Bioethics, Third, An Anthology by Kuhse, Helga -- Read -- Imperial Library of Trantor

Index

Cover Title Page Table of Contents Acknowledgments Introduction Part I: Abortion

Introduction 1 Abortion and Health Care Ethics

Most People Begin at Fertilization Justice, Beneficence and Non-maleficence for Mother and Child Rape Prenatal Screening and Genetic Counselling Participation Embryo Experimentation Benevolence and Autonomy References

2 Abortion and Infanticide

I Abortion and Infanticide II Terminology: “Person” versus “Human Being” III The Basic Issue: When is a Member of the Species Homo sapiens a Person? IV Some Critical Comments on Alternative Proposals V Refutation of the Conservative Position VI Summary and Conclusions

3 A Defense of Abortion 4 Why Abortion Is Immoral

I II III IV V VI

Part II: Issues in Reproduction

Introduction

Assisted Reproduction Prenatal Screening, Sex Selection, and Cloning

Assisted Reproduction 5 Multiple Gestation and Damaged Babies 6 Assisted Reproduction in Same Sex Couples

Historical Overview of Same Sex Reproduction in the USA The Emergence of Assisted Reproduction for Lesbians and Gay Men Barriers to Assisted Reproduction for Gay Couples Key Issues Regarding Same Sex Reproduction: Review of the Literature Motivations for Parenthood Family Relationships, Attitudes, and Behaviors Gender Identity and Sexual Orientation of Children of Gay Parents The Social and Psychological Adjustment of Children of Gay Parents Gay Fatherhood through Assisted Reproduction Medical Aspects of Reproduction for Same Sex Couples Lesbian Couples Gay Male Couples Social and Psychological Aspects of Same Sex Reproduction Homophobia Family and Social Support Legal Issues Decision-Making for Prospective Gay Parents Lesbians: Who Will Carry the Pregnancy? Lesbians: Decisions about the Donor Gay Male Couples: Who Will Provide the Sperm? Gay Male Couples: Decisions about Donors and Surrogates Psychological Evaluation of Same Sex Couples Entering ART Summary and Conclusions References

7 Rights, Interests, and Possible People 8 The Ethics of Uterus Transplantation

Introduction Ethical Foundation of Transplantation What Can UTx Deliver? UTx, Medical Harms and Risk of Pregnancy Questions Concerning Informed Consent to UTx Donor Issues Alternatives to UTx? Reproductive Autonomy and Uterus Transplantation as ART Conclusion

Prenatal Screening, Sex Selection, and Cloning 9 Genetics and Reproductive Risk

Huntington's Disease Possible Children and Potential Parents

10 Prenatal Diagnosis and Selective Abortion

Contrasting Medical and Social Paradigms of Disability Implications for People with Disabilities Implications for Family Life Implications for Professional Practice Acknowledgments References

11 Genetic Technology

Introduction Work in Genetics and Its Social Impact A Philosophical Response Child-Centred Approach The Adult-Centred Approach The Deaf Community Argument Conclusion References

12 Sex Selection and Preimplantation Genetic Diagnosis

Background The General Ethical Debate Preimplantation Genetic Diagnosis and Sex Selection: Joining the Particular Issues Recommendations

13 Sex Selection and Preimplantation Diagnosis

Introduction References

14 Conception to Obtain Hematopoietic Stem Cells

The Need for Transplants Creating a Child Assuring a Match Prenatal Diagnosis Preimplantation Genetic Diagnosis Embryonic Stem Cells Policy and Practice References

15 Why We Should Not Permit Embryos to Be Selected as Tissue Donors

Children as Things What Kind of Ethics Do We Need?

16 The Moral Status of the Cloning of Humans

Introduction Cloning: Persons, Human Beings, Organs, and Tissue Cloning in the Present Context Is It Intrinsically Wrong to Produce a Person by Cloning? Considerations in Support of the Cloning of Persons Objections to the Cloning of Humans Conclusion Bibliography

Part III: Genetic Manipulation

Introduction 17 Questions about Some Uses of Genetic Engineering

Avoiding the Debate about Genes and the Environment Methods of Changing the Genetic Composition of Future Generations The Positive–Negative Distinction The View That Overall Improvement Is Unlikely or Impossible The Family and Our Descendants Risks and Mistakes Not Playing God The Genetic Supermarket A Mixed System Values

18 The Moral Significance of the Therapy–Enhancement Distinction in Human Genetics

Introduction Somatic versus Germline Interventions The Concepts of Health and Disease The Goals of Medicine Our Humanness The Rights of the Unborn Eugenics Conclusion: The Significance of the Distinction

19 Should We Undertake Genetic Research on Intelligence?

Introduction The First Hurdle – What Is Intelligence? What Is Currently Known about the Genetics of Intelligence? Behavioural Genetic Studies of Intelligence Molecular Genetic Studies of Intelligence Should Genetic Research into Intelligence Be Done? What Should We Do with the Results of This Research? Conclusion Acknowledgments

20 In Defense of Posthuman Dignity

Transhumanists vs. Bioconservatives Two Fears about the Posthuman Is Human Dignity Incompatible with Posthuman Dignity? Why We Need Posthuman Dignity

Part IV: Life and Death Issues

Introduction

Killing and Letting Die Severely Disabled Newborns Brain Death Advance Directives Voluntary Euthanasia and Medically Assisted Suicide

21 The Sanctity of Life

1 Direct Objections and Side-Effects 2 Stating the Principle of the Sanctity of Life 3 The Boundary between Life and Death 4 ‘Being Alive Is Intrinsically Valuable’ 5 ‘Being Conscious Is Intrinsically Valuable’ 6 ‘Being Human Is Intrinsically Valuable’ 7 The Concept of a ‘Life Worth Living’ 8 Is the Desire to Live the Criterion of a Worthwhile Life? 9 Length of Life 10 The ‘No Trade-Off’ View 11 The Social Effects of Abandoning the Sanctity of Life References

22 Declaration on Euthanasia

I The Value of Human Life II Euthanasia III The Meaning of Suffering for Christians and the Use of Painkillers IV Due Proportion in the Use of Remedies Conclusion

Killing and Letting Die 23 The Morality of Killing

The Morality of Killing

24 Active and Passive Euthanasia

Reference

25 Is Killing No Worse Than Letting Die?

2 3 4

26 Why Killing is Not Always Worse – and Sometimes Better – Than Letting Die

I II III

27 Moral Fictions and Medical Ethics

The Concept of Moral Fictions Exposing the Moral Fictions The Moral Work of Moral Fictions Abandoning the Moral Fictions

Severely Disabled Newborns 28 When Care Cannot Cure

Extreme Prematurity Birth Defects: Conditions That Can Be Fixed Birth Defects: Conditions That Cannot Be Fixed Withholding Treatment

29 The Abnormal Child 30 Right to Life of Handicapped 31 Conjoined Twins, Embodied Personhood, and Surgical Separation

1 Conjoined Twins 2 The Issue of Separation 3 The History of Metaphysical Assumptions about Conjoined Twins 4 Embodied Personhood in Singletons, Non-Conjoined Twins, and Conjoined Twins 5 Some Conclusions Acknowledgments References

Brain Death 32 A Definition of Irreversible Coma

Characteristics of Irreversible Coma Other Procedures Comment Summary Reference

33 Are Recent Defences of the Brain Death Concept Adequate?

Flaws in the BD Concept and Criterion Recent Expert Explanations and Defences of the BD Concept Conclusion

34 Is the Sanctity of Life Ethic Terminally Ill?

I Introduction II Revolution by Stealth: The Redefinition of Death III Revolution by the Law Lords: The Case of Anthony Bland IV Conclusion

Advance Directives 35 Life Past Reason

Autonomy

36 Dworkin on Dementia

Advance Directives and Precedent Autonomy Critical and Experiential Interests: Problems with the Model The State's Interest in Margo's Life Acknowledgment

Voluntary Euthanasia and Medically Assisted Suicide 37 The Note

Statement

38 When Self-Determination Runs Amok

Self-Determination Killing and Allowing to Die Calculating the Consequences Euthanasia and Medical Practice

39 When Abstract Moralizing Runs Amok 40 Trends in End-of-Life Practices Before and After the Enactment of the Euthanasia Law in the Netherlands from 1990 to 2010

Introduction Methods Results Discussion References

41 Euthanasia in the Netherlands

References

Part V: Resource Allocation

Introduction 42 Rescuing Lives 43 Should Alcoholics Compete Equally for Liver Transplantation?

Should Patients with ARESLD Receive Transplants? Objections to Proposal Reasons Patients with ARESLD Should Have a Lower Priority on Transplant Waiting Lists Should Any Alcoholics Be Considered for Transplantation? Need for Further Research Comment References

44 The Value of Life

I The Moral Significance of Age

45 Bubbles under the Wallpaper

Bubbles under the Wallpaper A Rights-Based Approach? Randomness to the Rescue? Conclusion References

Part VI: Obtaining Organs

Introduction 46 Organ Donation and Retrieval 47 The Case for Allowing Kidney Sales

References

48 Ethical Issues in the Supply and Demand of Human Kidneys

Brief Background: The Status Quo Systems of Kidney Procurement Anti-Market Considerations The Integrity of the Body Policy

49 The Survival Lottery

Part VII: Experimentation with Human Participants

Introduction

Human Participants Human Embryos – Stem Cells

Human Participants 50 Ethics and Clinical Research

Reasons for Urgency of Study Frequency of Unethical or Questionably Ethical Procedures The Problem of Consent Examples of Unethical or Questionably Ethical Studies Comment on Death Rates Publication Summary and Conclusions References

51 Equipoise and the Ethics of Clinical Research

Responses to the Problems of Equipoise Theoretical Equipoise versus Clinical Equipoise The Implications of Clinical Equipoise Acknowledgement References

52 The Patient and the Public Good

The Tumour Women and Breast Cancer The Physician Patient-Centered Care The Public Good and Physician Responsibility References

53 Scientific Research Is a Moral Duty

Do No Harm Fairness The Moral Imperative for Research Do Universal Moral Principles Deny This Claim? Is There an Enforceable Obligation to Participate in Research? Mandatory Contribution to Public Goods Benefit Sharing A New Principle of Research Ethics On Whom Does the Obligation to Participate in Research Fall? Me and My Kind Children and the Incompetent Inducements to Participate in Research Conclusion Acknowledgement References

54 Participation in Biomedical Research Is an Imperfect Moral Duty

The Principle of Beneficence The Principle of Fairness Conclusions Acknowledgments References

55 Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries

Asking the Wrong Research Question Inadequate Analysis of Data from ACTG 076 and Other Sources Defining Placebo as the Standard of Care in Developing Countries Justifying Placebo-Controlled Trials by Claiming They Are More Rapid Toward a Single International Standard of Ethical Research References

56 We’re Trying to Help Our Sickest People, Not Exploit Them 57 Medical Researchers’ Ancillary Clinical Care Responsibilities

What Is Ancillary Care? Two Extreme Views A Better Model What Do Participants Entrust to Researchers? How Strong Is the Entrustment Responsibility? Conclusion Acknowledgments References

Human Embryos – Stem Cells 58 President Discusses Stem Cell Research 59 Killing Embryos for Stem Cell Research

1 Two Assumptions 2 Assisted Conception 3 Monozygotic Twinning 4 Are Six-Day-Old Embryos Human Organisms? 5 We Are Not Human Organisms 6 We Are Not Souls 7 When We Begin to Exist 8 Potential 9 Intrinsic Value Acknowledgments References

Part VIII: Experimentation with Animals

Introduction 60 Duties towards Animals 61 A Utilitarian View 62 All Animals Are Equal 63 Vivisection, Morals and Medicine

Note

Morals and Medicine

I II III References

Commentary from a Vivisecting Professor of Pharmacology Response

Part IX: Public Health Issues

Introduction 64 Ethics and Infectious Disease

I Distribution of Research Resources II The Ethical Importance of Infectious Disease III Why the neglect? Conclusion

65 Rethinking Mandatory HIV Testing during Pregnancy in Areas with High HIV Prevalence Rates

Liability for Harm to an Unborn Child The Traditional versus the Current Debate Defending Conditionality Conclusions Acknowledgments References

66 Mandatory HIV Testing in Pregnancy

Some Preliminaries: Human Rights for Women in the Developing World The Good to Be Obtained The Means Used Will Not Cause More Harm Means Used Will Achieve and Not Undermine the Objective A Compromise: Treatment in the Absence of Testing Is There Ever a Time?

67 XDR-TB in South Africa

The Threat to Regional and Global Health The True Extent of the Problem Factors Fuelling the Outbreak Factors That Could Undermine Efforts to Tackle the Outbreak Is There a Role for Involuntary Detention? Conclusion References

Part X: Ethical Issues in the Practice of Healthcare

Introduction

Confidentiality Truth-Telling Informed Consent and Patient Autonomy

Confidentiality 68 Confidentiality in Medicine

Two Aspects of Medical Confidentiality The Role of Confidentiality in Medicine Possible Solutions to the Confidentiality Problem Afterthought: Confidentiality and Indiscretion Conclusion

69 The Duty to Warn and Clinical Ethics

Introduction Leading Cases and Legislation Concerning Reckless HIV Infections The Allowance to Warn Is There a Duty to Warn? The Tarasoff Case The Reisner Case The Garcia Case The Frankfurt Case Anti-Tarasoff Jurisdiction How Should the Physician Decide? Clinical Ethics Committees and Confidentiality Conclusion References

Truth-Telling 70 On a Supposed Right to Lie from Altruistic Motives 71 Should Doctors Tell the Truth? 72 On Telling Patients the Truth Informed Consent and Patient Autonomy 73 On Liberty 74 From Schloendorff v. NewYork Hospital 75 Informed Consent

The Historical Foundations of Informed Consent The Concept of Informed Consent Current Challenges to Informed Consent Conclusion

76 The Doctor–Patient Relationship in Different Cultures

“Physicians Treat Patients Badly” Similarities and Differences Conceptions of Autonomy: East and West Truth-Telling

77 Amputees by Choice

Editors' Note

78 Rational Desires and the Limitation of Life-Sustaining Treatment

The President's Commission Report Part I. What Is Autonomy? Part II. “No Man Ever Threw Away Life, While It Was Worth Keeping” Part III. Limitations of Treatment of Incompetent Patients Limitation of Treatment of Competent Patients Two Objections Conclusion

79 The Nocebo Effect of Informed Consent

I II III

Part XI: Special Issues Facing Nurses

Introduction 80 The Relation of the Nurse to the Doctor and the Doctor to the Nurse 81 In Defense of the Traditional Nurse

Role Components Transitional Roles Barriers to Autonomy Defending the “Traditional Nurse” Patient Needs: The Prime Concern Limits on the “Mother” Role Provider of Humanistic Care The Feminist Perspective Conclusions

82 Patient Autonomy and Medical Paternity

Scenario Introduction Futility and the End of Life Autonomy Analysed Nurses’ Role in Futile Treatment Decisions Patient Knows Best Doctor Knows Best Us and Them: Do Doctors and Nurses Consider Patient Autonomy Differently? End-of-Life Care and Autonomy Avoiding a Medicalized Death Achieving a Sense of Control Avoiding Inappropriate Prolongation of Dying How Can We Determine a Patient’s Quality of Life? Delivery System Differences Conclusion References

83 Health and Human Rights Advocacy

Introduction Background Human Rights Research Findings Discussion Conclusion References

Part XII: Neuroethics

Introduction 84 Neuroethics

Free Will and Mind–Body Reductionism Reductionism Redux Personal Identity Impaired Consent Manipulations; Natural and Not Mind Wars Is Neuroethics New? Acknowledgment References

85 How Electrical Brain Stimulation Can Change the Way We Think 86 Neuroethics

The Ethics of Neuroscience Memory Modification and Enhancement References

87 Freedom of Memory Today

References

88 Towards Responsible Use of Cognitive-Enhancing Drugs by the Healthy

Paths to Enhancement Favouring Innovation Substantive Concerns and Policy Goals Maximum Benefit, Minimum Harm Conclusion References

89 Engineering Love

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