The following text is based on a public debate between Professor Julian Savulescu and Associate Professor Robert Sparrow on the topic of 'Making Better Babies,’ which took place in Melbourne, Australia, on Tuesday, October 2, 2012. The debate was introduced by Professor Michael Selgelid, the Director of the Centre for Human Bioethics, at Monash University, and facilitated by Associate Professor Justin Oakley. The text has been edited from the original transcript for clarity and brevity.

The global response to the recent coronavirus pandemic has revealed an ethical crisis in public health. This article analyses key pandemic public health policies in light of widely accepted ethical principles: the need for evidence, the least restrictive/harmful alternative, proportionality, equity, reciprocity, due legal process, and transparency. Many policies would be considered unacceptable according to pre-pandemic norms of public health ethics. There are thus significant opportunities to develop more ethical responses to future pandemics. This paper serves as the introduction to (...) this Special Issue of Monash Bioethics Review and provides background for the other articles in this collection. (shrink)

This article is based on a public lecture hosted by the Monash University Centre for Human Bioethics in Melbourne, Australia on 11 April 2013. The lecture recording was transcribed by Vicky Ryan; and, the original transcript has been edited — for clarity and brevity — by Vicky Ryan, Michael Selgelid and Jonathan Moreno.

This commentary continues an exchange on eugenics in Monash Bioethics Review between Anomaly (2018), Wilson (2019), and Veit, Anomaly, Agar, Singer, Fleischman, and Minerva (2021). The eponymous question, “Can ‘Eugenics’ be Defended?”, is multiply ambiguous and does not receive a clear answer from Veit et al.. Despite their stated desire to move beyond mere semantics to matters of substance, Veit et al. concentrate on several uses of the term “eugenics” that pull in opposite directions. I argue, first, that (...) Veit et al. (2021) makes much the same error as does Anomaly (2018) in characterizing eugenics; second, that the paper misunderstands the relationship between eugenics and enhancement; and third, that it distorts the views expressed in my “Eugenics Undefended”. (shrink)

Sigrid Fry-Revere’s The Kidney Sellers: A Journey of Discovery in Iran, an allegedly first-hand examination of the Iranian paid kidney donation model, has been criticized by Koplin in an essay formerly published in the Monash Bioethics Review. Koplin especially challenges Fry-Revere’s claim that financially compensating kidney vendors might facilitate altruistic kidney donation. The current situation in Iran, according to Koplin, suggests that the market model has undermined altruistic donation. On this point, this commentary tries to show that healthcare (...) policymakers in Iran no longer see the Iranian paid kidney donation model as a sustainable and ethically justifiable status quo. Briefly touching on the criticisms that have been made even by some positive commentators of the Iranian model, this commentary aims to call attention to the fact that the current dynamic within healthcare policymaking in Iran seeks primarily to decrease its reliance on the organ market instead of revising and modifying it. This complicates the plausibility of any kind of extrapolation, replication or extracting empirical support from the Iranian model to create organ markets in other countries, for example, as Fry-Revere suggests to conduct a trial of a financially incentivized kidney donation scheme in the US. The conclusion is that the Iranian healthcare system should tackle the organ shortage through increasing altruistic living and postmortem kidney donations. This might also provide, finally, a space for conducting extensive and long-term follow-up studies on well-being, satisfaction and social integration of Iranian kidney vendors. (shrink)

Research regulation is a timely topic for discussions in bioethics and public health policy. This response to articles in the previous special issue of the Monash Bioethics Review emphasises the importance of having both internal and external controls of human experimentation. Unless both elements are incorporated into research ethics governance frameworks, they will ultimately fail to achieve what should be their primary goal: human subject protection.

Reprint of an article that first appeared in Monash Bioethics Review (2018).

End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical (...) considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices. (shrink)

This article presents the findings of qualitative research which explored, from the mothers’ perspective, the process of decision-making about mode of delivery for a subsequent birth after a previous Caesarean Section. In contradiction to the clinical literature, the majority of mothers in this study were strongly of the opinion that a vaginal birth after caesarean (VBAC) posed a higher risk than an elective caesarean (EC). From the mothers’ perspective, risk discussions were primarily valuable for gaining support for their pre-determined choice, (...) rather than obtaining information. The findings posit ethical concerns with regards to informed consent and professional obstetric practice at a time when there is a documented and worrying trend towards an increase in births by caesarean section (CS). (shrink)

We examine the bioethical issues that arise from long-duration space missions, asking what there is that is distinctive about such issues. We pay particular attention to the possibility that such space missions, certainly if they lead to self-sustaining space settlements, may require human enhancement, and examine the significance of reproduction in space for bioethics. We conclude that while space bioethics raises important issues to do with human survival and reproduction in very hazardous environments, it raises no issues that are distinct (...) from those in terrestrial bioethics. Rather, space bioethics raises extreme versions of bioethical issues that are already found in the military, when working in extreme environments (such as Antarctica), or when living in circumstances (such as in prison) where one’s autonomy is severely curtailed. (shrink)

Daniel Steel’s new book on the precautionary principle illustrates the need to work ahead to fuse perspectives of epistemology and philosophy of science with those of ethics to accomplish progress in the debate on the proper role of precaution in a broad selection of bioethical areas. Steel advances the territory greatly with regard to conceptual clarity and epistemology, but from a bioethics standpoint he is mistaken in discounting the need for ethical underpinnings of a sound theory of the precautionary principle.

Respect for autonomy is a central moral principle in bioethics. It is sometimes argued that authenticity, i.e., being “real,” “genuine,” “true to oneself,” or similar, is crucial to a person’s autonomy. Patients sometimes make what appears to be inauthentic decisions, such as when anorexia nervosa patients refuse treatment to avoid gaining weight, despite that the risk of harm is very high. If such decisions are inauthentic, and therefore non-autonomous, it may be the case they should be overridden for paternalist reasons. (...) However, it is not clear what justifies the judgment that someone or something is inauthentic. This article discusses one recent theory of what justifies judgments of inauthenticity. It is argued that the theory is seriously limited, as it only provides guidance in three out of nine identified cases. There are at least six authenticity-related problems to be solved, and autonomy theorists thus have reason to engage with the topic of authenticity in practical biomedicine. (shrink)

This paper articulates a careful and detailed objection to the moral permissibility of postnatal abortion. Giubilini and Minerva claim that if being unable to nurture one’s newborn child without significant burdens to oneself, family or society, is a proper moral ground for the demand that the life of a fetus be terminated, then ‘after-birth abortion should be considered a permissible option for women who would be damaged by [rearing the child or] giving up their newborns for adoption.’ It will be (...) shown that the permissibility of postnatal abortion does not follow from the argument’s premises, in particular, the premise that the newborn is not a person in the morally relevant sense. (shrink)

Interactions between microbes and human hosts can lead to a wide variety of possible outcomes including benefits to the host, asymptomatic infection, disease (which can be more or less severe), and/or death. Whether or not they themselves eventually develop disease, asymptomatic carriers can often transmit disease-causing pathogens to others. This phenomenon has a range of ethical implications for clinical medicine, public health, and infectious disease research. The implications of asymptomatic infection are especially significant in situations where, and/or to the extent (...) that, the microbe in question is transmissible, potentially harmful, and/or untreatable. This article reviews the history and concept of asymptomatic infection, and relevant ethical issues associated with this phenomenon. It illustrates the role and ethical significance of asymptomatic infection in outbreaks, epidemics, and pandemics–including recent crises involving drug resistance, Zika, and Covid19. Serving as the Introduction to this Special Issue of Monash Bioethics Review, it also provides brief summaries of the other articles comprising this collection. (shrink)

The French bioethics laws of 1994 contain the principles of the anonymity and non commodification of all donations of body parts and products including gametes in medically assisted reproduction. The two revisions of the law, in 2004 and 2011 have upheld the rule. In view of the latest revision process, the French government organized a large public consultation in 2009. Within the event a “consensus conference” was held in Rennes about different aspects of assisted reproduction. In what follows we shall (...) first describe the anonymity clause for gamete donations in the French law and the debates surrounding it. We shall then analyse the procedure used for the 2009 public consultation and the related consensus conference, as well as its upshot concerning the anonymity doctrine. In this respect we shall compare the citizens’ own recommendations on the gamete anonymity issue and its translation in the consultation’s final report drafted by a philosopher mandated by the organizing committee. Whereas the final report cited some fundamental ethical arguments as reason for upholding the provisions of the law—most notably the refusal of the ‘all biological’ approach to reproductive issues—citizens were more careful and tentative in their position although they also concluded that for pragmatic reasons the anonymity rule should continue to hold. We shall argue that the conservative upshot of the public consultation is due to some main underlying presuppositions concerning the citizens’ role and expertise as well as to the specific design of the consensus conference. Our conclusion will be that public consultations and consensus conferences can only serve as an empirical support for devising suitable bioethics norms by using second-order normative assumptions. (shrink)

As scientific research continues to push forward the once seemingly insurmountable barriers of medical research, xenotransplantation has been viewed as a means to overcome the current and predicted future shortages of human donor organs. The current review of Australia’s xenotransplantation guidelines by the National Health and Medical Research Council provides for a timely evaluation of the scientific merits, ethical dilemmas and legal implications of this technology. This paper contends that even if the scientific barriers of xenotransplantation were successfully circumvented, (...) a myriad of ethical and legal questions remain. These questions include, but are not limited to, the use of ‘donor’ animals as a source of surrogate human tissues, the ability of seriously ill patients to provide fully informed consent, and the requirement of life-long monitoring of patients and third parties. This paper contends that the ethical questions and potential legal implications of xenotransplantation are so great as to outweigh any potential benefits that may be derived from this technology. Further, it is argued that as the public health risks of xenotransplantation have the potential to transcend sovereign borders and may remain latent for extended periods of time, a global regulatory approach is required in order to protect the global community and fundamental human rights. (shrink)

This article assesses the role of an important Russian public institution, the Russian Orthodox Church (ROC), in shaping the religious discourse on bioethics in Russia. An important step in this process was the approval of ‘The Basis of the Social Concept of the Russian Orthodox Church’ (2000), one chapter of which is devoted to bioethics. However, certain inadequacies in the creation of this document resulted in the absence of a clear position of the Russian Orthodox Church on some end-of-life issues, (...) reproductive technologies, embryo stem cells, and other topics.Using the example of reproductive dilemmas, the author researches how the ROC clarifies its teaching on issues relating to bioethics. In the 2010s the ROC introduced a new method of taking into account the views of believers and the articulation of the church’s position. This article examines the extensive public discussion of a new document, ‘Ethical issues Associated with In Vitro Fertilization’. (shrink)

There are increasing pressures for bioethics to emphasise ‘translation’. Against this backdrop, we defend ‘speculative bioethics’. We explore speculation as an important tool and line of bioethical inquiry. Further, we examine the relationship between speculation and translational bioethics and posit that speculation can support translational work. First, speculative research might be conducted as ethical analysis of contemporary issues through a new lens, in which case it supports translational work. Second, speculation might be a first step prior to translational work on (...) a topic. Finally, speculative bioethics might constitute different content altogether, without translational objectives. For each conception of speculative bioethics, important methodological aspects determine whether it constitutes good bioethics research. We conclude that whether speculative bioethics is compatible with translational bioethics—and to what extent—depends on whether it is being employed as tool or content. Applying standards of impact uniformly across bioethics may inappropriately limit speculative bioethics. (shrink)

This paper reflects on the relationship between theory and practice in bioethics, by using various concepts drawn from debates on innovation in healthcare research—in particular debates around how best to connect up blue skies ‘basic’ research with practical innovations that can improve human lives. It argues that it is a mistake to assume that the most difficult and important questions in bioethics are the most abstract ones, and also a mistake to assume that getting clear about abstract cases will automatically (...) be of much help in getting clear about more complex cases. It replaces this implicitly linear model with a more complex one that draws on the idea of translational research in healthcare. On the translational model, there is a continuum of cases from the most simple and abstract to the most concrete and complex. Insights need to travel in both directions along this continuum—from the more abstract to the more concrete and from the more concrete to the more abstract. The paper maps out some difficulties in moving from simpler to more complex cases, and in doing so makes recommendations about the future of bioethics. (shrink)

In debates about human cloning, a distinction is frequently drawn between therapeutic and reproductive uses of the technology. Naturally enough, this distinction influences the way that the law is framed. The general consensus is that therapeutic cloning is less morally problematic than reproductive cloning — one can hold this position while holding that both are morally unacceptable — and the law frequently leaves the way open for some cloning for the sake of research into new therapeutic techniques while banning it (...) for reproductive purposes. We claim that the position adopted by the law has things the wrong way around: if we accept a moral distinction between therapeutic and reproductive cloning, there are actually more reasons to be morally worried about therapeutic cloning than about reproductive cloning. If cloning is the proper object of legal scrutiny, then, we ought to make sure that we are scrutinising the right kind of clone. (shrink)

The role of Human Research Ethics Committees (HRECs) in health research is well established. Ethics committees have the good of research participants in mind but they must also assess scientific merit including the design and conduct of studies. In this article the authors’ focus is on qualitative research method and the challenge that the National Statement on Ethical Conduct in Human Research (2007) poses for ethics committees when they assess proposals using the methods outlined in the National Statement.We set out (...) a process for judging the standard of qualitative research proposals and propose that qualitative health research can be assessed using a hierarchy designed for evaluating interview studies. We contrast well-designed studies with those that have design flaws in order to focus on the hallmarks of research merit in studies that use qualitative research methods. Finally, we show that our proposal is compatible with the National Statement.Ethics review provides an early opportunity to identify and redesign inadequate studies that will not contribute to our knowledge base. The challenge for members of ethics committees with little experience in qualitative studies is to be able to assess research excellence by assessing research merit in proposals, recognising the special design features of qualitative research methods. (shrink)

The United Nations Scientific, Education and Cultural Organisation (UNESCO) has commenced drafting a Universal Bioethics Declaration. Some in the relevant UNESCO drafting committee have previously desired to restrict its content to general principles concerning the application (but not necessarily the goals) of science and technology. As potentially a crucial agenda-setting statement of global bioethics, however, it is arguably important the Universal Bioethics Declaration transparently address major bioethical dilemmas in the field of public health, such as universal access to affordable, essential (...) medicines. Article 13 (Social Responsibility) of the Preliminary Draft Universal Bioethics Declaration states: ‘Any decision or practice shall ensure that progress in science and technology contributes, wherever possible, to the common good, including the achievement of goals such as: (i) access to quality health care and essential medicines, including for reproductive health and the health of children.’Cost effectiveness pricing systems, such as that most notably used in Australia’s Pharmaceutical Benefits Scheme (PBS), arguably represent one of the most scientifically effective mechanisms whereby public monies may be utilised to assist in the provision of medicines for the common good. They contain two essential elements: first, a process of scientific evaluation of objectively demonstrated therapeutic significance, and then, a fiscal lever (the government reimbursement price) attached to that evaluation.It is now well established that the US Pharmaceutical Research and Manufacturers Association (Pharma), through the assistance of the US Trade Representative (USTR), saw the Australia United States Free Trade Agreement (AUSFTA) as an opportunity to fulfill a legislative mandate to ‘eliminate ’ the cost-effectiveness pricing system in Australia’s PBS. One of the most remarkable features of the arguments raised against the PBS in this context was the fact that they made almost no reference to the normative discourse of bioethics or international human rights. Provisions such as Article 13 in UNESCO’s Universal Bioethics Declaration, although they will create no immediate obligations under international law, may play an extremely valuable role in legitimising the use of bioethical and human rights concepts in access to medicines debates surrounding multilateral and bilateral international trade deals such as the AUSFTA. (shrink)

There are increasing pressures for bioethics research to have translational purposes. Against this backdrop, we argue in defense of speculative bioethics. We explore methods of speculation and their importance. Further, we examine the relationship between speculative bioethics and translational bioethics and posit that they are not dimorphous enterprises, but often support each other. First, speculative research might be conducted as ethical analysis of contemporary issues through a new lens, in which case it is a means of conducting translational work. Second, (...) speculative bioethics research might be a first step prior to translational work on a topic, in which case speculative bioethics is a necessary requirement for later translational work. Finally, speculative bioethics research might be a separate kind of bioethics altogether, in which case it does not have the same objectives of impact and translation as other bioethics work. For each type of work, important methodological aspects determine whether it constitutes good speculative bioethics research. We conclude that speculative bioethics is multipurpose, and whether it should have a translational dimension—and to what extent—depends on the issue. Applying standards of impact and translation as the gold standard across bioethics may inappropriately limit bioethics, particularly on emerging technologies. (shrink)

Bioethicists often defend novel practices by drawing analogies with practices that we are already familiar with and currently tolerate. If some novel practice is less bad than some widely-accepted practice, then (it is argued) we cannot rightly reject it. Using the bioethics literature on xenotransplantation and interspecies blastocyst complementation as a case study, I show how this style of argument can go awry. The key problem is that our moral intuitions about familiar practices can be distorted by their seeming normality. (...) When considering the ethics of emerging technologies and novel practices, we should remain open to the possibility that our moral views about familiar practices are mistaken. (shrink)

This paper suggests that the increasing bureaucracy of ethics review by committee is more about fulfilling institutional requirements than it is about ethics. It is suggested that ethics committees should not be instruments of bureaucratic regulation and control. They should be freed to play a critical role within the institution, to support and develop ethical research and researchers, and given time to discuss and explore difficult ethical issues where they arise. To burden research ethics committees with trivial bureaucratic tasks (...) is to miss an opportunity for healthy exchanges of views about ethics and to distort the nature and meaning of ethics. (shrink)

The term ‘bioethics’ is commonly associated with debates prompted by innovations in medical technology, yet the issues raised by bioethics are not new. They concern the extent to which medicine and social morality exist in harmony or opposition — issues routinely addressed in the social history of medicine. This paper will argue that historical thinking, understood broadly, has a significant role to play in understanding relations between medicine and social morality, and therefore in contemporary bioethics. It explores past and present (...) uses of metaphor and analogy in shaping perceptions of scientific innovation, and argues for the validity of apparently anachronistic thinking in our judgments of the past. The aims of the paper are ultimately pedagogical: to enable students to look at media reports about developments in medicine and biotechnology in order to problematise what are presented as the self-evident terms of current debate. (shrink)

AbstractHow far can smart machines, or carebots, go in performing the profoundly intimate human work of patient caregivers? How will mechanization alter how we understand the essential features of the human task of caregiving and the role of the caregiver? It is these complex questions, with real world implications, that this article discusses in reviewing “Caregiving, Carebots, and Contagion” by philosopher and bioethicist Michael Brannagan.

The community of inquiry methodology was developed by Professor Matthew Lipman to enable the teaching of philosophy in schools. Lipman felt that inquiry-based learning was essential in schools because:Education should empower children to be thoughtful about the lives they lead, and doing philosophy is important to that goalThe community of inquiry is a powerful pedagogical tool to foster student engagement, critical thinking, and collaborative and affective skills development As such it can be useful in the bioethics dassroom. This article describes (...) the community of inquiry methodology and how it can be a useful arrow in quiver to a teacher of bioethics. (shrink)

While solid organ transplantation for patients with substance use issues has attracted ethical discussion, a typology of the ethics themes has not been articulated in the literature. We conducted a scoping review of peer-reviewed literature on solid organ transplantation and substance use published between January 1997 and April 2016. We aimed to identify and develop a typology of the main ethical themes discussed in this literature and to identify gaps worthy of future research. Seventy articles met inclusion criteria and (...) underwent inductive content analysis. Four main ethical themes were identified: (1) personal responsibility; (2) utility; (3) moral character; and (4) fairness. Each theme had multiple sub-themes and there was substantial overlap between themes. This scoping review identified a disproportionate emphasis in the literature regarding personal responsibility, which was referenced by each of the other themes, and a narrow focus on alcohol and liver. We recommend future research further investigate these connections between ethical themes and focus on ethical issues associated with transplants from organ groups other than liver for patients who use substances other than alcohol. (shrink)