There can be little doubt, at least in the Western world, that autonomy is the ruling principle in contemporary bioethics. In spite of its ‘triumph’ however, the dominance of the utilitarian concept of autonomy is being increasingly questioned. In this paper, I explore the nature of autonomy, how it came to displace the Hippocratic tradition in medicine and how different concepts of autonomy have evolved. I argue that the reduction of autonomy to ‘the exercise of personal choice’ in medicine has (...) led to a ‘tyranny of autonomy’ which can be inimical to ethical medical practice rather than conducive to it. I take the case of Kerrie Wooltorton as an illustration of how misplaced adherence to respect for patient autonomy can lead to tragic consequences. An analysis of autonomy based on the work of Rachel Haliburton is described and applied to the role of autonomy in a recent bioethical debate — that arising from Savulescu's proposal that conscientious objection by health-care professionals should not be permit.. (shrink)

Ediorial Content Type Journal Article Category Editorial Pages 139-140 DOI 10.1558/hrge.v17i2.139 Authors Trevor Stammers, St Mary’s University College, London Journal Human Reproduction & Genetic Ethics Online ISSN 2043-0469 Print ISSN 1028-7825 Journal Volume Volume 17 Journal Issue Volume 17, Number 2 / 2011.

invited commentary on David Oderberg's call for conscientious objection in medicine to be permitted in the UK.

The demand for organs prompted the first use of elective ventilation in the UK in the 1990s. Recently the shortfall in supply of organs has once again prompted calls for elective ventilation to be instituted even in patients who are not brain dead. This paper proposes that the term ‘elective’ ventilation is a misnomer and the term non-therapeutic ventilation (NTV) should be used instead. It is further argued that the practice of NTV in cases of severe stroke is unethical and (...) has the potential of causing a variety of harms to the patient, their relatives, the healthcare professionals working in transplant teams and this may result in a backlash of reductions in the number of organ donations. (shrink)

Volume 26, Issue 2, June 2020, Page 81-81.

Editorial for issue with articles on tranhumanism, principlism, total body transplants and inter-uterine surgery for myelomeningocele.

Volume 25, Issue 2, June 2019, Page 101-102.

Volume 25, Issue 1, March 2019, Page 1-2.

Volume 25, Issue 4, December 2019, Page 293-294.

Editorial on papers relating to among other infanticide and intersex.

A review of the range of articles in the summer issue of The New Bioethics.

In 2017, The New Bioethics published its first special-themed issue on the topic of personalized medicine. It proved highly popular, especially Gyawali and Sullivan’s paper ‘Economics of Can...

‘There is a tide in the affairs of men.Which, taken at the flood, leads on to fortune;’Those who edit academic journals rarely seek fortune in finan...

Covid-19 and arguments related to abortion – these two topics between them take up the majority of the pages of this issue. That the first of these should do so, is no surprise. Over two years on f...

This issue provides an end of year feast with something for everyone. Browning and Veit note how, since the presence of sentience in mammals, birds and cephalopods received official scientific reco...

In last June's themed issue on environmental bioethics, presciently planned in early 2019, we published in addition our very first paper on Covid-19 – a critique of the British Medical Association'...

I suspect that most readers will, like me, be unfamiliar with the concept of chirality. Indeed I had never heard of the term before reading Dahlen’s paper proposing the completely novel concept of...

Bioethics is not a field for the faint-hearted. Life and death decisions are both at stake and everything in between. Increasingly, before-life decisions are being taken as well and this issue comm...

One of the insights gained from editing a journal is to see early trends in the research topics of submissions. The ethics of data management in healthcare is an issue on which we have published a...

Volume 26, Issue 3, September 2020, Page 195-196.

This is a must-read text for anyone interested in the ethics surrounding gene editing. The author, a professor of clinical psychology at the University of Texas and director of their Developmental...

Review of book on the nature of conscience and history of development of ideas about it.

Review of Arul Gawande's best seller about preparing for death.

Volume 25, Issue 1, March 2019, Page 97-100.

‘This book is the record of an exploration. I am a writer, a non-specialist in a specialist's wilderness and I find my way with a writer's tools’. Just as we should never judge a book by i...

Amidst a plethora of books about human genome engineering (HGE), this one by John H Evans, a professor of sociology in the United States, stands out with its original and interesting take on how th...

Arising from a research project from the Faraday Institute for Science and Religion in Cambridge, UK, this primer on gene editing is written by a postdoctoral researcher in the Faculty of Divinity...

On September 27, 2016 people across the world looked down at their buzzing phones to see the AP Alert: “Baby born with DNA from 3 people, first from new technique.” It was an announcement met with confusion by many, but one that polarized the scientific community almost instantly. Some celebrated the birth as an advancement that could help women with a family history of mitochondrial diseases prevent the transmission of the disease to future generations; others held it unethical, citing medical (...) tourism and consequences for the future of the therapy. The child in question was actually born a few months earlier on April 6, 2016, but the research was published a few months later in the October edition of Fertility and Sterility. The mother carries DNA that could have given the baby Leigh Syndrome, a severe neurological disorder characterized by psychomotor regression that typically results in death between ages two and three.[1] Also known as subacute necrotizing encephalomyelopathy, Leigh Syndrome is caused by genetic mutations in mitochondrial DNA, which causes defective oxidative phosphorylation. Because people with this condition cannot re-form ATP, “demyleniation, gliosis, necrosis, spongiosis, or capillary proliferation”[2] can occur, thereby producing bilateral lesions across the central nervous system. The 36-year-old mother previously had four miscarriages and successfully birthed two children, both of whom survived less than six years due to the syndrome. For religious reasons, the mother opted for Spindle Nuclear Transfer instead of Pronuclear Transfer,[3] which many religious organizations oppose because it entails the destruction of fertilized eggs.[4] In Pronuclear Transfer, both the parent and donor egg are fertilized. The parent’s nuclear material is then removed from the egg containing mutated mitochondria and inserted into the fertilized donor egg—from which the original nuclear material has been removed and destroyed. Spindle Nuclear Transfer, on the other hand, removes the mother’s nuclear material from the egg with unhealthy mitochondria, then implants it into a donor’s egg. The newly created egg is then fertilized with the father’s sperm. This Spindle Nuclear Transfer was performed in Mexico by a team of doctors led by Dr. John Zhang, the founder of the New Hope Fertility Center in New York City. In their report, the doctors outline that five oocytes were successfully reconstituted, four of which developed into blastocysts. Only one was euploid: containing 46 XY chromosomes. Researchers then biopsied that blastocyst and found that the transmission rate of maternal mtDNA was, “5.10 ± 1.11% and the heteroplasmy level for 8993T>G was 5.73%.”[5] This indicates that at the blastocyst stage, around five percent of the mitochondria are from the original maternal egg with the mutation for Leigh Syndrome. After birth, they biopsied different tissues and found that they had an average of less than 1.60 ± 0.92% of transmitted mtDNA from the original maternal egg. The baby is reportedly doing well and the team of doctors concluded that “[h]uman oocytes reconstituted by SNT are capable of producing a healthy live birth. SNT may provide a novel treatment option in minimizing pathogenic mtDNA transmission from mothers to their babies."[6] Even when considered theoretically, Spindle Nuclear Transfer is controversial. Many doctors believe that the risks at this stage of research are too great. Dr. Trevor Stammers, a bioethicist at St. Mary’s University in London, points out: “We do not yet have a clear picture of the interaction between nuclear DNA and mitochondria.”[7] Others hold that faulty mitochondrial DNA can still be transferred during the procedure. Still more argue this technology could create problems because of germline modification.[8] Dr. Paul Knoepfler, a cell biologist at the UC Davis School of Medicine, explains: “Since this is uncharted territory and the children born from this technology would have heritable genetic changes, there are also significant unknown risks to future generations.”[9] However, proponents counter these arguments. They say the benefits outweigh the risks, as “mitochondrial replacement techniques [like Spindle Nuclear Transfer] would eliminate maternal transmission of mitochondrial disease… allowing a woman with a family history of mitochondrial diseases to ensure her children would not be affected.”[10] Additionally, experts say that no symptoms will occur if less than 20% of the transferred mitochondrial DNA is faulty.[11] And while opponents see potential germline modification as a problem, advocates answer that this could stop a family history of mitochondrial disease, which they deem a more serious concern. In this case specifically, however, there are more issues at hand. While the team of doctors did eliminate the possibility of germline modification by selecting a male embryo, there are other ethical concerns. Some argue that this case could be described as “medical tourism.” While New Hope Medical Clinic does maintain a branch in Mexico, Dr. Zhang stated that Mexico has “no rules.”[12] It is a country with underdeveloped regulations, making it difficult to confirm that doctors adhere to widely-held medical and ethical standards. Furthermore, while it is highly unlikely that the child will develop Leigh’s Syndrome, Dr. Dietrich Egli of the New York Stem Cell Foundation says the 5% mitochondrial transfer rate indicates that the technique “was not carried out well.”[13] He points to studies of embryos where the rate of mtDNA transfer was almost ten times lower. Spindle Nuclear Transfer is currently legal in the UK,[14] and many are hoping to see it legalized in the US, although Congress currently prohibits the FDA from considering applications that would entail trials in people.[15] While Dr. Zhang’s work is arguably revolutionary, many wonder if the manner in which this study was performed—in Mexico and with a high mitochondrial transfer rate—will impact the technology’s future in the US. Last week, Dr. Zhang presented the report to scientists gathered in Salt Lake City, saying that while science isn’t a race, it is “in a sense, a race for the family to find a cure, to find hope.”[16] Only time will tell if this study set back other families racing and hoping for a cure. References 1. "Leigh Syndrome." Genetics Home Reference, US National Library of Medicine, 25 Oct. 2016. Accessed 26 Oct. 2016. 2. McKusick, Victor A., and Ada Hamosh. "LEIGH SYNDROME; LS." Online Mendelian Inheritance in Man, Johns Hopkins University, 20 Jan. 2016. Accessed 30 Oct. 2016. 3. Zhang, J, H Liu, S Luo, A Chavez-Badiola, and Z Liu. "First live birth using human oocytes reconstituted by spindle nuclear transfer for mitochondrial DNA mutation causing Leigh syndrome." Fertility and Sterility, vol. 106, no. 3, 2016, pp. e375-76. Accessed 30 Oct. 2016. 4. Sample, Ian. "‘Three-parent’ babies explained: what are the concerns and are they justified?" The Guardian, 2 Feb. 2015. Accessed 30 Oct. 2016. 5. Zhang, et al. 6. Ibid. 7. Knapton, Sarah. "Three-parent babies: the arguments for and against." The Telegraph, 3 Feb. 2015. 8. Ibid. 9. Ibid. 10. "Mitochondrial Replacement Therapy FAQs." New York Stem Cell Foundation Research Institute, New York Stem Cell Foundation. Accessed 30 Oct. 2016. 11. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 12. Hamzelou, Jessica. "Exclusive: World’s first baby born with new “3 parent” technique." New Scientist, 27 Sept. 2016. Accessed 30 Oct. 2016. 13. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 14. "3-Person IVF: A Resource Page." Center for Genetics and Society, 24 Oct. 2016. Accessed 30 Oct. 2016. 15. Ritter, Malcolm. "Baby born with DNA from 3 people, first from new technique." Associated Press, 27 Sept. 2016. Accessed 30 Oct. 2016. 16. Chen, Daphne. "Controversy swirls around first three-parent baby." Deseret News, 19 Oct. 2016. Accessed 30 Oct. 2016. Works consulted Swetlitz, Ike. "FDA urged to approve ‘three-parent embryos,’ a new frontier in reproduction." STAT, 3 Feb. 2016. Accessed 30 Oct. 2016. (shrink)

‘It is remarkable that “trust” is absent from the index of many texts on the ethics of transplantation’, writes the former editor of this journal, Trevor Stammers, in the introductory chapter of hi...

The Ethics of Generating Posthumans is a multi-disciplinary anthology edited by Calum MacKellar, director of research at the Scottish Council on Human Bioethics, and Trevor Stammers, editor-in-chie...

This commentary aims to place Grace de Laguna’s critique of pragmatism in its historical context. It examines her 1904 response to Henry Heath Bawden, her 1909 attack on John Dewey’s immediate empiricism, and her 1910 book Dogmatism and Evolution, focusing on the following question: Why did she describe her approach as an attempt to complete the pragmatists’ Darwinian revolution in logic?

This paper first argues that we can bring out a tension between the following three popular doctrines: (i) the canonical reduction of metaphysical modality to essence, due to Fine, (ii) contingentism, which says that possibly something could have failed to be something, and (iii) the doctrine that metaphysical modality obeys the modal logic S5. After presenting two such arguments (one from the theorems of S4 and another from the theorems of B), I turn to exploring various conclusions we might draw (...) in light of these results, and argue that none comes cost free. In the course of laying out possible responses to my arguments, we'll have a chance to evaluate various doctrines about the interplay between contingency and essence, as well as develop some alternative reductions of metaphysical modality to essence. I don't decisively come down in favor of one response over the others, though I say some things that point towards the conclusion that essence has no role to play in reducing metaphysical modality. (shrink)

The consensus among spacetime substantivalists is to respond to Leibniz's classic shift arguments, and their contemporary incarnation in the form of the hole argument, by pruning the allegedly problematic metaphysical possibilities that generate these arguments. Some substantivalists do so by directly appealing to a modal doctrine akin to anti-haecceitism. Other substantivalists do so by appealing to an underlying hyperintensional doctrine that implies some such modal doctrine. My first aim in this paper is to pose a challenge for all extant forms (...) of this consensus position. My second aim is to show what form substantivalism must take in order to uphold the consensus while addressing this challenge. The result is a novel "plenitudinous" substantivalist view, which predicts that certain modal facts about spacetime are vague or indeterminate. I then argue against this view on independent grounds, concluding that substantivalists should reject the consensus position. The paper also discusses the way forward for substantivalists in light of this conclusion. (shrink)

Formal criteria of theoretical equivalence are mathematical mappings between specific sorts of mathematical objects, notably including those objects used in mathematical physics. Proponents of formal criteria claim that results involving these criteria have implications that extend beyond pure mathematics. For instance, they claim that formal criteria bear on the project of using our best mathematical physics as a guide to what the world is like, and also have deflationary implications for various debates in the metaphysics of physics. In this paper, (...) I investigate whether there is a defensible view according to which formal criteria have significant non-mathematical implications, of these sorts or any other, reaching a chiefly negative verdict. Along the way, I discuss various foundational issues concerning how we use mathematical objects to describe the world when doing physics, and how this practice should inform metaphysics. I diagnose the prominence of formal criteria as stemming from contentious views on these foundational issues, and endeavor to motivate some alternative views in their stead. (shrink)

Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist (...) appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. We discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle. (shrink)

The hole argument purports to show that all spacetime theories of a certain form are indeterministic, including the General Theory of Relativity. The argument has given rise to an industry of searching for a metaphysics of spacetime that delivers the right modal implications to rescue determinism. In this paper, I first argue that certain prominent extant replies to the hole argument—namely, those that appeal to an essentialist doctrine about spacetime—fail to deliver the requisite modal implications. As part of my argument, (...) I show that threats to determinism of the sort brought out by the hole argument are more general than has heretofore been recognized. I then use these results to propose a novel essentialist doctrine about spacetime that successfully rescues determinism, what I call sufficiency metric essentialism. However, I go on to argue that once we realize what an essentialist doctrine about spacetime must look like in order to address the hole argument, we should reject all such doctrines, because they can't fulfill their ambition of improving on standard modal replies to the argument. I close by suggesting some lessons for future work on spacetime and the metaphysics of physics more broadly, and also drawing some general morals for contemporary metaphysics, in particular about (i) whether essence can be used to articulate a precise structuralist doctrine, and (ii) the relationship between essence and modality. (shrink)

This book considers how language can be appropriately theorized as both a natural and cultural phenomenon. In reaching his conclusion, Pateman draws on a wide range of work in linguistics, philosophy, and social theory, and argues in defense of Chomsky and against Wittgenstein, all within the framework of a realist philosophy of science and contemporary social theory.