Bioethics

1 Cover

2 Series Page

3 Title Page

4 Copyright Page

5 Acknowledgments

6 Introduction

7 Part I: Abortion

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