The “principle of double effect” is a vital tool for moral decision making and is applicable to all areas of medical practice, including (for example) end-of-life care, transplant medicine, and cases of conscientious objection. Both our ultimate and our more immediate intentions are relevant in making and evaluating choices— though side effects must be kept proportionate and can be morally conclusive when linked with some intentions. Intentions help to form the character of doctors, and of human beings generally. While hypocrisy (...) is certainly possible in regard to this form (and other forms) of moral reasoning, double effect reasoning, sincerely practised, remains indispensable in identifying moral problems and solutions. (shrink)
Abortion for life-limiting foetal anomaly is often an intensely painful choice for the parents; though widely offered and supported, it is surprisingly difficult to defend in ethical terms. Abortion on this ground is sometimes defended as foetal euthanasia but has features which sharply differentiate it from standard non-voluntary euthanasia, not least the fact that any suffering otherwise anticipated for the child may be neither severe nor prolonged. Such abortions may be said to reduce suffering for the family including siblings – (...) a consideration rarely stated so explicitly in defences of postnatal euthanasia – or for the woman who must in any case face the eventual loss of her baby, and for whom the abortion is seen as therapeutic in minimising pain. Finally, the abortion may be said to constitute the cessation of morally optional life support on the part of the woman, and/or to be a ‘social’ choice she is entitled to make, whether or not this in fact promotes her interests or those of her child. These defences need honest exploration: the intense parental suffering caused by the choice to end an often much-wanted pregnancy should not preclude but rather encourage the question whether this choice can indeed be ethically proposed to couples, especially compared with the neonatal palliative care (‘perinatal hospice’) approach so well received by parents who experience it. (shrink)
The presence of a human being/organism—a living human ‘whole’, with the defining tendency to promote its own welfare—has value in itself, as do the functions which compose it. Life is inseparable from health, since without some degree of healthy functionality the living whole would not exist. The value of life differs both within a single life and between lives. As with any other form of human flourishing, the value of life-and-health must be distinguished from the moral importance of human beings: (...) less fulfilled means not less important morally, but more in need of being fulfilled. That said, to say that life and health has value is not to say exactly what—if anything—that value requires by way of active promotion at a given time. Many factors must be taken into account in making health care decisions, even if the worth of all lives, and the dignity of all human beings, must in every case be acknowledged. (shrink)
What makes something an embryo—as opposed to what is actually, and not just in biotech parlance, a collection of cells? This question has come to the fore in recent years with proposals for producing embryonic stem cells for research. While some of those opposed to use of standard embryonic stem cells emphasise that adult cells have a clinical track record, others argue that there may be further benefits obtainable from cells very like those of embryos, provided such cells can be (...) derived in new ways. Rather than deriving them in ways that kill or otherwise endanger a living human embryo, they could be obtained from an entity that merely resembles a human embryo sufficiently closely for its cells to be of use. Such an entity might be created after introducing genetic changes to an ovum before it is activated by, for example, a cloning-type procedure, such that a gene essential to embryogenesis will be either absent, blocked in its expression, or overexpressed.1,2 The claim is that the ovum could be made to give rise to embryonic stem cells—mere living parts—without ever giving rise to a whole embryo, who is killed to obtain them. Whereas cloning “proper” winds back the specialisation of the cell nucleus to a point where a whole embryo is formed who has not yet specialised its cells, oocyte-assisted reprogramming , it is claimed, would wind back the specialisation merely to an intermediate point at which no embryo is created. Other methods proposed for deriving pseudoembryonic cells include parthenogenesis, in which an ovum is activated without a sperm, or even the insertion of an adult cell nucleus.1MORAL STATUS OF THE EMBRYOIn this paper, I assume that a genuine …. (shrink)
Preimplantation genetic diagnosis (PGD) raises serious moral questions concerning the parent-child relationship. Good parents accept their children unconditionally: they do not reject/attack them because they do not have the features they want. There is nothing wrong with treating a child as someone who can help promote some other worthwhile end, providing the child is also respected as an end in him or herself. However, if the child's presence is not valued in itself, regardless of any further benefits it brings, the (...) child is not being treated as an end in the full sense of the term. In this paper, I argue that these principles apply to human embryos, as well as to born human offspring: the human moral subject is a bodily being, whose interests and rights begin with the onset of his or her bodily life. The rights of the living, bodily human individual include a right not to be attacked/abandoned because of his or her genetic profile. PGD is harmful to the parent-child relationship, and we give mixed messages to parents by expecting them to show unconditional commitment to offspring after birth, while inviting them to take a very different approach at the prenatal stage. (shrink)
In a world of rapid technological advances, the moral issues raised by life and death choices in healthcare remain obscure. _Life and Death in Healthcare Ethics_ provides a concise, thoughtful and extremely accessible guide to these moral issues. Helen Watt examines, using real-life cases, the range of choices taken by healthcare professionals, patients and clients which lead to the shortening of life. The topics looked at include: * euthanasia and withdrawal of treatment * the persistent vegetative state * abortion * (...) IVF and cloning * life-saving treatment of pregnant women Clearly written and insightful, _Life and Death in Healthcare Ethics_ presupposes no prior knowledge of philosophy. It will be of interest to anyone confronting healthcare ethics for the first time, or seeking to develop his or her understanding of some core topics in the field. (shrink)
A difficult task for politicians who want to fight injustice without doing wrong themselves is identifying where it is permissible to vote for and/or promote so-called “imperfect laws” which somewhat improve existing unjust legal situations but leave closely related injustices intact. One approach is to seek a “selective ban” on some injustices which are politically preventable. This approach is acceptable at least in principle, unlike the approach of “regulation”—i.e., permitting or instructing others to do, or prepare to do, the unjust (...) act in specified ways. The latter necessarily involves us in formal cooperation with evil: wrongly intending that others choose wrongly; for example, that abortion doctors deliberately prepare for abortion, albeit in ways that make an abortion less risky or less likely. In relation to parental consent or parental notification, and to pregnancy counselling and provision of information to pregnant women, while there may be ways of requiring these without complicity in others’ wrongful choices, this is at least more difficult than is often recognised. There can also be problems of principle in seeking consensus with fellow-legislators who may positively intend and even promote the continuation of remaining injustices even as they collaborate with more consistent reformers in passing laws which mitigate injustice overall. (shrink)
What does it mean to respect life and health in an innocent fellow-human being? Separating conjoined twins where one twin will die as a result need not involve the intention to kill or harm. Arguably, however, not all side-effects are “mere” side-effects which could, in principle, be outweighed by sufficiently good intended effects. Rather, foreseen serious harm for an innocent person we non-therapeutically affect can be morally conclusive when linked to the intention to affect the person’s body or invade the (...) space it fills. In the case of infant conjoined twins, such as the Maltese twins Jodie and Mary, the twin who dies from separation has no unjust, or any, intentions as regards the twin saved. She thus has the moral immunity of any innocent person from lethal bodily invasions and other serious bodily harm. Neither the final act which killed Mary nor previous acts of cutting into Mary, including parts shared with her twin Jodie, were therefore morally permissible. (shrink)
Germ-line therapy has long been regarded with great caution both by scientists and by ethicists. Even those who do not reject germ-line therapy in principle have tended to reject it in practice as carrying unacceptable risks in our current state of knowledge. For this reason, a recent paper by Rubenstein, Thomasma, Shon, and Zinaman is unusual in putting forward a serious proposal for the use of germ-line therapy in the foreseeable future.
May a couple have the aim of conceiving as their primary purpose in having marital relations? In this paper, I argue against the view of Alexander Pruss that it is wrong to do this since it treats human beings as fungible in their creation when their unique features are not known to their parents. I argue that Pruss cannot separate seeking reproduction as part of a marital vocation from seeking the unknown, unspecified child who is part of what makes for (...) success in this particular area. While neither spouse should treat the other as a mere tool for having a child, success in the shared goal of conceiving, as well as the goal itself and its pursuit, is very much part of the conjugal good. Existing human beings are morally irreplaceable in the sense that they must be individually valued and respected, but we may promote the lives of unknown existing people under a ‘catch all’ description—and may also deliberately conceive new people of some unknown, indeterminate kind. (shrink)
The guidelines on Decisions Relating to Cardiopulmonary Resuscitation begin with a reassuringly objective view of medicine: its “primary goal” is to benefit patients by “restoring or maintaining their health as far as possible, thereby maximising benefit and minimising harm”. Some might want to add that medicine has several goals, not all of which relate to promoting health; however, those who see the aim of the profession as more than consumer satisfaction will welcome the suggestion here that not just any choice (...) counts as medicine. In the same way, the statement which heads the next paragraph would be rejected by very few readers if “quality of life” were suitably defined. If all we mean by “quality of life” is the patient's level of wellbeing, with no suggestion that the value of his or her “being” can fall to zero or below, it is uncontroversial that “it is not an appropriate goal of medicine to prolong life at all costs with no regard to its quality or the burdens of treatment on the patient”. This is, however, an overly benign interpretation of “quality of life” observations as they appear in the guidelines. (shrink)
The proposal for reproducing human generations in vitro raises the question to what extent parenthood is possible in embryos and to what extent human rights and interests are dependent on conscious awareness. This paper argues that the interest in not being made a parent non-consensually for the benefit of others persists throughout the lifespan of the individual human organism. We do not become genetic parents by learning that we are parents; rather, we discover (or fail to discover) an existing genetic (...) relationship between our offspring and ourselves. The claim to genetic parenthood of an embryo used for reproduction in vitro is, if anything, clearer than the claim of the adult for whom gametes are derived via ips cells, in that an embryo’s cells, unlike an adult’s somatic cells, are already functionally geared to producing gametes (among other types of cell). An embryo used to make gametes that are used in reproduction is immediately and non-consensually made a genetic parent and to that extent is wronged whether or not the parent embryo survives – as some could survive – the harvesting of cells. All human individuals carry objective interests in benefits appropriate to the kind of being they are; these include the stake in not being made a parent without one’s consent, whether posthumously or otherwise. (shrink)
Some form of potential or "capacity" is often seen as evidence of human moral status. Opinions differ as to whether the potential of the embryo should be regarded as such evidence. In this paper, I discuss some common arguments against regarding the embryo's potential as a sign of human status, together with some less common arguments in favour of regarding the embryo's potential in this way.