Darwinians that today are prone to give us moral advice on this subject. 9

What appears to worry Fukuyama is that introducing new kinds of enhanced person into the world might cause some individuals (perhaps infants, or the mentally handicapped, or unenhanced humans in general) to lose some of the moral status that they currently possess, and that a fundamental precondition of liberal democracy, the principle of equal dignity for all, would be destroyed.

The underlying intuition seems to be that instead of the famed ‘expanding moral circle’, what we have is more like an oval, whose shape we can change but whose area must remain constant. Thankfully, this purported conservation law of moral recognition lacks empirical support. The set of individuals accorded full moral status by Western societies has actually increased, to include men without property or noble descent, women, and non‐white peoples. It would seem feasible to extend this set further to include future posthumans, or, for that matter, some of the higher primates or human–animal chimaeras, should such be created – and to do so without causing any compensating shrinkage in another direction. (The moral status of problematic borderline cases, such as foetuses or late‐stage Alzheimer patients, or the brain‐dead, should perhaps be decided separately from the issue of technologically modified humans or novel artificial life forms.) Our own role in this process need not be that of passive bystanders. We can work to create more inclusive social structures that accord appropriate moral recognition and legal rights to all who need them, be they male or female, black or white, flesh or silicon.

Dignity in the second sense, as referring to a special excellence or moral worthiness, is something that current human beings possess to widely differing degrees. Some excel far more than others do. Some are morally admirable; others are base and vicious. There is no reason for supposing that posthuman beings could not also have dignity in this second sense. They may even be able to attain higher levels of moral and other excellence than any of us humans. The fictional brave new worlders, who were subhuman rather than posthuman, would have scored low on this kind of dignity, and partly for that reason they would be awful role models for us to emulate. But surely we can create more uplifting and appealing visions of what we may aspire to become. There may be some who would transform themselves into degraded posthumans – but then some people today do not live very worthy human lives. This is regrettable, but the fact that some people make bad choices is not generally a sufficient ground for rescinding people’s right to choose. And legitimate countermeasures are available: education, encouragement, persuasion, social and cultural reform. These, not a blanket prohibition of all posthuman ways of being, are the measures to which those bothered by the prospect of debased posthumans should resort. A liberal democracy should normally permit incursions into morphological and reproductive freedoms only in cases where somebody is abusing these freedoms to harm another person.

The principle that parents should have broad discretion to decide on genetic enhancements for their children has been attacked on the grounds that this form of reproductive freedom would constitute a kind of parental tyranny that would undermine the child’s dignity and capacity for autonomous choice; for instance, by Hans Jonas:

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