This chapter contains sections titled: Information Management: Confidentiality, Autonomy and Non‐Directiveness Predictive Genetic Testing Childhood Genetic Testing Genetic Screening Informed Consent to Screening Newborn Screening Carrier Screening Prenatal Screening Susceptibility Screening Further Information Management Goals of Genetic Screening: Public Health vs Individual Choice Conclusion References Further reading.

Due to new developments in prenatal testing and therapy the fetus is increasingly visible, examinable and treatable in prenatal care. Accordingly, physicians tend to perceive the fetus as a patient and understand themselves as having certain professional duties towards it. However, it is far from clear what it means to speak of a patient in this connection. This volume explores the usefulness and limitations of the concept of ¿fetal patient¿ against the background of the recent seminal developments in prenatal or (...) fetal medicine. It does so from an interdisciplinary and international perspective. Featuring internationally recognized experts in the field, the book discusses the normative implications of the concept of ¿fetal patient¿ from a philosophical-theoretical as well as from a legal perspective. This includes its implications for the autonomy of the pregnant woman as well as its consequences for physician-patient-interactions in prenatal medicine. (shrink)

BackgroundEthics consultation is recognized as an opportunity to share responsibility for difficult decisions in prenatal medicine, where moral intuitions are often unable to lead to a settled decision. It remains unclear, however, if the general standards of ethics consultation are applicable to the very particular setting of pregnancy.Main textWe sought to analyze the special nature of disagreements, conflicts and value uncertainties in prenatal medicine as well as the ways in which an ethics consultation service (ECS) could possibly respond to them (...) and illustrated our results with a case example. Ethics facilitation and conflict mediation, currently, have no broadly consented normative framework encompassing prenatal diagnosis and therapy as well as reproductive choice to draw on. Even so, they can still be helpful instruments for ethically challenging decision-making in prenatal medicine provided two additional rules are respected: For the time being, ECSs should (a) refrain from issuing content-heavy recommendations in prenatal medicine and (b) should not initiate conflict mediations that would involve the pregnant woman or couple as a conflict party.ConclusionIt seems to be vital that ethics consultants as well as health care professionals acknowledge the current limitations and pitfalls of ethics consultation in prenatal medicine and together engage in the advancement of standards for this particularly complex setting. (shrink)

Contributions to this study are drawn both from health professionals engaged in genetic counselling and from observers and critics with backgrounds in law, philosophy, biology, and the social sciences. This diversity will enable health professonals to examine their activities with a fresh eye, and will help the observer-critic to understand the ethical problems that arise in genetic counselling practice, rather than in imaginary encounters. Most examinations of the ethical issues raised by genetics are concerned in a broad sense with the (...) application of new technology to human reproduction. This volume focuses on genetic counselling and screening as such, providing valuable insights for the health professional, social scientist, philosopher, lawyer, and bioethicist. (shrink)

The paper by Mand et al raises important questions about the predictive genetic testing of children. They focus on those claims made by professionals that are open to empirical enquiry and give too little weight to those claims that do not require empirical support. The authors remind us that some commentators oppose empirical enquiry because of the concern that gathering evidence of the consequences of such testing may itself be harmful or unethical. They respond by asserting that the relevant research (...) questions are ‘eminently testable’ but fail to discuss the challenges of such research, including the questions of timescale, consent or the nature of the data whose collection (they assert) would resolve the perceived difficulties with the genetic testing of children. They conclude that empirical research is required without resolving the weighty arguments against predictive testing of young children or explaining how the evidence they wish to collect could overcome the force of the arguments that favour caution. (shrink)

Clinical genetics encompasses a wider range of activities than discussion of reproductive risks and options. Hence, it is possible for a clinical geneticist to reduce suffering associated with genetic disease without aiming to reduce the birth incidence of such diseases. Simple cost-benefit analyses of genetic-screening programmes are unacceptable; more sophisticated analyses of this type have been devised but entail internal inconsistencies and do not seem to result in changed clinical practice. The secondary effects of screening programmes must be assessed before (...) they can be properly evaluated, including the inadvertent diagnosis of unsought conditions, and the wider social effects of the programmes on those with mental handicap. This has implications for the range of prenatal tests that should be made available. While autonomy must be fully respected, it cannot itself constitute a goal of clinical genetics. The evaluation of these services requires interdepartmental comparisons of workload, and quality judgements of clients and peers. (shrink)

The paper by Bowman-Smart et al. (2023) on noninvasive prenatal genetic testing (NIPT) for non-medical traits aims to set out the case for and the case against such testing. In response to their pa...

Contributions to this study are drawn both from health professionals engaged in genetic counselling and from observers and critics with backgrounds in law, philosophy, biology, and the social sciences. This diversity will enable health professonals to examine their activities with a fresh eye, and will help the observer-critic to understand the ethical problems that arise in genetic counselling practice, rather than in imaginary encounters. Most examinations of the ethical issues raised by genetics are concerned in a broad sense with the (...) application of new technology to human reproduction. This volume focuses on genetic counselling and screening as such, providing valuable insights for the health professional, social scientist, philosopher, lawyer, and bioethicist. (shrink)

Non-invasive prenatal testing is an emerging form of prenatal genetic testing that provides information about the genetic constitution of a foetus without the risk of pregnancy loss as a direct result of the test procedure. As with other prenatal tests, information from NIPT can help to make a decision about termination of pregnancy, plan contingencies for birth or prepare parents to raise a child with a genetic condition. NIPT can also be used by women and couples to test purely ‘for (...) information’. Here, no particular action is envisaged following the test; it is motivated entirely by an interest in the result. The fact that NIPT can be performed without posing a risk to the pregnancy could give rise to an increase in such requests. In this paper, we examine the ethical aspects of using NIPT ‘purely for information’, including the competing interests of the prospective parents and the future child, and the acceptability of testing for ‘frivolous’ reasons. Drawing on several clinical scenarios, we claim that arguments about testing children for genetic conditions are relevant to this debate. In addition, we raise ethical concerns over the potential for objectification of the child. We conclude that, in most cases, using NIPT to test for adult-onset conditions, carrier status or non-serious traits presenting in childhood would be unacceptable. (shrink)

Discussion of a “duty to recontact” emerged as technological advances left professionals considering getting back in touch with patients they had seen in the past. While there has been much discussion of the duty to recontact as a matter of theory and ethics, there has been rather little empirically based analysis of what this “duty” consists of. Drawing on interviews with 34 professionals working in, or closely with, genetics services, this paper explores what the “duty to recontact” means for healthcare (...) professionals involved in genetics. Using a discourse analytic framework, the paper identifies three system generated discourses on recontact (governance, legal and responsibilizing discourses) and three lifeworld discourses (situating recontact as a formal duty; more loosely as an obligation; and as a personal sense of responsibility). In summary, the paper shows that the “duty” to recontact involves a complex interplay of system responsibilities with professional duties, responsibilities and obligations. (shrink)

The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dys-morphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms (...) of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future. (shrink)

The prevention, treatment and management of disease are closely linked to how the causes of a particular disease are explained. For multi-factorial conditions, the causal explanations are inevitably complex and competing models may exist to explain the same condition. Selecting one particular causal explanation over another will carry practical and ethical consequences that are acutely relevant for health policy. In this paper our focus is two-fold; the different models of causal explanation that are put forward within current scientific literature for (...) the high and rising prevalence of the common complex conditions of coronary artery disease and type 2 diabetes mellitus ; and how these explanations are taken up within national health policy guidelines. We examine the causal explanations for these two conditions through a systematic database search of current scientific literature. By identifying different causal explanations we propose a three-tier taxonomy of the most prominent models of explanations: evolutionary, lifecourse, and lifestyle and environment. We elaborate this taxonomy with a micro-level thematic analysis to illustrate how some explanations are semantically and rhetorically foregrounded over others. We then investigate the uptake of the scientific causal explanations in health policy documents with regard to the prevention and management recommendations of current National Service Frameworks for CAD and T2D. Our findings indicate a lack of congruence between the complexity and frequent overlap of causal explanations evident in the scientific literature and the predominant focus on lifestyle recommendations found in the mainstream health policy documents. (shrink)

In "Mathematical Truth", Paul Benacerraf articulated an epistemological problem for mathematical realism. His formulation of the problem relied on a causal theory of knowledge which is now widely rejected. But it is generally agreed that Benacerraf was onto a genuine problem for mathematical realism nevertheless. Hartry Field describes it as the problem of explaining the reliability of our mathematical beliefs, realistically construed. In this paper, I argue that the Benacerraf Problem cannot be made out. There simply is no intelligible problem (...) that satisfies all of the constraints which have been placed on the Benacerraf Problem. The point generalizes to all arguments with the structure of the Benacerraf Problem aimed at realism about a domain meeting certain conditions. Such arguments include so-called "Evolutionary Debunking Arguments" aimed at moral realism. I conclude with some suggestions about the relationship between the Benacerraf Problem and the Gettier Problem. (shrink)

This a general account of the school of Mo-tzu, its social basis as a movement of craftsmen, its isolated place in the Chinese tradition, and the nature of its later contributions to logic, ethics, and science. It assesses the relation of Mohist thinking to the structure of the Chinese language, and grapples with the textual dynamics of later Mohist writings, particularly in regard to grammar and style, technical terminology, the use and significance of stock examples, and overall organization. Includes edited (...) and annotated Chinese text with an English translation and commentary, a glossary, and a photographic reproduction of the unemended text from the Taoist Patrology. (shrink)

This paper arises out of the transition from a PhD thesis on Heidegger's phenomenology to my attempts to come to terms with ‘becoming a teacher’. The paper will provide a phenomenological interpretation of being a teacher in relation to the question of an ‘authentic’ interpretation of teaching/learning and the possibility of an authentic interpretative praxis. I will argue that being a teacher is a phenomenon of human existence which can be interpreted as a possible way of being with authentic and (...) inauthentic potentialities. This way of being is intrinsically linked to that of learning; of becoming human or becoming the authentic possibilities of being‐human. As such, the problem of being a teacher is primarily an ethical question (or a question of ɛτηοσ—dwelling); of who we are as humans and of how being a teacher engages with the in‐formation of the becoming of students as authentic human beings. This then leads to the problem of how a phenomenological interpretation of education can be applied or lived; of authenticity in teaching/learning and the possibilities of authentic learning environments (educational dwelling). (shrink)

The idea that animal rights can be married to environmental ethics is still a minority opinion. The land ethic of Aldo Leopold, as interpreted by J. Baird Callicott, remains fundamentally at odds with the ascription of substantial rights to (nonhuman) animals. Similarly, Laura Westra’s notion of “respectful hostility,” which attempts to reconcile a holistic environmental ethic with “respect” for animals, has no place for animal rights.In this paper, I argue that only by ascribing rights to sentient animals can an environmental (...) ethic avoid an unacceptable degree of anthropocentrism because only a rights-based environmental ethic can prohibit humans from significantly interfering with sentient animals when human vital needs are not at stake. A rights view that permits significant interference when it is required for the satisfaction of human vital needs avoids problems that otherwise plague a rights view. The “vital-needs rights view” reconciles the rights of animals with the satisfaction of human vital needs—including the vital need to have a flourishing natural environment—suggesting a possible alliance between animal rights and deep ecology and revealing the connections among vital needs, capitalism, and environmental degradation. (shrink)

All these specialist aspects of one life are different facets of the intellectual diamond which scintillates in the huge quarry of The Bertrand Russell Archives at McMaster University, Hamilton, Ontario. This is the quintessential man, the bundle of contradictions passionately dedicated to intellect, at times carrying the rational argument to irrational extremes; the natural-born emotional adventurer forever hampered by orphaned youth and too-early marriage. This Russell in the round is greater than the sum of his constituent parts, a man of (...) epic proportions, struggling through a lifetime beset with frustration and near-disaster; in youth the constitutional sceptic, in old age the sometimes splendid figure with "courage never to submit or yield.". (shrink)

It is argued that reliance on the testimony of others cannot be viewed as reliance on a kind of evidence. Speech being essentially voluntary, the speaker cannot see his own choice of words as evidence of their truth, and so cannot honestly offer them to others as such. Rather, in taking responsibility for the truth of what he says, the speaker offers a guarantee or assurance of its truth, and in believing him the hearer accepts this assurance. I argue that, (...) contrary to appearances, this account is compatible with the hearer acquiring knowledge, and in fact throws interesting light on the idea of knowledge. -/- . (shrink)

Fire safety expertise was in great demand following the Grenfell Tower fire in London in June 2017. The government established a review of building regulations and an expert panel to inform its responses to Grenfell, and many other relevant organisations also formed their own expert panels. However, expert knowledge in fire safety is a highly contested domain, with knowledge claims based on differing sources. Fire fighters can claim expertise based on their experience of fighting fires, scientists and science-based engineers can (...) claim expertise from experimentation, and those who create and enact regulations can claim expertise in what can termed ’codespeak’—the language of regulation. Although distanced from fundamental empirical experience of fire, codespeak is powerful because of its relative clarity and certainty, and legal status. Building users also bring their own form of ‘local’ expertise—they have first-hand experience of the practicalities of the solutions wrought by the other experts. Policy-makers thus face many competing forms of expert advice on fire safety, and their ability to judge what is most relevant in any particular case rests on the existence of a sufficient range and depth of in-house government expertise. (shrink)

Machine generated contents note: Preface; Introduction Angus Dawson; Part I. Concepts: 1. Resetting the parameters: public health as the foundation for public health ethics Angus Dawson; 2. Health, disease and the goal of public health Bengt Brülde; 3. Selective reproduction, eugenics and public health Stephen Wilkinson; 4. Risk and precaution Stephen John; Part II. Issues: 5. Smoking, health and ethics Richard Ashcroft; 6. Infectious disease control Marcel Verweij; 7. Population screening Ainsley Newson; 8. Vaccination ethics Angus Dawson; (...) 9. Environment, ethics and public health: the climate change dilemma Anthony Kessel and Carolyn Stephens; 10. Public health research ethics: is non-exploitation the new principle for population-based research ethics? John McMillan; 11. Equity and population health: toward a broader bioethics agenda Norman Daniels; 12. Health inequities James Wilson; Index. (shrink)

In these twelve papers notable ethicists use the resources of ethical theory to illuminate important theoretical and practical topics, including the nature of public health, notions of community, population bioethics, the legitimate role of law, the use of cost-effectiveness as a methodology, vaccinations, and the nature of infectious disease.

A groundbreaking collection of contemporary essays from leading international scholars that provides a balanced and expert account of the resurgent debate about substance dualism and its physicalist alternatives. Substance dualism has for some time been dismissed as an archaic and defeated position in philosophy of mind, but in recent years, the topic has experienced a resurgence of scholarly interest and has been restored to contemporary prominence by a growing minority of philosophers prepared to interrogate the core principles upon which past (...) objections and misunderstandings rest. As the first book of its kind to bring together a collection of contemporary writing from top proponents and critics in a pro-contra format, The Blackwell Companion to Substance Dualism captures this ongoing dialogue and sets the stage for rigorous and lively discourse around dualist and physicalist accounts of human persons in philosophy. Chapters explore emergent, Thomistic, Cartesian, and other forms of substance dualism—broadly conceived—in dialogue with leading varieties of physicalism, including animalism, non-reductive physicalism, and constitution theory. Loose, Menuge, and Moreland pair essays from dualist advocates with astute criticism from physicalist opponents and vice versa, highlighting points of contrast for readers in thematic sections while showcasing today’s leading minds engaged in direct debate. Taken together, essays provide nuanced paths of introduction for students, and capture the imagination of professional philosophers looking to expand their understanding of the subject. Skillfully curated and in touch with contemporary science as well as analytic theology, The Blackwell Companion to Substance Dualism strikes a measured balanced between advocacy and criticism, and is a first-rate resource for researchers, scholars, and students of philosophy, theology, and neuroscience. (shrink)

Many recent decisions in tort law attempt to combine two conceptually incommensurable features: a traditional 'but for' test of factual causation, and the scientific or medical evidence that is required to explain how some injury occurred. Even when applied to macroscopic objects, the 'but for' test fails to identify causes, because it merely rephrases in the language of possible worlds what may be inferred from what is inductively known about the actual world. Since scientific theories explain the occurrence of events (...) without reference to causes, this test of causation is not only ineffectual but also inapplicable to scientific or medical evidence. Tort law, therefore, should abandon the 'but for' test; when scientific or medical evidence is required in a tort case, the courts should rely on the explanatory strategies that function within the theories from which they borrow such evidence. (shrink)

The move towards the use of new technologies and the new focus on citizen engagement in Scotland provides the opportunity for e-democracy to emerge. Working towards the goal of e-democracy, the International Teledemocracy Centre is developing a body of ICT, supporting skills, tools and techniques, designed specifically to facilitate the use of technology, capable of enhancing democratic engagement. This paper begins to articulate how citizens are engaging with government and with their elected representatives about issues that concern them, using technology (...) specially designed for the purpose. The paper examines the nature of e-democracy and considers concepts of democracy, issues of democratization, and issues surrounding citizen access and participation. In addition, the paper discusses the design and use of two electronic tools developed by the ITC between 1999 and 2001 i. e. e-consultant and e-petitioner. Finally, the paper presents analyses of findings drawn from research to monitor and evaluate the use of these tools and the arrangements which accompany their entry into society. (shrink)

John Dupr argues that 'scientific imperialism' can result in 'misguided' science being considered acceptable. 'Misguided' is an explicitly normative term and the use of the pejorative 'imperialistic' is implicitly normative. However, Dupr has not justified the normative dimension of his critique. We identify two ways in which it might be justified. It might be justified if colonisation prevents a discipline from progressing in ways that it might otherwise progress. It might also be justified if colonisation prevents the expression of important (...) values in the colonised discipline. This second concern seems most pressing in the human sciences. (shrink)

In the Transcendental Aesthetic (TA), Kant is typically held to make negative assertations about “things in themselves,” namely that they are not spatial or temporal. These negative assertions stand behind the “neglected alternative” problem for Kant’s transcendental idealism. According to this problem, Kant may be entitled to assert that spatio-temporality is a subjective element of our cognition, but he cannot rule out that it may also be a feature of the objective world. In this paper, I show in a new (...) way how Kant’s view (focusing on his conclusions about space) is not subject to this objection, by showing that he does not make the denial about mind-independent reality that he is typically held to make. The argument develops consequences of a new reading of Kant’s expression “an sich selbst” (‘in itself’; ‘in themselves’). I argue that “an sich selbst” or “per se” has a special, judgment-level role, so that this expression does not form new noun-terms adjectivally. It follows that the conceptual unit of Kant’s “Conclusions” in the TA is simply “things” (Dinge), since “things in themselves” is not a nominal expression; Kant adopts the Wolffian ontological use of “thing” as the basic kind-term for any existent. The arguments that things per se are not in space are arguments that space cannot be a necessary property or relations of things as a kind. I show that this does not involve the positive claim about mind-independent reality that inspires the neglected alternative objection. (shrink)

Part I: The 'explanatory gap'. 1. Why take morality to be objective? -- 2. The gap opens: evolution and our capacity for moral knowledge -- Part II: Secular responses. 3. Alternatives to realism: Simon Blackburn and Allan Gibbard -- 4. Procedures and reasons: Tim Scanlon and Christine Korsgaard -- 5. Natural goodness: Philippa Foot's moral objectivism -- 6. Natural goodness and 'second nature': John McDowell and David Wiggin -- Part III: Theism. 7. From goodness to God: closing the explanatory gap (...) -- 8. Purpose without theism? Axiarchism and Neoplatonism. (shrink)

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Recent years have witnessed an escalation in corporate social reporting (CSR) by UK companies (Gray, Kouhy and Lavers 1995). Whilst some elements of CSR reporting are required by law, much of it represents voluntary reporting. By investigating the non‐mandatory reporting of two aspects of social responsibility, corporate community involvement (CCI) and environmental impact, this paper seeks to explore why companies choose to make such disclosures. It specifically asks whether companies are primarily motivated by the strategic need to manage their reputation (...) and legitimacy rather than by the recognition of their ethical accountability, which is the stated purpose of reports produced by cutting edge companies (Clarke 1998). (shrink)

This original, contemporary synthesis between phenomenology and Marx’s late work begins from Edmund Husserl’s The Crisis of the European Sciences and Transcendental Phenomenology to chart a new program for Socratic phenomenology in the current confrontation between planetary technology and place-based Indigeneity.