BackgroundClinical ethical practice (CEP) is required for healthcare workers (HCWs) to improve health-care delivery. However, there are gaps between accepted ethical standards and CEP in Ethiopia. There have been limited studies conducted on CEP in the country. Therefore, this study aimed to determine the magnitude and associated factors of CEP among healthcare workers in healthcare facilities in Ethiopia.MethodFrom February to April 2021, a mixed-method study was conducted in 24 health facilities, combining quantitative and qualitative methods. Quantitative (survey questionnaire) and qualitative (...) (semi-structured interviews) data were collected. For quantitative and qualitative data analysis, Stata version 14 and Atlas.ti version 7 were utilized. Multiple logistic regression and thematic analysis for quantative and qualitative respectively used.ResultsFrom a total of 432 study participants, 407 HCWs were involved in the quantitative analysis, 36 participants were involved in five focus group discussions (FGDs), and eleven key informant interviews (KIIs) were involved in the qualitative analysis. The score of good CEP was 32.68%. Similarly, the scores of good knowledge and attitude were 33.50% and 25.31%, respectively. In the multiple logistic regression models, satisfaction with the current profession, availability of functional CECs, compassionate leaders, previously thought clinical ethics in pre-service education and good attitude were significant factors associated with CEP. Among these significant factors, knowledge, compassionate leaders, poor infrastructure, a conducive environment and positive attitudes were also determinants of CEP according to qualitative findings.ConclusionsThe CEP in health care services in Ethiopia is low. Satisfaction with the current profession, functional CECs, positive attitude, compassionate leaders and previously thought clinical ethics were significant factors associated with CEP. The Ministry of Health (MoH) should integrate interventions by considering CECs, compassionate leadership, and positive attitudes and enhance the knowledge of health professionals. Additionally, digitalization, intersectoral collaboration and institutionalization are important for promoting CEP. (shrink)

Recent advances in genetic research pose many complex problems for moral and political philosophers. On the one hand, these advances promise great things. Genetic enhancement techniques might allow us to prevent or cure a variety of debilitating diseases. But on the other hand, talk about intervening in people's genetic make-up conjures up memories of the sinister episodes of past eugenic movements. Such movements violated the most basic principles of justice. How can society capitalize on the benefits of (...) genetic intervention and yet avoid the injustices of past eugenic movements? What basic moral principles should guide public policy and individual choice concerning the use of genetic interventions? These important questions are tackled by Allen Buchanan, Dan Brock, Norman Daniels, and Daniel Wikler inFrom Chance to Choice: Genetics and Justice. This book brings together the thoughts of leading scholars in the field and is likely to set the agenda for serious debate on this topic. (shrink)

There has been considerable recent debate on the ethics of human enhancement. A number of prominent authors have been concerned about or critical of the use of technology to alter or enhance human beings, citing threats to human nature and dignity as one basis for these concerns. Frances Kamm has given a detailed rebuttal of Sandel's arguments, arguing that human enhancement is permissible. Nicholas Agar, in his book Liberal Eugenics, argues that enhancement should be permissible but not obligatory. He argues (...) that what distinguishes liberal eugenics from the objectionable eugenic practices of the Nazis is that it is not based on a single conception of a desirable genome and that it is voluntary and not obligatory. This article takes a more provocative position. It aims to argue that, far from its being merely permissible, we have a moral obligation or moral reason to enhance ourselves and our children. Indeed, we have the same kind of obligation as we have to treat and prevent disease. It begins by considering the current interests in and possibilities of enhancement. It then offers three arguments that we have very strong reasons to seek to enhance. (shrink)

Recent advances in genetic research pose many complex problems for moral and political philosophers. On the one hand, these advances promise great things. Genetic enhancement techniques might allow us to prevent or cure a variety of debilitating diseases. But on the other hand, talk about intervening in people's genetic make-up conjures up memories of the sinister episodes of past eugenic movements. Such movements violated the most basic principles of justice. How can society capitalize on the benefits of (...) genetic intervention and yet avoid the injustices of past eugenic movements? What basic moral principles should guide public policy and individual choice concerning the use of genetic interventions? These important questions are tackled by Allen Buchanan, Dan Brock, Norman Daniels, and Daniel Wikler in From Chance to Choice: Genetics and Justice. This book brings together the thoughts of leading scholars in the field and is likely to set the agenda for serious debate on this topic. (shrink)

The centerpiece of Aldous Huxley's Brave New World is state control of the human reproduction process as a means of ensuring social stability. Although written as fiction, recent advances in human genetic and reproductive technology promise to give us more control over our biological destiny, including procreation. Concurrently, they create new social policy dilemmas, challenge prevailing "givens" of the human condition, and, technologically, increase the possibility of centralized control over reproduction. After reviewing the current status of human genetic (...) technology and discussing its use in the United States, this article analyzes the implications of these innovations for the future. (shrink)

Jürgen Habermas has argued against prenatal genetic interventions used to influence traits on the grounds that only biogenetic contingency in the conception of children preserves the conditions that make the presumption of moral equality possible. This argument fails for a number of reasons. The contingency that Habermas points to as the condition of moral equality is an artifact of evolutionary contingency and not inviolable in itself. Moreover, as a precedent for genetic interventions, parents and society already affect children's (...) traits, which is to say there is moral precedent for influencing the traits of descendants. A veil-of-ignorance methodology can also be used to justify prenatal interventions through its method of advance consent and its preservation of the contingency of human identities in a moral sense. In any case, the selection of children's traits does not undermine the prospects of authoring a life since their future remains just as contingent morally as if no trait had been selected. Ironically, the prospect of preserving human beings as they are – to counteract genetic drift – might even require interventions to preserve the ability to author a life in a moral sense. In light of these analyses, Habermas' concerns about prenatal genetic interventions cannot succeed as objections to their practice as a matter of principle; the merits of these interventions must be evaluated individually. (shrink)

In the near future we may be able to manipulate human embryos through genetic intervention. Jürgen Habermas has argued against the development of technologies which could make such intervention possible. His argument has received widespread criticism among bioethicists. These critics argue that Habermas's argument relies on implausible assumptions about human nature. Moreover, they challenge Habermas's claim that genetic intervention adds something new to intergenerational relationships pointing out that parents have already strong control over their children (...) through education. In this paper a new approach to Habermas's theory is suggested which makes clear that he has a strong point against genetic intervention. A more charitable reading of Habermas with respect to his assumptions concerning human nature is presented. Moreover, Habermas's assumption concerning the power of genetic controlling is evaluated. By means of a close comparison of genetic and educational control it is shown that Habermas's argument relies on much weaker assumptions than generally understood. (shrink)

What does the prospect of being able to alter a human being's “natural assets” by genetic engineering imply for our understanding of the requirements of justice, and of equal opportunity in particular? Although their proponents are reluctant to admit it, some of the most prominent contemporary theories of justice yield a quite radical conclusion: If safe and effective intervention in the genetic “natural lottery” becomes feasible, there will be at least a strong prima facie case for doing (...) so in the name of equality of opportunity , if this is the most effective way to meet the demands of justice. (shrink)

The ArgumentSome have claimed that negative genetic interventions are morally permissible while positive ones are not, but the distinction cannot be used to draw this moral boundary. Underlying the negative/positive distinction is a distinction between treatment and enhancement. The treatment/enhancement distinction at best provides an imperfect guide to which health care services we are obliged to provide and which we are not. It offers only some “warning flags” to help us think about what is permissible or not.

Genetic interventions, which include transgenic engineering, gene editing, and other forms of genome modification aimed at altering the information “in” the genetic code, are rapidly increasing in power and scale. Biosemiotics offers unique tools for understanding the nature, risks, scope, and prospects of such technologies, though few in the community have turned their attention specifically in this direction. Bruni is an important exception. In this paper, I examine how we frame the concept of “side effects” that result from (...) genetic interventions and how the concept stands up to current perspectives of the role of organism activity in development. I propose that once the role of living systems in constructing and modifying the informational value of their various developmental resources is taken into account, the concept of a “side effect” will need to be significantly revised. Far from merely a disturbance brought about in a senseless albeit complex system, a biosemiotic view would take “side effects” as at least sometimes the organism’s active re-organization in order to accommodate or make use of novelty. This insight is nascent in the work of developmental plasticity and niche construction theory, but it is brought into sharper focus by the explicitly interpretive perspective offered by biosemiotics. Understanding the “side effects” of genetic interventions depends in part on being able to articulate when and where unexpected consequences are a result of semiotic activity at various levels within the system. While a semiotic interpretation of “side effects” puts into question the naive attitude that would see all unintended side effects as indications of disturbance in system functionality, it certainly does not imply that such side effects are of no concern for the viability of the organisms in the system. As we shall see, the fact that such interventions do not respect the translation of information that occurs in multi-level biological systems ensures that disruption is still likely. But it does unprivilege the human agent as the sole generator of meaning and information in the products of biotechnology, with important consequences on how we understand our relationship with other species. (shrink)

In the present paper it is argued that genetic interventions on human embryos are in principle permissible if they promote the health of the persons that these embryos will one day become and impermissible if they compromise their health. This so called health-intervention principle is reached by, inter alia, rejecting alternative approaches to the problem of the permissibility of genetic intervention. The health-intervention principle can be interpreted in different ways depending on how the notion of (...) health is understood. The central part of the paper is an attempt to find a concept of health which is such that it makes the health-intervention principle normatively plausible. For this purpose I examine two influential competing theories of health: Cristopher Boorse’s biostatistical theory of health and Lennart Nordenfelt’s welfare theory of health. I argue that the health-intervention principle is more plausible if health is understood in the latter sense, although it is not ruled out that the principle may be given an even more plausible explication in terms of some other notion of health. (shrink)

Genetic intervention is on the near horizon for the treatment of substance abu se. Genetic intervention involves a reprogramming of a person’s own genetic instructions so that that person will no longer have the physical craving for the drug of choice. Unlike pharmacologic intervention, genetic intervention will change the genetic identity of the person, albeit slightly. The legal issue is whether one has a fundamental right to this medical procedure. A fundamental (...) right is one that the government cannot deny without a compelling interest. The case law indicates that the right o f medical necessity applies when the person’s affliction is serious, there are no reasonable or effective alternatives, the person did not intentionally cause the condition, and the treatment is effective for the long term. Unlike the medical marijuana ph enomenon, genetic intervention is per se anti - drug, unrelated to illegal, recreational drug use, and on its face has a medical use. Legal doctrines to date though not directly on point are conceptually compatible with the existence of a fundamental right of medical necessity for genetic intervention. (shrink)

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of (...) the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge. (shrink)

The Nobel prize-winning molecular biologist Walter Gilbert described the mapping and sequencing of the human genome as “the grail of molecular biology.” The implication, endorsed by enthusiasts for the new genetics, is that possessing a comprehensive knowledge of human genetics, like possessing the Holy Grail, will give us miraculous powers to heal the sick, and to reduce human suffering and disabilities. Indeed, the rhetoric invoked to garner public support for the Human Genome Project appears to appeal to the best of (...) the Western tradition's enthusiasm for progress: the idea of improving human lives through the practical application of scientific knowledge. (shrink)

Volume 20, Issue 8, August 2020, Page 49-50.

In responding to our paper, Matthew D. Bacchetta and Gerd Richter include several misinterpretations and misrepresentations of our IVONT protocol and structure for ethical debate. We actively invited scrutiny of our IVONT protocol; however, for us to seriously respond to criticisms of our publication, we suggest respectfully that those who critique the article critique the protocol that we proposed. First and foremost, we certainly do not have a regarding mitochondrial genetics.

Obesity is the focus of multiple lines of inquiry that have -- together and separately -- produced many deep insights into the physiology of weight gain and maintenance. We examine three such streams of research and show how they are oriented to obesity intervention through multilevel integrated approaches. The first research programme is concerned with the genetics and biochemistry of fat production, and it links metabolism, physiology, endocrinology and neurochemistry. The second account of obesity is developmental and draws together (...) epigenetic and environmental explanations that can be embedded in an evolutionary framework. The third line of research focuses on the role of gut microbes in the production of obesity, and how microbial activities interact with host genetics, development and metabolism. These interwoven explanatory strategies are driven by an orientation to intervention, both for experimental and therapeutic outcomes. We connect the integrative and intervention-oriented aspects of obesity research through a discussion of translation, broadening the concept to capture the dynamic, iterative processes of scientific practice and therapy development. This system-oriented analysis of obesity research expands the philosophical scrutiny of contemporary developments in the biosciences and biomedicine, and has the potential to enrich philosophy of science and medicine. (shrink)

Pretty much everyone knows that our genes have at least something to do with how able or how high achieving we are. Some believe that we should not speak of this common knowledge, nor inquire into how genetic influence works or what it might mean. If we do not keep an open mind to the fact of genetic influence on academic achievement, however, then we cannot explore its possible implications. And if we do not consider the implications, then (...) we cannot, as a society, harness any potential benefits or avoid possible pitfalls. So that's what this essay is about—exploring what behavioral genetics research might be able to offer to educational theory, policy, and practice.We cannot yet use biological information to make accurate predictions for all children. We do know, however, that academic achievement is heritable, which is to say that differences between individuals are influenced by differences in their DNA. If genes are part of the problem for some pupils (to take the negative spin on this), then it seems likely that studying them could be part of a solution. And that's what behavioral geneticists are trying to do—to chart and understand pathways from DNA to behavior and to identify interventions that can maximize outcomes for all. The fact is, though, that we have an awfully long way to go. (shrink)

The possibility of early diagnosis and intervention is radically changed by the advent of genetic testing. The recent report of the Nuffield Council on Bioethics is timely and helpful. I have suggested, that not only the severity of the disability indicated by genetic information, and the accuracy of the data, ought to govern the approach to the implementation of screening for genetic disorders. In addition, assessment of the value of the information to those involved should be (...) considered. The efficacy of the available therapeutic measures, combined with the prognostic data are important indices of the value of the information. These measures fall into three categories and thus indicate that three different courses of intervention may be appropriate. Three approaches to diagnosis and intervention are then outlined, drawing on the experience of various clinical initiatives. (shrink)

Yasha Rohwer and Emma Marris argue there is no prima facie duty to preserve genetic integrity; they contend, rather, that preserving the integrity of specific genomes is only a mean...

CRISPR is widely considered to be a disruptive technology. However, when it comes to the most controversial topic, germline genome editing (GGE), there is no consensus on whether this technology has any substantial advantages over existing procedures such as embryo selection after in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). Answering this question, however, is crucial for evaluating whether the pursuit of further research and development on GGE is justified. This paper explores the question from both a clinical (...) and a moral viewpoint, namely whether GGE has any advantages over existing technologies of selective reproduction and whether GGE could complement or even replace them. In a first step, I review an argument of extended applicability. The paper confirms that there are some scenarios in which only germline intervention allows couples to have (biologically related) healthy offspring, because selection will not avoid disease. In a second step, I examine possible moral arguments in favour of genetic modification, namely that GGE could save some embryos and that GGE would provide certain benefits for a future person that PGD does not. Both arguments for GGE have limitations. With regard to the extended applicability of GGE, however, a weak case in favour of GGE should still be made. (shrink)

Behavioral genetics typically finds that the so-called shared environment contributes little or nothing to explaining within-population variation on most traits. If true, this has important implications for where not to look for good targets of interventions: Namely all things that are within the normal range of variation from one rearing environment to the next in that population.

This paper explores the analytical relevance of Foucault's notion of biopower in the context of regulating and managing non-human lives and populations, specifically those animals that are the focus of livestock breeding based on genetic techniques. The concept of biopower is seen as offering theoretical possibilities precisely because it is concerned with the regulation of life and of populations. The paper approaches the task of testing the 'analytic mettle' of biopower through an analysis of four policy documents concerned with (...) farm animal genetics: the UK's National Scrapie Plan (2003); the UK National Action Plan on Farm Animal Genetic Resources (2006); the Agriculture and Environment Biotechnology Committee's report on Animals and Biotechnology (2002); and the Farm Animal Welfare Council's report on the Welfare Implications of Animal Breeding and Breeding Technologies in Commercial Agriculture (2004). Of interest is whether and how the four policy case studies articulate a form of biopower in relation to human-livestock animal relations in the context of genetic approaches to livestock breeding, and how biopower is variably expressed in relation to the different policy issues addressed. In concluding, the paper considers the overall applicability and relevance of biopower in the context of regulating animal lives within livestock breeding, highlighting both possibilities and limitations, and offers suggestions for taking forward research on livestock populations from a neo-Foucaultian perspective. (shrink)

There are many ways that biological theory can inform ethical discussions of genetic engineering and biomedical enhancement. In this essay, we highlight some of these potential contributions, and along the way provide a synthetic overview of the papers that comprise this special issue. We begin by comparing and contrasting genetic engineering with programs of selective breeding that led to the domestication of plants and animals, and we consider how genetic engineering differs from other contemporary biotechnologies such as (...) embryo selection. We go on to consider the implications of genetic engineering for human nature, human evolution, and persistence of the human species. Finally, we question whether genetic interventions warrant the extraordinary ethical scrutiny they are often given, and we show how the misleading “genetic blueprint” metaphor has imposed a faulty structure on the enhancement debate. We conclude by considering the nature of biological development and the sobering limits it places on what genetic engineering can reasonably hope to achieve. (shrink)

Medical genetic interventions can be performed in two ways. First, genetic defects may be repaired (gene therapy). Secondly, a possible future individual (an embryo or a possible combination of gametes) may be preselected because of its favourable genetic make-up (by using genetic diagnostic methods and procedures from reproductive medicine so called Preimplantation Genetic Diagnosis). The first kind of intervention means that someone gets medical treatment in the normal sense, however, the second kind does not. (...) Rather, in that case, the potential patient is exchanged for another individual who is in no need of treatment. The paper explores to what extent arguments for and against these kinds of genetic intervention apply equally to all of them. For example, may the benefits that can be achieved through gene therapy be equally well achieved through genetic preselection? Are fears of a resurrection of eugenic practices through gene technology more warranted regarding therapeutic interventions than regarding preselective ones (or vice versa)? Since genetic preselection is an intervention at the germ-line level and is presently clinically applied: How is it possible to motivate that clinical application of germ-line gene therapy is not similarily permitted? (shrink)

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem (...) of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies–that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice. (shrink)

Imagine a future in which a country’s government is thinking about whether to pursue human enhancement. There are several ways that humans might be enhanced, among them physical aids, pharmaceutical interventions, and genetic modification. In this imagined scenario...

Rawls’ principle of fair equality of opportunity has been regularly discussed and criticized for being inadequate regarding natural inequalities. In so far as this egalitarian goal is sound, the purpose of the paper is to see how the prospect of radical genetic intervention might affect this particular inadequacy. I propose that, in a post-genetic setting, an appropriate response would be to extend the same rules regulating societal inequalities to a regulation of comparable genetic inequalities. I defend (...) this stance against recent arguments from the authors of From Chance to Choice and from Colin Farrelly’s alternative of the genetic difference principle. (shrink)

In this paper I argue that the account of deliberative democracy advanced by Amy Gutmann and Dennis Thompson (1996, 2004) is a useful normative theory that can help enhance our deliberations about public policy in morally pluralistic societies. More specifically, I illustrate how the prescriptions of deliberative democracy can be applied to the issue of regulating non-medical uses of pre-implantation genetic diagnosis (PGD), such as gender selection. Deliberative democracy does not aim to win a philosophical debate among rival first-order (...) theories, such as libertarianism, egalitarianism or feminism. Rather, it advances a second-order analysis that strives to help us determine what would constitute a reasonable balance between the conflicting fundamental values that arise in the context of regulating PGD. I outline a theoretical model (called the Reasonable Genetic Intervention Model) that brings these issues to the fore. Such a model incorporates the concern for both procedural and substantive principles; and it does so in way that takes provisionality seriously. (shrink)

Bioconservative commentators argue that parents should not take steps to modify the genetics of their children even in the name of enhancement because of the damage they predict for values, identities and relationships. Some commentators have even said that adults should not modify themselves through genetic interventions. One commentator worries that genetic modifications chosen by adults for themselves will undermine moral agency, lead to less valuable experiences and fracture people's sense of self. These worries are not justified, however, (...) since the effects of modification will not undo moral agency as such. Adults can still have valuable experiences, even if some prior choices no longer seem meaningful. Changes at the genetic level will not always, either, alienate people from their own sense of self. On the contrary, genetic modifications can help amplify choice, enrich lives and consolidate identities. Ultimately, there is no moral requirement that people value their contingent genetic endowment to the exclusion of changes important to them in their future genetic identities. Through weighing risks and benefits, adults also have the power to consent to—and assume the risks of—genetic modifications for themselves in a way not possible in prenatal genetic interventions. (shrink)

It has been argued by some authors that our reaction to deaf parents who choose deafness for their children ought to be compassion, not condemnation. Although I agree with the reasoning proposed I suggest that this practice could be regarded as unethical. In this article, I shall use the term “dysgenic” as a culturally imposed genetic selection not to achieve any improvement of the human person but to select genetic traits that are commonly accepted as a disabling condition (...) by the majority of the social matrix; in short as a handicap. As in eugenics, dysgenics can be achieved in a positive and a negative way. Positive dysgenics intends to increase the overall number of people with a particular genetic trait. Marriage between deaf people or conceiving deaf children through reproductive technology are examples of positive dysgenics. Negative dysgenics can be obtained through careful prenatal or pre-implantation selection and abortion (or discarding) of normal embryos and foetuses. Only deaf children would be allowed to live. If dysgenics is seen as a programmed genetic intervention that undesirably shapes the human condition – like deliberately creating deaf or dwarf people – the professionals involved in reproductive technologies should answer the question if this should be an accepted ethical practice because the basic human right to an open future is violated. (shrink)

: Genetic interventions raise a host of moral issues and, of its various species, germ-line genetic enhancement is the most morally contentious. This paper surveys various arguments against germ-line enhancement and attempts to demonstrate their inadequacies. A positive argument is advanced in favor of certain forms of germ-line enhancements, which holds that they are morally permissible if and only if they augment Rawlsian primary goods, either directly or by facilitating their acquisition.

Creation Ethics illuminates an array of issues in "reprogenetics" through the lens of moral philosophy. With novel frameworks for understanding prenatal moral status and human identity, David DeGrazia tackles the ethics of abortion and embryo research, genetic enhancement and prenatal genetic interventions, procreation and parenting, and obligations to future generations.