Cover Page

Contents

Notes on Contributors

Acknowledgments

General Introduction

Who Is This Book for?

What Is Bioethics?

The Canon of Bioethics

Motivations for Topics in Bioethics

The Classification of Bioethics

A Philosophical Discipline

Dealing with Hot-Button Issues

References

Part 1 Are There Universal Ethical Principles That Should Govern the Conduct of Medicine and Research Worldwide?

Introduction

References

Chapter One There Are Universal Ethical Principles That Should Govern the Conduct of Medicine and Research Worldwide

Introduction

The Universalism–Particularism Debate in Historical Perspective

Emergence of the Concept of Human Dignity

The Dynamics of Dignity and Moral Particularism

Conclusion

References

Chapter Two There Are No Universal Ethical Principles That Should Govern the Conduct of Medicine and Research Worldwide

Introduction

Principles: One Part of a Balanced Breakfast

Universalism: Promises and Pitfalls

Binding Moral Norms and Self-Evidence

Conclusion

References

Reply to Decker

References

Reply to Pullman

Human Dignity and Speciesism

The Redundancy of Basic Dignity

Conclusion

References

Part 2 Is It Morally Acceptable to Buy and Sell Organs for Human Transplantation?

Introduction

References

Chapter Three It Is Morally Acceptable to Buy and Sell Organs for Human Transplantation

Introduction

Some Background Numbers

Financial Incentives: Increasing Access to Transplantation

Human Organs Are Instrumental Goods

Marketplace Morality

Coerced Altruism

Persons and Their Bodies

Conclusion

Acknowledgment

References

Chapter Four It Is Not Morally Acceptable to Buy and Sell Organs for Human Transplantation

The Harsh Reality of Allowing Markets in Organs—Trafficking of the Poor

Scarcity—Bad, Underestimated, and Growing Worse

Duties to Those in Need and Duties to Those Who Might Supply an Organ

The Prevailing Ethical Framework for Obtaining Organs and Tissues

Increasing the Supply

The Trouble with Markets in Kidneys

A Better Option—Default to Donation

Conclusion

References

Reply to Caplan

References

Reply to Cherry

Part 3 Were It Physically Safe, Would Human Reproductive Cloning Be Acceptable?

Introduction

References

Chapter Five Were It Physically Safe, Human Reproductive Cloning Would Be Acceptable

Dolly: A Wolf in Sheep’s Clothing?

What Is Reproductive Cloning?

The Argument that Reproductive Cloning Is Physically Unsafe

Reasons For Reproductive Cloning

Reasons Against Reproductive Cloning

Harm to Others

Eugenics

Human Dignity

Conclusion

Note

References

Chapter Six Were It Physically Safe, Human Reproductive Cloning Would Not Be Acceptable

Introduction

The Identical Twin Analogue

The ART Analogue

The Adopted Child Analogue

The Parent–Child Resemblance Analogue

The Replacement Child Analogue

Cloning as “Unnatural”

HRC as a Means

Autonomy and Beyond

Societal Prejudice and Respect

Conclusion

References

Reply to Levick

The Identical Twin Analogy

The Assisted Reproduction Analogy

The Adoption Analogy

The Parent–Child Resemblance Analogy

The Replacement Child Analogy

Reply to Devolder

On Reasoning by Analogy

The Identical Twin Analogue

The Assisted Reproductive Technology Analogue

The Parent–Child Resemblance Analogue

The Replacement Child Analogue

Devolder’s Conclusions in Her Reply

The Child of the Famous Analogue

Conclusion

References

Part 4 Is the Deliberately Induced Abortion of a Human Pregnancy Ethically Justifiable?

Introduction

References

Chapter Seven The Deliberately Induced Abortion of a Human Pregnancy Is Ethically Justifiable

Introduction

The Moral Question of Abortion: Learning about the Key from the Keyhole

The Asymmetric Value of Human Life: Respecting Persons and Protecting Their Lives

Morality and Mattering: What Makes Killing Humans Wrong

References

Chapter Eight The Deliberately Induced Abortion of a Human Pregnancy Is Not Ethically Justifiable

The Reproductive Freedom Perspective

The Innocent-Human-Life Perspective

Warren’s Personhood Perspective

The Pro-Attitude Perspective

The Future of Value View

The P-Future of Value View

The Superiority of the P-Future of Value View

The Ideal Desire Perspective

Thomson’s Defense of Abortion Rights

Conclusion

References

Reply to Marquis

Reply to Reiman

References

Part 5 Is It Ethical to Patent or Copyright Genes, Embryos, or Their Parts?

Introduction

References

Chapter Nine It Is Ethical to Patent or Copyright Genes, Embryos, or Their Parts

Introduction

Intellectual Property Rights

Creativity and Innovation Policy

Ethics and Morality

Myths and Legends

Genes, Embryos, and Their Parts

Patent Eligible Subject Matter

A Path Forward?

Notes

References

Chapter Ten It Is Not Ethical to Patent or Copyright Genes, Embryos, or Their Parts

Introduction

Intellectual Property

Patenting “Life”

Consequentialism

Deontological Arguments

Conclusions

References

Reply to Koepsell

Reply to Sung

References

Part 6 Should a Child Have the Right to Refuse Medical Treatment to Which the Child’s Parents or Guardians Have Consented?

Introduction

References

Chapter Eleven The Child Should Have the Right to Refuse Medical Treatment to Which the Child’s Parents or Guardians Have Consented

Introduction

Competence and Incompetence

Legal Incompetence of Minors and the Categorical Age Criterion

The Moral Rights of Adolescents to Consent to or Refuse Medical Treatment

Treatment-Refusal Situations

References

Chapter Twelve The Child Should Not Have the Right to Refuse Medical Treatment to Which the Child’s Parents or Guardians Have Consented

Introduction

Speaking the Language of Rights in the Vernacular of the Law

A Foundation in Law: The Child and the Parent

The Law, Psychology, and Neurology: Consent and Refusal to Consent, or Dissent

The Right to Decide: Consent and the Refusal of Consent

Conclusion: Respecting Childhood and Adolescence

Note

References

Reply to Brooks

Reply to Winslade

Part 7 Is Physician-Assisted Suicide Ever Ethical?

Introduction

References

Chapter Thirteen Physician-Assisted Suicide Is Ethical

Introduction

Magda

The Value of Human Life

Confusing Essence with Existence

Social and Political Reasons

Kant and Mill

The Morality of Suicide and Physician-Assisted Suicide

Being Careful, Cautious, and Conscientious

Provisos

References

Chapter Fourteen Physician-Assisted Suicide Is Not Ethical

Introduction

Why Intentionally Killing Innocent People (Including Oneself) Is Morally Wrong

Intentional Killing vs. Accepting Death as a Side Effect

The Denial That Life Is in Itself Valuable

Can Innocent Human Life Lose Its Value?

Can the Intrinsic Value of Life Be Outweighed by Other Considerations?

References

Reply to Lee

Objective Values

Human Nature

Shaping Lives

Life as a Basic Good

Benefits and Burdens

Losing Features

Reply to Lachs

Part 8 Should Stem-Cell Research Utilizing Embryonic Tissue Be Conducted?

Introduction

References

Chapter Fifteen Stem-Cell Research Utilizing Embryonic Tissue Should Be Conducted

Introduction

What Are Stem Cells?

What Are Embryonic Stem Cells?

Embryonic Stem-Cell Research

Mistakes of Opponents

We Should Allow Stem-Cell Research

References

Chapter Sixteen Stem-Cell Research Utilizing Embryonic Tissue Should Not Be Conducted

Introduction

Respect for the Individual

Are Embryos Persons?

Arbitrary Lines

Two Responses

Warren, Singer, and Tooley

The Nothing-Is-Lost Principle and the Principle of Waste Avoidance

Conclusion: Adult Stem Cells

Note

References

Joint Reply

Part 9 Should We Prohibit the Use of Chimpanzees and Other Great Apes in Biomedical Research?

Introduction

References

Chapter Seventeen We Should Prohibit the Use of Chimpanzees and Other Great Apes in Biomedical Research

Models for Humans

Apes, Art, Trees

The Moral Status of Animals

Our Obligations to Animals

Rights for Apes

The Great Apes Are Special

Progress?

References

Chapter Eighteen We Should Not Prohibit the Use of Chimpanzees and Other Great Apes in Biomedical Research

Introduction

Biological Similarities

Chimpanzee as the Ideal Model

A Bit of History

AIDS and Hepatitis

The Continued Need for Chimpanzee Research

A Special Moral Category?

References

Reply to Cohen

References

Reply to Kazez

References

Part 10 Should the United States of America Adopt Universal Healthcare?

Introduction

References

Chapter Nineteen The United States of America Should Adopt Universal Healthcare

Introduction

Historical and International Perspectives

The Current Untenable Healthcare Landscape

The Case for UHC

The Market

Social Basis for UHC

Political Basis for UHC

UHC: A Real Alternative

Conclusion

References

Chapter Twenty The United States of America Should Not Adopt Universal Healthcare

Introduction

The “Right” to Healthcare vs. Freedom of Choice

What Is Wrong with US Healthcare?

The True Story of US Healthcare

What about Single-Payer?

Everybody’s Business: Socialized Costs vs. Personal Freedom

The Alternative

References

Reply to Whitman

References

Reply to Geyman

Mischaracterization of the US System

Hostility to Markets

Misplaced Concern with Inequality

Rose-Colored Single-Payer Glasses

References

Part 11 Is There a Legitimate Place for Human Genetic Enhancement?

Introduction

References

Chapter Twenty One There Is a Legitimate Place for Human Genetic Enhancement

Introduction

Defining Genetic Enhancement

The Interactionist View of Human Development

Potential Problems

Exploring Enhancement’s Moral Limits

The Inhumanity of Radical Enhancement

Comparing Moderate and Radical Enhancement

References

Chapter Twenty Two There Is No Legitimate Place for Human Genetic Enhancement

Introduction

The Philosophers

American Eugenics

The Final Solution

Since World War II

References

Reply to Black

Too Many Slippery Slopes

Genetic Enhancement vs. Eugenics

Slippery Slopes and Slip-Proof Ladders

References

Reply to Agar

References

Part 12 Can There Be Agreement as to What Constitutes Human Death?

Introduction

References

Chapter Twenty Three There Can Be Agreement as to What Constitutes Human Death

Statement of the Problem

A Biophilosophical Analysis of Death

The Paradigm of Death

Challenges to the Paradigm of Death

The Definition of Death

The Criterion of Death

Conclusion

Notes

References

Chapter Twenty Four There Cannot Be Agreement as to What Constitutes Human Death

Introduction

Three Examples of Death

Definitions, Criteria, and Biological Kinds

Life and Death as Biological Natural Kinds

Note

References

Reply to Chiong

References

Reply to Bernat

References

Part 13 Is There Ever a Circumstance in Which a Doctor May Withhold Information?

Introduction

References

Chapter Twenty Five There Are Circumstances in Which a Doctor May Withhold Information

Introduction

Historical Background of the Problem

A Framework of Principles for Biomedical Ethics

Problems of Autonomy Limitation: The Harm Principle and Medical Paternalism

The Nature of Autonomy-Limiting Principles

The Harm Principle and Its Import for Withholding Information from Patients

The Principle of Paternalism and Its Import for Withholding Information from Patients

Clinical Judgment and Strategies of Information Disclosure

References

Chapter Twenty Six There Are No Circumstances in Which a Doctor May Withhold Information

Introduction

History and Definition of Therapeutic Privilege

Ethical Frameworks for Analysis

Reasons Supporting Therapeutic Deception

Reasons Against Therapeutic Deception

AMA Policy

Conclusion

References

Reply to Eberl

Reply to Beauchamp

Part 14 Should In Vitro Fertilization Be an Option for a Woman?

Introduction

References

Chapter Twenty Seven In Vitro Fertilization Should Be an Option for a Woman

Introduction

Critiques of IVF

Addressing Consequentialist Concerns

No IVF!

Conclusion

References

Chapter Twenty Eight In Vitro Fertilization Should Not Be an Option for a Woman

I

II

III

IV

V

VI

VII

References

Reply to Tollefsen

Reply to Purdy

References

Part 15 Are International Clinical Trials Exploitative?

Introduction

References

Chapter Twenty Nine Clinical Trials Are Inherently Exploitative

Introduction

Exploitation and Valdman’s Position

The Motivation for International Clinical Trials

Problems with Obtaining Informed Consent in Developing Countries

The Weakness of Human Moral Motivation and Interpretation

The Argument

Conclusions

References

Chapter Thirty International Clinical Trials Are Not Inherently Exploitative

Introduction

Three Puzzles

Act Consequentialism and Priority

Multi-Level Consequentialism

Exploitation

Exploitation and the Three Puzzles

Summary

References

Reply to Arneson

References

Reply to Watson

Index

Contemporary Debates in Philosophy

 

In teaching and research, philosophy makes progress through argumentation and debate. Contemporary Debates in Philosophy provides a forum for students and their teachers to follow and participate in the debates that animate philosophy today in the western world. Each volume presents pairs of opposing viewpoints on contested themes and topics in the central subfields of philosophy. Each volume is edited and introduced by an expert in the field, and also includes an index, bibliography, and suggestions for further reading. The opposing essays, commissioned especially for the volumes in the series, are thorough but accessible presentations of opposing points of view.

 

1. Contemporary Debates in Philosophy of Religion
edited by Michael L. Peterson and Raymond J. Vanarragon

2. Contemporary Debates in Philosophy of Science
edited by Christopher Hitchcock

3. Contemporary Debates in Epistemology
edited by Matthias Steup and Ernest Sosa

4. Contemporary Debates in Applied Ethics
edited by Andrew I. Cohen and Christopher Heath Wellman

5. Contemporary Debates in Aesthetics and the Philosophy of Art
edited by Matthew Kieran

6. Contemporary Debates in Moral Theory
edited by James Dreier

7. Contemporary Debates in Cognitive Science
edited by Robert Stainton

8. Contemporary Debates in Philosophy of Mind
edited by Brian McLaughlin and Jonathan Cohen

9. Contemporary Debates in Social Philosophy
edited by Laurence Thomas

10. Contemporary Debates in Metaphysics
edited by Theodore Sider, John Hawthorne, and Dean W. Zimmerman

11. Contemporary Debates in Political Philosophy
edited by Thomas Christiano and John Christman

12. Contemporary Debates in Philosophy of Biology
edited by Francisco J. Ayala and Robert Arp

13. Contemporary Debates in Bioethics
edited by Arthur L. Caplan and Robert Arp

Image

This edition first published 2014
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Library of Congress Cataloging-in-Publication Data

Contemporary debates in bioethics / edited by Arthur L. Caplan, Robert Arp.
p. ; cm. – (Contemporary debates in philosophy ; 13)
Includes bibliographical references and index.

ISBN 978-1-118-32847-7 (epub) – ISBN 978-1-118-32848-4 (epdf) – ISBN 978-1-118-32849-1 (emobi) – ISBN 978-1-118-32850-7 – ISBN 978-1-118-32851-4 – ISBN 978-1-4443-3713-6 (cloth : alk. paper) – ISBN 978-1-4443-3714-3 (pbk. : alk. paper)
I. Caplan, Arthur L. II. Arp, Robert. III. Series: Contemporary debates in philosophy ; 13.
[DNLM: 1. Bioethical Issues. 2. Biomedical Research–ethics. 3. Genetic Enhancement–ethics. 4. Patient Rights–ethics. 5. Reproductive Techniques–ethics. WB 60]
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Notes on Contributors

Nicholas Agar, Ph.D., is Reader in Philosophy at Victoria University of Wellington, New Zealand. He is interested in ethical issues arising out of human enhancement. His most recent book on this topic is Humanity’s End: Why We Should Reject Radical Enhancement (2010).

Richard J. Arneson, Ph.D., holds the Valtz Family Chair in Philosophy in the Department of Philosophy at the University of California, San Diego. His recent current research is on distributive justice. Some of this work explores how one might best incorporate a reasonable account of personal responsibility into a broadly egalitarian theory of justice. He also considers how consequentialist morality (one ought always to do an act the consequences of which are no worse than those of any alternative available act) might be developed in a version that is appealing and appropriately responsive to its critics. This latter project involves exploring the structure of moderate deontology to identify the best rival of consequentialism.

Robert Arp, Ph.D., is author of Scenario Visualization: An Evolutionary Account of Creative Problem Solving (2008), co-editor with George Terzis of Information and Living Systems: Philosophical and Scientific Pers­pectives (2011), co-editor with Francisco Ayala of Contemporary Debates in Philosophy of Biology (Wiley-Blackwell, 2009), and co-editor with Alex Rosenberg of Philosophy of Biology: An Anthology (Wiley-Blackwell, 2009), and he has interests in bioethics as well. He works as a data analyst and modeler (see www.robertarp.webs.com).

Tom L. Beauchamp, Ph.D., is Professor of Philo­sophy and Senior Research Scholar, Kennedy Institute of Ethics, Georgetown University. His research interests are in the ethics of human-subjects research, the ethics of animal-subjects research and human uses of animals, the place of universal principles and rights in biomedical ethics, methods of bioethics, Hume and the history of modern philosophy, and business ethics.

James L. Bernat, M.D., is the Louis and Ruth Frank Professor of Neuroscience, and Professor of Neurology and Medicine at the Geisel School of Medicine at Dartmouth. He is a neurologist at Dartmouth-Hitchcock Medical Center where he directs the program in clinical ethics. bernat@dartmouth.edu.

Edwin Black is the award-winning, New York Times-bestselling and international investigative author of 80 award-winning editions in 14 languages in 65 countries, as well as scores of newspaper and magazine articles in the leading publications of the United States, Europe, and Israel. With more than a million books in print, his work focuses on genocide and hate, corporate criminality and corruption, governmental misconduct, academic fraud, philanthropic abuse, oil addiction, alternative energy, and historical investigation. For his award-winning eugenic work, War Against the Weak: Eugenics and America’s Campaign to Create a Master Race, he has received the Justice for All Award, the International Human Rights Award, and numerous other citations.

Catherine M. Brooks, J.D., is a professor of law at Creighton University in Omaha, Nebraska, ­specializing in children’s and family law. She is the co-founder of the Creighton Center for the Study of Children’s Issues and co-editor of the Nebraska Juvenile Court Procedures Manual. She has numerous publications in peer-reviewed journals and law reviews. Professor Brooks provides consultations to family law practitioners, child advocacy groups, and other social-service organizations, particularly in ­matters involving child custody disputes and child protection. She earned her law degree from the University of Virginia and her bachelor’s and master’s degrees from Thomas More College of Fordham University and the Graduate School of Arts and Sciences of Fordham University. Her current work focuses on the use of mediation and negotiation in resolving disputes within families and between families and state protection agencies.

Arthur L. Caplan, Ph.D., is the Drs William F. and Virginia Connolly Mitty Professor and founding head of the Division of Bioethics at New York University Langone Medical Center in New York City. Prior to coming to NYU, he was the Sidney D. Caplan Professor of Bioethics at the University of Pennsylvania Perelman School of Medicine in Philadelphia where he created the Center for Bioethics and the Department of Medical Ethics. He is the author or editor of 30 books and over 550 papers in refereed journals. His most recent books are Smart Mice Not So Smart People (2006) and the Penn Guide to Bioethics (2009).

Mark J. Cherry, Ph.D., is the Dr Patricia A. Hayes Professor in Applied Ethics and Professor of Philosophy at St. Edward’s University. He earned his undergraduate degree in philosophy from the University of Houston and his doctorate degree in philosophy from Rice University in Houston, Texas. His research compasses ethics and bioethics, together with social and political philosophy. He is author of Kidney for Sale by Owner: Human Organs, Transplantation and the Market (2005) as well as editor of The Journal of Medicine and Philosophy, associate senior editor of Christian Bioethics, Editor-in-Chief of HealthCare Ethics Committee Forum, co-editor of the book series The Annals of Bioethics, and editor of the book series Philosophical Studies in Contemporary Culture.

Winston Chiong, M.D., Ph.D., is a clinical ­fellow in the University of California, San Francisco Department of Neurology, and is a postdoctoral research fellow in the Helen Wills Neuroscience Institute at the University of California, Berkeley. His current research encompasses neuroscientific and conceptual methods to investigate changes in decision-making, moral agency, and personhood in the context of neurological illness.

Carl Cohen, Ph.D., is Professor of Philosophy at the University of Michigan, and co-author (with Tom Regan) of The Animal Rights Debate (2001). He was for years a member of the Animal Care and Use Committee of the Pfizer Corporation, and has served for decades on the Institutional Review Board of the University of Michigan Medical Center in Ann Arbor.

Kevin S. Decker, Ph.D., is Associate Professor of Philosophy and Associate Dean of the College of Arts and Letters at Eastern Washington University near Spokane, Washington. His areas of research interest include American pragmatism, social and political theory, and applied ethics. He is the co-editor of three books on philosophy and popular culture.

Katrien Devolder, Ph.D., is Senior Research Fellow at Bioethics Institute Ghent at Ghent University. Her research interests include medical ethics (in particular, the ethics of cloning), stem-cell research, genetic selection, chemical castration, and medical complicity in others’ wrongdoing.

Jason T. Eberl, Ph.D., is Associate Professor and Graduate Director of Philosophy in the Indiana University School of Liberal Arts at Indiana University-Purdue University, Indianapolis. He is also an affiliate faculty member of the IU Center for Bioethics and the IUPUI Medical Humanities & Health Studies program. He has published articles and reviews in American Journal of Bioethics, Bioethics, Journal of Medicine and Philosophy, National Catholic Bioethics Quarterly, and Linacre Quarterly. His book Thomistic Principles and Bioethics was published in 2006.

John Geyman, M.D., is Professor Emeritus of Family Medicine at the University of Washington School of Medicine, where he chaired the Department of Family Medicine from 1976 to 1990. He has also practiced family medicine in rural communities for 13 years, edited family-medicine journals for 30 years, served as president of Physicians for a National Health Program from 2005 to 2007, and is a member of the Institute of Medicine. His books include The Corporate Transformation of Health Care: Can the Public Interest Still Be Served? (2004), The Corrosion of Medicine: Can the Profession Reclaim Its Moral Legacy? (2008), and Health Care Wars: How Market Ideology and Corporate Power Are Killing Americans (2012).

Jean Kazez, Ph.D., is Adjunct Assistant Professor of Philosophy at Southern Methodist University. She is the author of Animalkind: What We Owe to Animals (2010) and The Weight of Things: Philosophy and the Good Life (2007), both published by Wiley-Blackwell.

David Koepsell, Ph.D., earned his law degree and Ph.D. in philosophy from the University at Buffalo. He teaches ethics in the Philosophy Section, Faculty of Values and Technology, Delft University of Technology, The Netherlands. He has published widely on the philosophy of intellectual property, applied ethics, ontology, and civil rights (see http://davidkoepsell.com).

John Lachs, Ph.D., is Centennial Professor of Philo­sophy at Vanderbilt University. His latest book, Stoic Pragmatism (Indiana University Press), has just appeared.

Patrick Lee, Ph.D., holds the John N. and Jamie D. McAleer Chair of Bioethics, and is the Director of the Institute of Bioethics, at Franciscan University of Steubenville. He has published widely on bioethics, including written articles and books on bioethics, including Body-Self Dualism in Contemporary Ethics and Politics (with Robert P. George, 2007), Abortion and Unborn Human Life (2010).

Stephen E. Levick, M.D., is a clinical assistant professor of psychiatry at the University of Pennsylvania School of Medicine, where he supervises psychotherapy, and has his own private practice nearby. His book, Clone Being: Exploring the Psychological and Social Dimensions (2004), was described by cloning pioneer, Ian Wilmut, as “the first framework for detailed analysis of the ethical, psychological, and social consequences of human reproductive cloning.” He employs arguments generated from that framework as both siege engines and battlements in his debate with Dr Devolder on the issue in this volume.

Jane Maienschein, Ph.D., is Regents’ Professor, President’s Professor, and Parents Association Profes­sor at Arizona State University, where she serves as Director of the Center for Biology and Society. She is also Adjunct Scientist and Director of the History and Philosophy of Science Program at the Marine Biological Laboratory in Woods Hole, Massachusetts. An MBL-ASU/HPS collaboration includes the Embryo Project (embryo.mbl.edu), HPS Repository, and Digital HPS Consortium. She is (co)editor of a dozen books and author of three, including Whose View of Life? Embryos, Cloning, and Stem Cells with Harvard University Press.

Bertha Alvarez Manninen, Ph.D., is an associate professor of philosophy at Arizona State University’s West campus. Her primary area of research is bioethics with an emphasis on the moral status of embryos and fetuses. Other interests include philosophy of religion, ancient philosophy, social and political philosophy, and philosophy and film.

Don Marquis, Ph.D., is Professor of Philosophy at The University of Kansas. His essay “Why Abortion is Immoral” was published in The Journal of Philosophy in 1989 and has been reprinted over 90 times.

Daryl Pullman, Ph.D., is a professor of medical ethics in the Faculty of Medicine, at Memorial University in Newfoundland and Labrador, Canada. He has published widely on issues in clinical and research ethics.

Laura Purdy, Ph.D., is Professor Emerita of Philosophy at Wells College. Her research has focused primarily on issues in reproduction and family.

Jeffrey Reiman, Ph.D., is the William Fraser McDowell Professor of Philosophy at American University in Washington, DC. He is the author of In Defense of Political Philosophy (Harper & Row, 1972), Justice and Modern Moral Philosophy (1990), Critical Moral Liberalism: Theory and Practice (1997), The Death Penalty: For and Against (with Louis Pojman, 1998), Abortion and the Ways We Value Human Life (1999), The Rich Get Richer and the Poor Get Prison: Ideology, Class, and Criminal Justice (with Paul Leighton, 2012), As Free and As Just as Possible: The Theory of Marxian Liberalism (Wiley-Blackwell, 2012), and more than 120 articles in philosophy and criminal justice journals and anthologies.

Lawrence M. Sung, J.D., Ph.D., is a Partner with the law firm of Baker & Hostetler LLP in the Washington, DC office, specializing in biotechnology, pharmaceutical, and medical device patent litigation, counseling, and technology transfer. Dr Sung is also a professor and the Director of the Intellectual Property Law Program at the University of Maryland School of Law in Baltimore, MD. He may be contacted at lsung@bakerlaw.com or lsung@law.umaryland.edu.

Christopher Tollefsen, Ph.D., is Professor of Philosophy at the University of South Carolina; he has twice been a visiting fellow in the James Madison Program at Princeton University. He has published over 60 articles, book chapters, and reviews on ­bioethics and natural law ethics, and is the author, co-author, or editor of five recent books, including Biomedical Research and Beyond: Expanding the Ethics of Inquiry (2012) and, with Robert P. George, Embryo: A Defense of Human Life (2011). He has recently completed a book manuscript, provisionally titled Truth, Lies, and the Natural Law: Why Lying for a Good Cause is Always Wrong. Tollefsen sits on the editorial board of a number of journals and is the editor of the Springer book series, Catholic Studies in Bioethics.

Jamie Carlin Watson, Ph.D., is Assistant Professor of Philosophy at Young Harris College (Young Harris, GA). With Robert Arp, he is the author of Critical Thinking: An Introduction to Reasoning Well (2011), Philosophy DeMYSTiFied (2011), and What’s Good on TV: Understanding Ethics Through Television (Wiley-Blackwell, 2011). He is currently working with Peter Fosl and Galen Foresman on The Critical Thinker’s Toolkit (Wiley-Blackwell).

Glen Whitman, Ph.D., is a professor of economics at California State University, Northridge and an adjunct scholar with the Cato Institute. He received his Ph.D. in economics from New York University in 2000. His research in applied game theory, economic analysis of law, and economic methodology has appeared in the Journal of Legal Studies, UCLA Law Review, Journal of Economic Behavior and Organization, and other scholarly journals. His current research interests include healthcare and paternalistic legislation.

William J. Winslade, J.D., Ph.D., Ph.D., is James Wade Rockwell Professor of Philosophy of Medicine, Professor of Preventive Medicine and Community Health, and Professor of Psychiatry and Behavioral Sciences, and is a member of the Institute for the Medical Humanities at the University of Texas Medical Branch, Galveston, Texas. He is also Distinguished Visiting Professor of Law at the University of Houston Health Law and Policy Institute. Philosophic, legal, and psychoanalytic ideas are applied in his work to the study of human values in science, medicine, technology, and law. His book Confronting Traumatic Brain Injury: Devastation, Hope and Healing was published in 1998. He has co-authored three other books: Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, Sixth Edition (2006), written for health professionals; The Insanity Plea: The Uses and Abuses of The Insanity Defense (1983), written for a general audience; and Choosing Life and Death (1986), written for patients and their families as well as health professionals about medical–moral–legal–technological topics such as kidney dialysis, organ transplantation, treatment or non-treatment of damaged newborns, termination of life support, genetic screening and counseling, and healthcare costs and policies. In addition, he has written numerous scholarly articles and essays for general readers on topics such as privacy and confidentiality, human rights, death and dying, and legal and ethical aspects of mental-health practice. He is currently working on a book with Stacey Tovino, J.D., Ph.D., tentatively titled The Birth Life and Death of the Brain: Legal and Ethical Perspectives.

Acknowledgments

Art wants to acknowledge the support of the New York University Langone Medical Center and its Dean, Robert Grossman, in giving him the opportunity to complete this book. Rob acknowledges the support of Jeff Dean at Wiley-Blackwell, who believed in the project in the first place.

General Introduction

Who Is This Book for?

This book features chapters written by contemporary scholars doing work in the central topics of the branch of applied ethics known as bioethics. The chapters are presented in a debate style with yes and no responses—often qualified—to core contemporary quandaries in the field. The book is intended to provoke discussion and debate for students in ethics, bioethics, and medical ethics classrooms in high school, college, and professional school.

What Is Bioethics?

The English word “bioethics” comes from two Greek words: bios (βίος) meaning “life” and ethikos (ἠθικός) meaning “displaying moral character.” In 1927, Fritz Jahr used the term in an article, “Bio-Ethik: Eine Umschau über die ethischen Beziehungen des Menschen zu Tier und Pflanze,” which can be translated as “Bio-Ethics: A Review of the Ethical Relationships of Humans to Animals and Plants” (Jahr, 1927; Sass, 2007; Goldim, 2009). In that article, Jahr wanted to extend a “bioethical imperative” to all forms of life, arguing that we ought to treat other humans and living things with respect as ends in and of themselves (Kant, 1785/1998). In 1971, Van Rensselaer Potter also used the term in his book, Bioethics: Bridge to the Future (Potter, 1971). He subsequently wrote Global Bioethics: Building on the Leopold Legacy, and in 1995 co-authored the article, “Global Bioethics: Converting Sustainable Development to Global Survival” (Potter, 1971, 1988; Potter & Potter, 1995). For both Jahr and Potter, what they referred to as “bioethics” would be considered today to be the related branch of applied ethics known as environmental ethics. This area of ethics explores our relationship to the natural world, our duties to preserve and protect nature, and whether morality extends beyond humans to animals, other living things, and the entire biosphere itself (Attfield, 2003; Keller, 2010).

Bioethics, while keenly aware of the ways in which health is shaped by climate and the environment, is focused today mainly on humans and the issues that emerge in conducting biomedical and clinical research, healthcare, and the policies that ought to govern medicine, nursing, allied health, and the related biomedical sciences (Caplan, 1992b, 1994, 1997, 1998, 2009; Jonsen et al., 2011). So, while the name “bioethics” derives from scholars seeking to create environmental ethics, the history of bioethics is actually rooted in medical ethics, a branch of applied ethics concerned with the practice of medicine and healthcare (Ramsey, 1970; Katz, 1984; Veatch, 1989, 2011; Pellegrino, 2008; Kuhse & Singer, 2009; Pence, 2010). Given the close connection between bioethics and medical ethics, some refer to the discipline as ­biomedical ethics (Beauchamp & Childress, 1979/2009; also Glannon, 2004; Mappes & DeGrazia, 2005).

The Canon of Bioethics

Bioethics has a subject matter and specific questions that it has developed near the end of the twentieth century, and the topics that comprise this subject matter include:

Most of these topics are debated by the contributors to this book. Each core topic is described further in the introductions to each section, including relevant reading material. The reader should consult various other resources in bioethics to get a sense of the scope and breadth of view on the core topics such as:

Edited books and encyclopedias:

Journals:

Bioethics centers maintain websites with useful information, including:

Motivations for Topics in Bioethics

The core topics of bioethics oftentimes emerged as a result of the moral outcry elicited by some highly publicized practice, event, or series of events in biomedicine or clinical research that actually (or potentially) harmed people, animals, or even the biosphere. In this respect, the topics in bioethics are no different than any ethical topic that has emerged in the course of human history (Cavalier et al., 1989; MacIntyre, 1998).

For example, the Nazi experimentation on humans that took place between 1939 and 1945, where people were subjected to various hazardous and horrific experiments often designed to assist in the advancement of military medicine and the physician-directed racial euthanasia campaigns of the Nazis, raised many questions about the ethics of those involved (Caplan, 1992a; Conot, 1993; Annas & Grodin, 1995; Lifton, 2000; Spitz, 2005). During and after the Nuremberg trials (1946–1949), where numerous Nazis were tried for a variety of atrocious crimes, the Nuremberg Code was devised and codified in response to the systematic abuse of human subjects in research. The Code, which was in reality the decision in one of the trials of German doctors, includes basic biomedical principles related to human experimentation (clinical research) such as absence of coercion in recruiting subjects, the necessity of informed consent, non-maleficence toward participants in experiments, and the correct formulation of a scientific protocol (Weindling, 2004; Schmidt & Frewer, 2007; NIH, 2011a).

It would seem that anyone who lived during the middle of the twentieth century and was made aware of the Nazi human experimentation would sympathize with the Jewish slogan that refers to the atrocities of the Holocaust and murder fueled by racism and anti-Semitism: Never Again! However, the US and the world were shocked to hear in 1972 that, for 40 years, an experiment monitoring the effects of syphilis upon poor, rural, and illiterate African-American men—who, having been lied to by researchers, thought they were being treated for the disease but in fact were not—had been conducted by the US Public Health Service and Centers for Disease Control and Prevention. The Tuskegee Syphilis Experiment—so named because Tuskegee Institute was a willing ­participant—began as an observational study in 1932 with 600 African-American men, 399 with syphilis and 201 without the disease. In 1972, when the study became known through whistle-blowing in the media, 74 of the 600 men were still alive. Concerning the original 399 men with syphilis, 28 died of syphilis, and 100 died of syphilis-related complications, while 40 of their wives were infected with syphilis, and 19 of their children were born with syphilis (Jones, 1992; Reverby, 2009). What makes this experiment all the more insidious is the fact that, by 1945, penicillin was being mass-produced in the US to treat diseases like syphilis, and the infected men in the experiment easily could have been treated after 1945; and many lives would have been saved as well as much pain and suffering avoided (Katz & Warren, 2011).

In response to the Tuskegee Syphilis Experiment as well as increased public awareness of other unethical experiments conducted in the US and in other countries (Beecher, 1966), in 1974 the National Research Act (Pub. L. 93-348) of the US established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974–1978), and in 1979 the Commission issued a landmark document for biomedicine or clinical research called, “The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research.” It was named “The Belmont Report” for the Smithsonian Institution’s Belmont Conference Center (Elkridge, MD) where the Commission met in February of 1976 when first drafting the report (Childress et al., 2005; NIH, 2011b). The Belmont Report affirmed all of the basic bioethical principles found in the Nuremberg Code, as well as articulated other principles, including the principle of justice whereby “equals ought to be treated equally.” The report called for peer review of all studies to insure that the risk/benefit ratio involved made moral sense and that the informed consent of subjects was adequate. Unfortunately, there are numerous cases of unethical human experimentation documented in the US and other countries throughout the twentieth century, and these cases form the basis for a central topic in bioethics (Moreno, 2000; Dresser, 2001; Goliszek, 2003; Guerrini, 2003; the papers in Hawkins & Emanuel, 2008).

Scandal was not the only driver of bioethics. Controversy plays a key role in the development of the field as well. Although abortion has been practiced by numerous cultures throughout human history and even can be traced to a Chinese medical text from the reign of Shen Nung (2737–2696 BCE), and although it is true that, by 1970, scholars had already been debating the abortion issue as a result of increased recognition of women’s reproductive rights, improvement in abortion technology, many ER instances of bungled backroom abortions, and the American Medical Association’s call to decriminalize abortion in the US (Noonan, 1970; Thomson, 1971; Warren, 1973), it was the landmark decision by the US Supreme Court to disallow many state and federal restrictions on abortion in Roe v. Wade (410 US 113) in 1973 that brought bioethical attention to the abortion issue (Jonsen, 1998; Joffe, 2009). And with that attention, another topic in bioethics was solidified.

Technological innovation has also driven the emergence of bioethics. Although Willem Kolff is credited with inventing the first kidney-dialysis machine (he also helped invent the artificial heart and heart–lung machine, as well as invented an artificial eye and ear, and the intra-aortic balloon pump), it was Belding Scribner who improved upon Kolff’s machine and opened the first center devoted to dialysis, the Seattle Artificial Kidney Center, in 1962 (Pietzman, 2007; Brown, 2009). Since there were a limited number of machines in the center and many more patients who needed dialysis in order to live, ethical questions related to who should receive dialysis emerged immediately (Jonsen, 2000, pp. 104–106; also Katz & Capron, 1982; Emanuel, 1991; Elger et al., 2008).

Harvard medical researchers, Philip Drinker and Louis Agassiz Shaw, invented the “iron lung” in 1927 to assist or restart breathing in individuals; but even with John Emerson’s improvements on the mechanism in 1931, iron lungs were big, bulky, and expensive to operate. Simple, hand-operated, bag valve mask ventilators began to be used by doctors and others in 1953; but they suffered from the obvious problem of having to be constantly squeezed by someone (Gorman, 1979; Laurie, 2002; Ambu, 2011). In 1971, Siemens introduced the medical world to a small, fairly quiet electronic ventilator—the SERVO 900—and various models soon became a staple in ERs, then in ambulances, too (Maquet Critical Care, 2001, 2005). The electronic ventilator now could be used to assist someone in their breathing, potentially indefinitely, and this occurred regularly for people in comas. The extended use of a ventilator (usually in combination with a feeding tube) has been the source of much debate, and cases of people in persistent vegetative states requiring ventilators and feeding tubes—such as the widely publicized cases of Karen Ann Quinlan, who lived with a feeding tube in a persistent vegetative state from 1975 to 1985, and Terri Schiavo, who lived with a feeding tube in a persistent vegetative state from 1990 to 2005—cause people to think about the extent to which these biomedical technologies are ethically appropriate or not (Armstrong & Colen, 1988; Buchanan & Brock, 1990; Caplan et al., 2006).