Bioethics

Acknowledgments xiii

Introduction 1

Part I Abortion 9

Introduction 11

1 Abortion and Infanticide 15
Michael Tooley

2 A Defense of Abortion 31
Judith Jarvis Thomson

3 The Wrong of Abortion 42
Patrick Lee and Robert P. George

4 Why Abortion is Immoral 54
Don Marquis

Part II Issues in Reproduction 67

Introduction 69

Assisted Reproduction 73

5 The McCaughey Septuplets: God's Will or Human Choice? 75
Gregory Pence

6 The Meaning of Synthetic Gametes for Gay and Lesbian People and Bioethics Too 78
Timothy F. Murphy

7 Rights, Interests, and Possible People 85
Derek Parfit

Prenatal Screening, Sex Selection, and Cloning 91

8 Genetics and Reproductive Risk: Can Having Children Be Immoral? 93
Laura M. Purdy

9 Sex Selection and Preimplantation Genetic Diagnosis 101
The Ethics Committee of the American Society of Reproductive Medicine

10 Sex Selection and Preimplantation Diagnosis: A Response to the Ethics Committee of the American Society of Reproductive Medicine 107
Julian Savulescu and Edgar Dahl

11 Why We Should Not Permit Embryos to Be Selected as Tissue Donors 110
David King

12 The Moral Status of Human Cloning: Neo-Lockean Persons versus Human Embryos 115
Michael Tooley

Part III Genetic Manipulation 133

Introduction 135

13 Questions about Some Uses of Genetic Engineering 139
Jonathan Glover

14 The Moral Significance of the Therapy-Enhancement Distinction in Human Genetics 151
David B. Resnik

15 In Defense of Posthuman Dignity 162
Nick Bostrom

16 Statement on NIH Funding of Research Using Gene-Editing Technologies in Human Embryos 170
Francis S. Collins

17 Genome Editing and Assisted Reproduction: Curing Embryos, Society or Prospective Parents? 172
Giulia Cavaliere

18 Who's Afraid of the Big Bad (Germline Editing) Wolf? 185
R. Alta Charo

19 An Ethical Pathway for Gene Editing 191
Julian Savulescu and Peter Singer

Part IV Life and Death Issues 195

Introduction 197

20 The Sanctity of Life 207
Jonathan Glover

21 Declaration on Euthanasia 218
Sacred Congregation for the Doctrine of the Faith

Killing and Letting Die 223

22 Active and Passive Euthanasia 225
James Rachels

23 The Morality of Killing: A Traditional View 230
Germain Grisez and Joseph M. Boyle, Jr.

24 Is Killing No Worse Than Letting Die? 235
Winston Nesbitt

25 Why Killing is Not Always Worse - and Sometimes Better - Than Letting Die 240
Helga Kuhse

26 Moral Fictions and Medical Ethics 244
Franklin G. Miller, Robert D. Truog, and Dan W. Brock

Newborns 255

27 Can a Physician Ever Justifiably Euthanize a Severely Disabled Newborn? 257
Robert M. Sade

28 No to Infant Euthanasia 259
Gilbert Meilaender

29 Physicians Can Justifiably Euthanize Certain Severely Impaired Neonates 262
Udo Schuklenk

30 You Should Not Have Let Your Baby Die 266
Gary Comstock

31 After-Birth Abortion: Why Should the Baby Live? 269
Alberto Giubilini and Francesca Minerva

32 Does a Human Being Gain the Right to Live after He or She is Born? 275
Christopher Kaczor

33 Hard Lessons: Learning from the Charlie Gard Case 280
Dominic Wilkinson and Julian Savulescu

Brain Death 289

34 A Definition of Irreversible Coma 291
Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death

35 The Challenge of Brain Death for the Sanctity of Life Ethic 296
Peter Singer

36 The Philosophical Debate 308
The President's Council on Bioethics

37 An Alternative to Brain Death 318
Jeff McMahan

Advance Directives 323

38 Life Past Reason 325
Ronald Dworkin

39 Dworkin on Dementia: Elegant Theory, Questionable Policy 333
Rebecca Dresser

Voluntary Euthanasia and Medically Assisted Suicide 343

40 The Note 345
Chris Hill

41 When Self-Determination Runs Amok 350
Daniel Callahan

42 When Abstract Moralizing Runs Amok 356
John Lachs

43 Physician-Assisted Death and Severe, Treatment-Resistant Depression 361
Bonnie Steinbock

44 Are Concerns about Irremediableness, Vulnerability, or Competence Sufficient to Justify Excluding All Psychiatric Patients from Medical Aid in Dying? 378
William Rooney, Udo Schuklenk, and Suzanne van de Vathorst

Part V Resource Allocation 393

Introduction 395

45 In a Pandemic, Should We Save Younger Lives? 399
Peter Singer and Lucy Winkett

46 The Value of Life 403
John Harris

47 Bubbles under the Wallpaper: Healthcare Rationing and Discrimination 413
Nick Beckstead and Toby Ord

48 Rescuing Lives: Can't We Count? 420
Paul T. Menzel

49 Should Alcoholics Compete Equally for Liver Transplantation? 423
Alvin H. Moss and Mark Siegler

Part VI Obtaining Organs 431

Introduction 433

50 Organ Donation and Retrieval: Whose Body is it Anyway? 435
Eike-Henner W. Kluge

51 The Case for Allowing Kidney Sales 439
Janet Radcliffe-Richards, A. S. Daar, R. D. Guttmann, R. Hoffenberg, I. Kennedy, M. Lock, R. A. Sells and N. Tilney and for the International Forum Transplant Ethics

52 Ethical Issues in the Supply and Demand of Kidneys 443
Debra Satz

53 The Survival Lottery 456
John Harris

Part VII Ethical Issues in Research 463

Introduction 465

Experimentation with Humans 473

54 Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research 475
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research

55 Scientific Research is a Moral Duty 483
John Harris

56 Participation in Biomedical Research is an Imperfect Moral Duty: A Response to John Harris 495
Sandra Shapshay and Kenneth D. Pimple

57 Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries 501
Peter Lurie and Sidney M. Wolfe

58 We're Trying to Help Our Sickest People, Not Exploit Them 507
Danstan Bagenda and Philippa Musoke-Mudido

59 Pandemic Ethics: The Case for Risky Research 510
Peter Singer and Richard Yetter Chappell

Experimentation with Animals 515

60 Duties towards Animals 517
Immanuel Kant

61 A Utilitarian View 519
Jeremy Bentham

62 The Harmful, Nontherapeutic Use of Animals in Research is Morally Wrong 521
Nathan Nobis

63 The Use of Nonhuman Animals in Biomedical Research 535
Dario L. Ringach

64 Ethical Issues When Modelling Brain Disorders in Non-Human Primates 550
Carolyn P. Neuhaus

Academic Freedom and Research 559

65 On Liberty 561
John Stuart Mill

66 Should Some Knowledge Be Forbidden?: The Case of Cognitive Differences Research 566
Janet A. Kourany

67 Academic Freedom and Race: You Ought Not to Believe What You Think May Be True 575
James R. Flynn

Part VIII Public Health Issues 585

Introduction 587

68 Ethics and Infectious Disease 591
Michael J. Selgelid

69 XDR-TB in South Africa: No Time for Denial or Complacency 602
Jerome Amir Singh, Ross Upshur, and Nesri Padayatchi

70 Clinical Ethics During the Covid-19 Pandemic: Missing the Trees for the Forest 612
Vijayaprasad Gopichandran

71 The Moral Obligation to be Vaccinated: Utilitarianism, Contractualism, and Collective Easy Rescue 620
Alberto Giubilini, Thomas Douglas, and Julian Savulescu

72 Taking Responsibility for Responsibility 638
Neil Levy

Part IX Ethical Issues in the Practice of Healthcare 651

Introduction 653

When do Doctors have a Duty to Treat? 659

73 What Healthcare Professionals Owe Us: Why Their Duty to Treat During a Pandemic is Contingent on Personal Protective Equipment (PPE) 661
Udo Schuklenk

74 Conscientious Objection in Health Care 667
Mark R. Wicclair

75 Conscientious Objection in Medicine: Accommodation versus Professionalism and the Public Good 682
Udo Schuklenk

Confidentiality 693

76 Confidentiality in Medicine: A Decrepit Concept 695
Mark Siegler

77 A Defense of Unqualified Medical Confidentiality 699
Kenneth Kipnis

Truth-Telling 713

78 On a Supposed Right to Lie from Altruistic Motives 715
Immanuel Kant

79 Should Doctors Tell the Truth? 717
Joseph Collins

80 On Telling Patients the Truth 724
Roger Higgs

Informed Consent and Patient Autonomy 731

81 On Liberty 733
John Stuart Mill

82 From Schloendorff v. NewYork Hospital 736
Justice Benjamin N. Cardozo

83 Informed Consent: Its History, Meaning, and Present Challenges 737
Tom L. Beauchamp

84 The Doctor-Patient Relationship in Different Cultures 745
Ruth Macklin

85 Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well But Cause Harm 758
Maura Priest

86 Amputees by Choice 777
Carl Elliott

87 Rational Desires and the Limitation of Life-Sustaining Treatment 788
Julian Savulescu

Part X Disability 807

Introduction 809

88 Valuing Disability, Causing Disability 811
Elizabeth Barnes

89 Is Disability Mere Difference? 829
Greg Bognar

90 Prenatal Diagnosis and Selective Abortion: A Challenge to Practice and Policy 835
Adrienne Asch

91 Down Syndrome Screening Isn't about Public Health: It's about Eliminating a Group of People 851
Renate Lindeman

92 I Would've Aborted a Fetus with Down Syndrome: Women Need that Right 854
Ruth Marcus

Part XI Neuroethics 857

Introduction 859

93 Neuroethics: Ethics and the Sciences of the Mind 861
Neil Levy

94 Engineering Love 867
Julian Savulescu and Anders Sandberg

95 Unrequited Love Hurts: Should Doctors Treat Broken Hearts? 870
Francesca Minerva

96 Stimulating Brains, Altering Minds 876
Walter Glannon

97 Authenticity or Autonomy? When Deep Brain Stimulation Causes a Dilemma 883
Felicitas Kraemer

98 On the Necessity of Ethical Guidelines for Novel Neurotechnologies 889
Sara Goering and Rafael Yuste

Index 895