Gregor Samsa awakes to find himself transformed into a gigantic bug. The creature’s inchoate flailing leads Gregor’s sister to conclude that Gregor is no more, having been replaced by a brute beast lacking any vestige of human understanding. Sadly, real cases of brain injury and disease can lead to psychological metamorphoses so profound that we cannot easily think that the survivor is the person we knew. I argue that there can be cases in which statements like, “It’s just not Gregor (...) anymore,” are not merely figures of speech. With this in mind, I consider three possible results of saving a biological life: (1) ordinary cases where saving the life will save the person, with strong duties to save the life; (2) cases where the intervention needed to save the life will replace the person, with strong duties not to save the life; (3) cases in which it is indeterminate whether the person will be saved or replaced. How should we think about indeterminate cases? Impersonal ethical considerations miss the point, while standard person-affecting considerations are inapplicable. I suggest turning attention away from survival towards a richer focus on what I call “personal concern.” I show how considerations of personal concern, unlike those of self-interest, need not be tied to survival and how this allows personal concern to provide a basis for ethically substantive discussion of cases where saving a life might result in losing the patient. (shrink)
How do people manage to refer to chocolate, despite knowing so little about it? Traditional semantic externalism gives a two-part answer, a negative claim that meanings are not determined inside speakers' heads, and a positive claim that meanings are fixed by external factors. This gets the semantics of ‘chocolate’ half right: the negative claim is correct, but the positive claim is not. There is nothing special about ‘chocolate’, and scientifically respectable natural-kind terms also fail to live up to the positive (...) expectations of traditional externalism. However, kind-term indeterminacy is compatible with important advances associated with externalism's de re understanding of kind terms. (shrink)
I argue that defenders of general duties of species preservation are faced with an impossible task. I distinguish derivative from non-derivative value and argue that the derivative value of species can yield only limited and contingent duties of preservation. There can be no general duty of species preservation unless all species have non-derivative value. Ongoing controversy over the ’species’ notion has not deterred some from claiming settled authority for whatever notion appears most conducive to their favored account of species value. (...) This is a mistake. The actual task is to state biologically plausible criteria for a ’species’ notion and to make the case that these criteria demarcate something of moral value. I argue that the task is made impossible by the same basic biological facts that led Darwin to the view that species are “merely artificial combinations made for convenience.‘. (shrink)
In this paper we challenge the moral consensus against selection for disability. Our discussion will concern only those disabilities that are compatible with a life worth living from the point of view of the disabled individual. We will argue that an influential, impersonal argument against selection for disability falls to a counterexample. We will then show how the reach of the counterexample can be broadened to make trouble for anyone who objects to selection for disability. If we are right about (...) the problems for objections to selection for disability, why are objections are so widespread? We suggest that intuitions are being skewed against selection for disability by certain quirks in the usual ways of presenting the issue. Nevertheless, we must confess to finding our own result surprising. (shrink)
Reproductive technologies do not allow us to choose future people, but they do change who will exist. Confusion arises because of the different senses in which ”identity’ is used in ethical debate. I distinguish qualitative, cultural, and numerical identity. Reproductive choices do impact the qualitative features of children in ways that affect wellbeing, both directly and indirectly via cultural identification. I explain how the nonidentity problem makes it difficult to say what, if anything, is wrong with risky reproductive choices, and (...) I outline four strategies or responding to the non-identity problem. (shrink)
This paper uses chronic beryllium disease as a case study to explore some of the challenges for decision-making and some of the problems for obtaining meaningful informed consent when the interpretation of screening results is complicated by their probabilistic nature and is clouded by empirical uncertainty. Although avoidance of further beryllium exposure might seem prudent for any individual whose test results suggest heightened disease risk, we will argue that such a clinical precautionary approach is likely to be a mistake. Instead, (...) advice on the interpretation of screening results must focus not on risk per se, but on avoidable risk, and must be carefully tailored to the individual. These points are of importance for individual decision-making, for informed consent, and for occupational health. (shrink)
: Stem cell therapies should be available to people of all ethnicities. However, most cells used in the clinic will probably come from lines of cells stored in stem cell banks, which may end up benefiting the majority group most. The solution is to seek additional funding, earmarked for lines that will benefit minorities and offered as a public expression of apology for past discrimination.
The scientific, ethical, and policy issues raised by research involving the engraftment of human neural stem cells into the brains of nonhuman primates are explored by an interdisciplinary working group in this Policy Forum. The authors consider the possibility that this research might alter the cognitive capacities of recipient great apes and monkeys, with potential significance for their moral status.
We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)
If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.