A majority opinion seems to have emerged in scholarly analysis of the assortment of technologies that have been given the label “synthetic biology.” According to this view, society should allow the technology to proceed and even provide it some financial support, while monitor­ing its progress and attempting to ensure that the development leads to good outcomes. The near‐consensus is captured by the U.S. Presidential Commission for the Study of Bioethical Issues in its report New Directions: The Ethics of Synthetic Biology (...) and Emerging Technologies, which arguably marked the end of a preliminary round of analysis about the ethical and policy questions raised by synthetic bi­ology. Like a number of other, earlier documents issued by various groups around the world, the re­port called attention to questions about how the technology will be used; whether it might be mis­used; what sorts of accidents might happen along the way; the economic, environmental, and social impacts of the eventual applications; whether the very idea of “synthetic biology” should be trou­bling; and how the debate over all of these ques­tions will be conducted. Also like most similar documents, however, while it called for careful monitoring and oversight of technology, it did not recommend any significant new constraints on its development and use. The commission's stance was that it would be “imprudent either to declare a moratorium on synthetic biology until all risks can be determined and mitigated, or to simply ‘let science rip,’ regardless of the likely risks.”In this report, we will take stock of the current consensus, comment on some of the major points of disagreement, and identify the next steps for the debate. In part I, we offer a brief overview of the research and applications commonly grouped together under the heading of synthetic biology, partly in order to set the stage for the rest of the discussion and partly because we want to highlight some conceptual problems that attend the very la­bel given this field. In parts II, III, and IV, we take up, respectively, three broad classes of concerns that arise in the context of synthetic biology: con­cerns about the intrinsic or inherent value of do­ing synthetic biology, concerns about the concrete harms and benefits of doing synthetic biology, and concerns about justice. Addressing these concerns requires a method for bringing the public's values to bear on policy‐making concerning emerging biotechnologies; in part V, we discuss the chal­lenges in developing such a method. (shrink)

A range of views on the morality of synthetic biology and its place in public policy and political discourse.

Much work in bioethics tries to sidestep bedrock questions about moral values. This is fine if we agree on our values; arguments about human enhancement suggest we do not. One bedrock question underlying these arguments concerns the role of emotion in morality: worries about enhancement are derided as emotional and thus irrational. In fact, both emotion and reason are integral to all moral judgment.

How strong is the argument for requiring public deliberation by very large publics—at national or even global levels—before moving forward with efforts to use gene editing on wild populations of plants or animals? Should there be a general moratorium on any such efforts until such broad public deliberation has been successfully carried out? This article works toward recommendations about the need for and general framing of broad public deliberation. It finds that broad public deliberation is highly desirable but not flatly (...) necessary before moving forward with any local cases of gene editing in the wild. It also finds that broad public deliberation would be most helpful in generating very general guidance and is unlikely to be appropriate for specific cases. Broad public deliberation is most helpful for cases that involve higher levels of uncertainty and moral ambiguity, but separating out a distinct class of cases for deliberation is not yet possible. (shrink)

The emergence of de‐extinction is a study in technological optimism. What has already been accomplished in recovering ancient genomes, recreating them, and reproducing animals with engineered genomes is amazing but also has a long ways to go to achieve “de‐extinction” as most people would understand that term. Still, with some caveats in place, creating a functional replacement for an extinct species may sometimes be doable, and given the right goals, might sometimes make sense. The International Union for Conservation of Nature (...) guidelines for de‐extinction do a reasonable job of keeping the caveats in place and clarifying the goals. In fact, given the right caveats about what de‐extinction can accomplish, we should pay a lot of attention to the technology and should think carefully about the goals. Not only has the technology been advancing, but our environmental standards have been getting looser and more flexible, providing less guidance for implementing the technology. The guiding ideals for conservation are often explained as a choice between John Muir, founder of The Sierra Club, and Gifford Pinchot, who helped create the U.S. Forest Service. Muir argued for preserving some places in the world in their natural state because of their great value and beauty. Pinchot, by contrast, was bluntly utilitarian. He argued for trying to keep some natural places more or less undamaged so that we could use them later. There has long been dissatisfaction with this choice, and in the last couple of decades, a number of prominent voices have proposed a “gardening ethic” as a new standard that combines elements of Muir and Pinchot. A gardening ethic is supposed to both celebrate the land and declare that it must now be managed. But what would good gardening mean when it comes to de‐extinction? (shrink)

Much work in bioethics tries to sidestep bedrock questions about moral values. This is fine if we agree on our values; arguments about human enhancement suggest we do not. One bedrock question underlying these arguments concerns the role of emotion in morality: worries about enhancement are derided as emotional and thus irrational. In fact, both emotion and reason are integral to all moral judgment.

The emerging phenomenon of genetic paternity testing shows how good science and useful social reform can run off the rails. Genetic paternity testing enables us to sort out, in a transparent and decisive way, the age-old but traditionally never-quite-answerable question of whether a child is genetically related to the husband of the child's mother. Given the impossibility of settling this question for certain, British and American law has long held that a biological relationship must almost always be assumed to exist. (...) According to what is known as the “marital presumption” or “presumption of legitimacy,” a child born to a woman within a marital relationship is assumed to be the biological child of the woman's husband unless he was absent, impotent, or sterile. In other words, if paternity was not a physical impossibility for the husband, there was a nearly irrebuttable presumption that he was the father of the child. The husband was locked into the role of fatherhood. a. (shrink)

: A comparison of casuistry with the strain of particularism developed by John McDowell and David Wiggins suggests that casuistry is susceptible to two very different mistakes. First, as sometimes developed, casuistry tends toward an implausible rigidity and systematization of moral knowledge. Particularism offers a corrective to this error. Second, however, casuistry tends sometimes to present moral knowledge as insufficiently systematized: It often appears to hold that moral deliberation is merely a kind of perception. Such a perceptual model of deliberation (...) cannot offer a convincing account of the possibility of moral progress. This second problem is one to which particularism is itself prone. To redress it, other aspects of casuistry must be exploited: Casuistry contains an account of presumptive generalizations that explains how moral deliberation might be structured by rules while also depending at critical junctures on perception. (shrink)

Can we make wise policy decisions about still‐emerging technologies—decisions that are grounded in facts yet anticipate unknowns and promote the public's preferences and values? There is a widespread feeling that we should try. There also seems to be widespread agreement that the central element in wise decisions is the assessment of benefits and costs, understood as a process that consists, at least in part, in measuring, tallying, and comparing how different outcomes would affect the public interest. But how benefits and (...) costs are best weighed when making decisions about whether to move forward with an emerging technology is not clear. Many commentators feel that the weighing is often inadequate or inappropriate. Those who argue for a “precautionary” approach to the weighing do so precisely because they feel the need for a restraint on the dominant decision‐making tools and processes for assessing outcomes.This Hastings Center special report examines those tools and processes, taking the method known as cost‐benefit analysis as a starting point. In U.S. governance, CBA, sometimes informed by risk assessment, is the most widely used and extensively studied method, and authoritative reports on genetic and reproductive technologies often use language suggestive of cost‐benefit analysis. There is also a long‐running debate about the role of values in CBA and other formal impact assessment mechanisms—and about how those mechanisms compare to the precautionary principle. The guiding idea in the report is to engage in a close examination of the strengths and limits of CBA for ensuring that emerging technologies are used in ways that square with the public's values, drawing on applications of synthetic biology to illustrate and sharpen the analysis and then considering corrections to CBA and some alternative methodologies that handle values differently. (shrink)

Concerns about the sacred—common in everyday moral thinking—have crept into bioethics in various forms. Further, given a certain view of the metaphysics of morals that is now widely endorsed in Western philosophy, there is in principle no reason that judgments about the sacred cannot be part of careful and reasoned moral deliberation.

A competent person can avoid the onset of dementia by refusing life‐sustaining medical care and by voluntarily stopping eating and drinking, bringing life to an end well before any health crisis. A competent person can also try to limit the duration of dementia by drafting an advance directive that sets bounds on the life‐sustaining care, including artificial nutrition and hydration, that medical caregivers can provide when the person no longer has the capacity to make her own medical decisions. But between (...) these two strategies there can lie a significant gap. A person could live with moderate to severe dementia for a considerable time, no longer able to voluntarily stop eating and drinking yet also not yet requiring the life‐sustaining care forbidden by advance directive.This gap has been much discussed in recent years in the Hastings Center Report. Several years ago (in the May‐June 2014 issue), Paul Menzel and M. Colette Chandler‐Cramer argued for what they described as a moderate correction to the dominant view that food and water should always be offered to a patient with dementia if the patient expresses a desire to eat and drink. The problem is taken up again by the legal scholar Norman L. Cantor in this issue (July‐August 2018), and Cantor, too, tries to find a moderate alternative. (shrink)

Generative artificial intelligence (AI) has the potential to transform many aspects of scholarly publishing. Authors, peer reviewers, and editors might use AI in a variety of ways, and those uses might augment their existing work or might instead be intended to replace it. We are editors of bioethics and humanities journals who have been contemplating the implications of this ongoing transformation. We believe that generative AI may pose a threat to the goals that animate our work but could also be (...) valuable for achieving those goals. In the interests of fostering a wider conversation about how generative AI may be used, we have developed a preliminary set of recommendations for its use in scholarly publishing. We hope that the recommendations and rationales set out here will help the scholarly community navigate toward a deeper understanding of the strengths, limits, and challenges of AI for responsible scholarly work. (shrink)

The lead article in this issue of the Hastings Center Report explores the ideas underpinning the Precision Medicine Initiative, the effort announced by President Obama in 2015 to promote the development of treatments adjusted to genetic and other variations. Authors Maya Sabatello and Paul Appelbaum hold that the effort works by appealing to a sense of collective identity and shared commitment—an understanding that they call the “PMI nation.” But what are the moral implications of this idea? Sabatello and Appelbaum's question (...) about the impact of an imagined community is an unusual way of exploring a set of values questions. In the second article, Johann Brännmark defends what is, at least in bioethics, an unusual philosophical framework for moral values. Brännmark starts by calling attention to large, never-quite-solved problems with the field's going way of understanding personhood and autonomy, and then argues that the body of tradition, law, and international governance known as the human-rights framework offers a solution to those problems. And a supplement to this issue offers a set of essays on a topic outside the usual range for bioethics: the prospect of “de-extinction”—that is, of using genetic and reproductive technologies to construct simulacra of extinct animals that might eventually be introduced into the wild. (shrink)

This issue of the Hastings Center Report features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers’ authority when the surrogates’ judgments about a patient's treatment conflict with the physicians’. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to (...) provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient—even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma. The second article, by physician Jeffrey Berger, flips the questions. If a physician decides that a patient's intractable suffering requires palliative sedation, may the surrogate prevent it anyway? Or can the physician, pointing to a duty to alleviate the suffering, administer palliative sedation even in the face of the surrogate's objections? Such circumstances, says Berger, show the need for conceptual work delineating the limits of surrogates’ authority and practical work on mechanisms for doing so—protecting patients and giving physicians a clear route to follow. (shrink)

How should we think about synthetic biology—about the potential benefits and risks of these applications as well as the very idea of designed, extensively genetically modi­fied organisms? The lead article in this report sets out our thinking, but the article is rounded out with nine commentaries that sometimes expand on and sometimes argue with our perspective. Jonathan Wolff, a philosopher at the University College of London and a member of the Nuffield Council on Bioethics, and Mark Bedau, a philosopher at (...) Reed College and a participant in several projects aimed at de­veloping artificial cells, discuss the potential consequences of synthetic biology and suggest some reasons for a precau­tionary approach to deliberating about the consequences. Jane Calvert, reader in science, technology, and innovation studies at the University of Edinburgh and a member of the Nuffield Council on Bioethics working party on emerging biotechnologies, recommends, however, that deliberation about the governance of emerging technologies focus less on consequences than on aims and purposes.Gigi Gronvall, senior associate at the Center for Health Security in the University of Pittsburgh Medical Center, and David Relman, a microbiologist and immunologist at the Stanford School of Medicine, offer contrasting per­spectives about a question we raise concerning “the eth­ics of knowledge”—the values at stake in generating and disseminating potentially dangerous information. Gaymon Bennett offers some ruminations on the questions we raise about how synthetic biology might change the human re­lationship to nature in morally significant ways. He argues, too, that we can think about the ethics of synthetic biology more effectively by getting “upstream” in another way—by sitting next to the bioengineers doing the work and study­ing their “everyday practice” rather than by paying attention only to what is thought and said about their work. Colleen Grogan, professor at the University of Chicago's School of Social Administration and an expert on democratic partici­patory processes in governance, builds on our comments about the challenge of creating a meaningful public dialog about synthetic biology. Jim Thomas, a researcher with the ETC Group, challenges our view of how the public debate about synthetic biology is trending. And Sarah Carter, a policy analyst with the J. Craig Venter Institute, puts our discussion about synthetic biology in the context of debates about other new products and technologies. (shrink)

Several items in this issue of the Hastings Center Report try to fill gaps or resolve uncertainties in the regulatory systems that govern research on human subjects. The biggest of these items is a special report, published as a supplement to the issue, that considers a long‐running and vexing regulatory problem: the uncertain relationship between the two sets of federal regulations for research. The goal of the report is to provide guidance.The lead article inside the issue addresses a problem generated (...) by newly emerging genomic research. How should potential subjects be informed of the possibility of incidental findings? When and how should such findings be passed along to them? Paul Appelbaum and colleagues argue that routine approaches to informed consent will probably not work, and they develop four alternative approaches. One of the essays in the issue, by Joseph Fins of New York Cornell Medical Center, poses questions about the relationship between regulations and ethics. “Is it always enough,” Fins asks, “to abide by the rules and regulations for human subjects research? (shrink)

This issue of the Hastings Center Report features a couple of interesting takes on the governance challenges of emerging technologies. In an essay on the National Academies of Science, Engineering, and Medicine report published this February on human germ-line gene editing, Eric Juengst, a philosopher at the University of North Carolina, argues that the NASEM committee did not manage to rethink the rules. Juengst reaches what he calls an “eccentric conclusion”: “The committee's 2017 consensus report has been widely interpreted as (...) ‘opening the door’ to inheritable human genetic modification and holding a line against enhancement interventions. But on a close reading it does neither.” In the column Policy and Politics, Sarah Chan, a chancellor's fellow at the University of Edinburgh, discusses the emerging science of “organoids,” “embryoids,” and “synthetic human entities with embryo-like features” and calls for a sustained effort to rethink the rules for embryo research. (shrink)

Over email a few days after the death of Daniel Callahan, cofounder of The Hastings Center and for many years its director and then president, Joseph Fins, a longtime Hastings colleague, offered this comfort: “[H]enceforth every issue of the Report is a living memorial to Dan the writer, editor, and institution builder.” In the Hastings Center Report's first issue, published in June 1971, Dan stated, “To say that [the work of the Report] must be multi‐disciplinary is only to say the (...) issues [it will address] are as complex as human beings themselves.” This July–August 2019 issue continues the tradition Dan began. An essay by Laura Guidry‐Grimes expands on the importance of interdisciplinary conversations and problem solving—and attends to the complexity of human beings—in recalling a patient who was failed by multiple social institutions. In the lead article, a team of authors led by James Sabin identifies a challenge to conducting ethical research within learning health organizations, where research and care are integrated with the aid of patient data from health insurance providers. (shrink)

As described by Lori Gruen in the Perspective column at the back of this issue, federally supported biomedical research conducted on chimpanzees has now come to an end in the United States, although the wind-down has taken longer than expected. The process began with a 2011 Institute of Medicine report that set up several stringent criteria that sharply limited biomedical research. The National Institutes of Health accepted the recommendations and formed a committee to determine how best to implement them. The (...) immediate question raised by this transition was whether the IOM restrictions should be extended in some form to other nonhuman primates—and beyond them to other kinds of animals. In the lead article in this issue, Anne Barnhill, Steven Joffe, and Franklin Miller consider the status of other nonhuman primates. (shrink)

What are the boundaries of bioethics? Where does bioethics give way to other kinds of ethics—organizational ethics, environmental ethics, social ethics, or just ethics? According to one commonly cited account of the origin of bioethics, the field always had a relatively broad remit; it was supposed to be about the ethics of the life sciences in general. In the early days of bioethics, however, the topic that seemed most in need of critical attention was the encounter between experts in medicine (...) and the laity—doctors or medical researchers on the one hand and patients or medical research subjects on the other. Even given the narrow focal point, however, bioethics very naturally expanded.Much of the September‐October 2018 issue of the Hastings Center Report either argues or assumes that bioethics extends well beyond into social ethics. A special report published as a supplement to this issue pushes the point explicitly. (shrink)

I recently wrote to a friend and occasional Report contributor that part of the job of editor, as I understand it, is to recognize the merit in and, in effect, foster the advancement of work that one actually believes is in some sense wrongheaded. It's a point I want on the table as I introduce the two articles in this issue of the Report—not because I necessarily think these articles are wrongheaded, but because I want it clear that publishing the (...) articles does not necessarily mean I or others at the Center think they are right, either. We publish articles that we think advance thinking, but that can mean publishing articles that challenge morally compelling positions. Thus, deciding whether one agrees with a .. (shrink)

There is widespread agreement that medical care offered at the end of a life ought to accord with the preferences of the person whose life it is, at least if the care requested would not be futile. There is considerable evidence, too, that making care more “patient‐centered” in this way would tend to lower the cost of care, for the simple reason that people in those straits often prefer to avoid the most intrusive and therefore most expensive care. So patient‐centered (...) care could be a win‐win of sorts: there could be a collective benefit of lowering costs along with the individual benefit of conforming care better to what the patient wants. But to what degree should the collective benefit be an express goal of health reform, in light of the fact that a given patient might want whatever intrusive, aggressive interventions stand a chance of prolonging life? This question animates several items in this issue of the Report. (shrink)

The March–April issue of the Hastings Center Report offers another in a series of articles over the last few years on the structure and the ethics of surrogate decision‐making. Here, Daniel Brudney addresses how to help the surrogate deal with a treatment decision. A core insight he offers is that the structure of the surrogate’s decision has been misunderstood and the misunderstanding makes the task yet harder. As usually understood, the surrogate is supposed to be guided by the question, what (...) would the patient choose, if the patient were making the choice herself? Brudney argues that this conception is impossible, and that the surrogate’s task is instead to consider the patient’s best interests, as illuminated in part by the patient’s expressed values and past choices. This understanding leads, he argues, to a different guiding question: what could the patient choose, given her values? (shrink)

Several themes in this issue of the Hastings Center Report deserve mention. Entirely fortuitously, several shorter pieces in this issue discuss the nature of the doctor‐patient relationship and the need for physicians to engage patients personally rather than only technically. Also, a special supplement to this issue addresses the shifting terrain of the debate about the use of animals in medical research. Perhaps the most prominent topic in the issue, however, is the physical modification of women's genitals. Both articles address (...) this topic, and though there are significant differences between the two articles, both circle specifically around the question of whether the modification of women's genitals may be driven by cultural norms of womanhood and how women differ from men, and both comment not just on the questions but on the social debate about them. (shrink)

In the lead article in the May‐June 2019 issue of the Hastings Center Report, Aaron Wightman and coauthors consider the guiding principles for making decisions about life‐sustaining treatment for children who have profound cognitive impairments. They argue that the usual standard, which asks decision‐makers to consider what will be in the child's best interests, cannot provide sufficient guidance. Discussing this problem in HCR thirty‐five years ago, the philosopher John Arras proposed addressing it by means of a “relational potential standard,” according (...) to which decisions about providing life‐sustaining treatment to a child should depend in part on whether the child has the capacity to form human relationships. Wightman et al. build on Arras's work, but where Arras had suggested that the capacity to form relationships could be gauged by examining the child's cognitive capabilities, the authors suggest that the medical team should lean heavily on the parents’ views. (shrink)

This essay introduces a special report from The Hastings Center entitled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose, which grew out of a project supported by the John S. and James L. Knight Foundation. This multiauthored report offers wide‐ranging assessments of increasing polarization and partisanship in American government and politics, and it proposes constructive responses to this in the provision of objective information, institutional reforms in government and the electoral system, and a reexamination of cultural and (...) political values needed if democracy is to function well in a pluralistic and diverse society. The essays in the special report explore the norms of civic learning and institutions, social movements, and communal innovations that can revitalize civic learning in practice. This introductory essay defines and explains the notion of civic learning, which is a lynchpin connecting many of the essays in the report. Civic learning pertains to the ways in which citizens learn about collective social problems and make decisions about them that reflect the duties and responsibilities of citizenship. Such learning can occur in many social settings in everyday life, and it can also be facilitated through participation in the processes of democratic governance on many levels. Civic learning is not doctrinaire and is compatible with a range of public goals and policies. It is an activity that increases what might be called the democratic capability of a people. (shrink)

Two articles in the September–October 2022 issue of the Hastings Center Report discuss health‐related reasons that people might have to actively bring their lives to an end. In one, Brent Kious considers the situation of a person who, because of illness, becomes a burden on loved ones. A person in such a situation might prefer to die, and Kious argues that, while there is no obligation to hasten one's death, the choice to do so could sometimes be reasonable. In a (...) second article, Henri Wijsbek and Thomas Nys discuss a case in the Netherlands in which a woman with severe dementia was euthanized at a point when her advance euthanasia directive did not align with what she said, when asked, about death. Wijsbek and Nys defend the authority of her advance directive against a range of objections.In a third article, Henry Silverman and Patrick Odonkor, physicians at the University of Maryland Medical Center, where the first pig‐to‐human heart transplantation was performed in early 2022, develop recommendations for clinical trials of porcine heart transplantation. And an essay in the issue criticizes the allocation recommendations developed for Covid‐19 vaccines by the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. (shrink)

We are living in what is widely considered the sixth major extinction. Most ecologists believe that biodiversity is disappearing at an alarming rate, with up to 150 species going extinct per day according to scientists working with the United Nations Convention on Biological Diversity. Part of the reason the loss signified by biological extinction feels painful is that it seems irremediable. These creatures are gone, and there's nothing to be done about it. In recent years, however, the possibility has been (...) broached that, just possibly, something can be done, in at least some cases. Human ingenuity, a contributing factor in the extinction crisis, might achieve their “de‐extinction”—in at least some cases, and with sometimes significant qualifications about whether the original species had been “recreated” and whether it could resume its original place in the environment. De‐extinction is an entry point into a larger set of questions about how biotechnological tools can support, coexist with, or undermine the goals of conservation and about the very meaning of conservation. Are we beings in control of the world or beings who prosper by accommodating ourselves to webs of symbiotic interdependencies? Are we creators or creatures, or both—and if both, then how can we achieve the balance between them that might be called humility? The interplay of perfecting and accommodating is not unique to human beings—perhaps it characterizes all forms of life on Earth—but with humans, these modes of being are distinctive, and our technology greatly expands their scale and effects. It is such questions that the ten essays in this special report explore. (shrink)

The January‐February issue of the Report introduced a number of new features designed to provide opportunities for further give‐and‐take in our pages. In this issue, we put to use our revamped letters to the editor, Exchange, with a set of commentaries on another of the January‐February articles, Daniel Callahan's “Obesity: Chasing an Elusive Epidemic.” Commentaries in Other Voices and special reports are planned and solicited, in consultation with scholars in the field and with the guest editors of the special reports, (...) but our hope is that Exchange will provide an opportunity for unsolicited voices in the Report. Of course, Callahan's controversial article is all too good for drumming up unsolicited commentary: Callahan argued that the rise in obesity requires an aggressive public health campaign that employs some stigmatization of obesity. (shrink)