English summary: Provocative Public Philosophy In 2017, I argued that people with Down syndrome cannot live full lives. This sparked a heated debated in the Norwegian public sphere. This gave rise to a debate over what academics should and should not say in public. A certain form of public philosophy, what I will call provocative public philosophy, was criticized for being harmful, imperialistic, for eroding trust in philosophers, and for creating too much noise. In this article I will, in light (...) of the Down syndrome debate, defend provocative public philosophy against these allegations. -/- Norsk sammendrag: En uttalelse om at personer med Downs syndrom ikke kan leve fullverdige liv, satte i gang en stor og opphetet debatt i den norske offentligheten i 2017. Denne ga opphav til en mer overordnet debatt om hva akademikere bør og ikke bør si i offentligheten. En viss form for offentlig filosofi, det jeg vil kalle provokativ offentlig filosofi, er blitt utpekt som synder. I denne artikkelen vil jeg, med utgangspunkt i debatten om fullverdige liv, forsvare provokativ offentlig filosofi mot både epistemiske og etiske innvendinger. (shrink)

Some disability rights advocates criticise prenatal testing and selective abortion on the grounds that these practices express negative attitudes towards existing persons with disabilities. Disability rights advocates also commonly criticise and oppose physician-assisted suicide (PAS) and euthanasia on the same grounds. Despite the structural and motivational similarity of these two kinds of arguments, there is no literature comparing and contrasting their relative merits and the merits of responses to them with respect to each of these specific medical practices. This paper (...) undertakes such a comparison. My thesis is that a number of potentially significant weaknesses of the expressivist argument against reproductive technologies are avoided when the argument is used against PAS. In particular, I try to show that three common criticisms of the expressivist argument applied to reproductive technologies, whatever merit they have, have even less merit when they are used to reply to the expressivist argument applied to PAS. This is important because the expressivist argument applied to the end of life scenario does not get as much attention as the argument applied to the beginning of life scenario, and yet it has a relatively stronger position. (shrink)

Are police officers morally justified in issuing unsolicited personal safety advice to women? Such advice often attracts accusations of ‘victim blaming’, although prevention advice remains a common tool used by police to address many crime and safety risks. While some examples of police advice are clearly outrageous, this article considers whether there is a place for ‘sound’ advice, i.e., advice that is proportionate, easy to follow, empirically justified, and objectively likely to reduce harm. To explore this, the article proposes a (...) thought experiment that compares safety advice dealing with threats to women from human sources with safety advice issued in response to natural phenomena, such as flooding. It argues that, despite apparent differences, safety advice addressing risks from humans and natural phenomena are relevantly similar. Consequently, if advice dealing with natural phenomena is morally justified then advice to women about human threats is also morally justifiable. Nevertheless, the article also considers whether the purported prevalence of sexism in policing may make safety advice for women morally problematic. While levels of sexism in policing may vary across time and location, it is argued that safety advice would be morally justified even if sexism was widespread among police officers. Finally, the article considers whether crime prevention advice may backfire by effectively curtailing women’s freedoms. Rather than curtailing freedom, however, it is argued that sound advice may actually enable women to flourish by helping them overcome fear of crime and achieve non-instrumental goals that they have set for themselves. (shrink)

Norway’s liberal abortion law allows for abortion on social indications, yet access to screening for fetal abnormalities is restricted. Norwegian regulation of, and public discourse about prenatal screening and diagnosis has been exceptional. In this study, we wanted to investigate whether the exceptional regulation is mirrored in public attitudes. An electronic questionnaire with 11 propositions about prenatal screening and diagnosis was completed by 1617 Norwegian adults (response rate 8.5%). A majority of respondents supports increased access to prenatal screening with ultrasound (...) (60%) and/or full genome sequencing of fetal DNA (55%) available for all pregnant women. Significant minorities indicate, however, that a public offer of prenatal screening for all pregnant women would signal that people with Down syndrome are unwanted (46%) or could be criticized for contributing to a ‘sorting society’ (48%). Results indicate deeper ambivalences and a cultural sensitivity to the ethical challenges of prenatal screening and subsequent abortions. The specific diagnosis of Down syndrome and the fear of becoming a ‘sorting society’ which sorts human life due to diagnoses, appear to play prominent roles in citizen deliberations. The low response rate means that a non-response bias cannot be excluded, yet reasons why results are still likely to be of value are discussed. (shrink)

Human germline genome editing is increasingly being seen as acceptable provided certain conditions are satisfied. Accordingly, genetic modifications would take place on eggs or sperm (or their prec...

Preimplantation genetic diagnosis allows the detection of genetic abnormalities in embryos produced through in vitro fertilization. Current funding models in Australia provide governmental subsidies for couples undergoing IVF, but do not extend to PGD. There are strong reasons for publicly funding PGD that follow from the moral principles of autonomy, beneficence and justice for both parents and children. We examine the objections to our proposal, specifically concerns regarding designer babies and the harm of disabled individuals, and show why these are (...) substantially outweighed by arguments for subsidizing PGD. We argue that an acceptance of PGD is aligned with present attitudes towards procreative decision making and IVF use, and that it should therefore receive government funding. (shrink)

In this original and interesting article,1 Phil Reed argues that the objections launched against expressivism at the beginning of life do not apply to expressivism at the end of life. Moreover, he claims that the expressivist argument adds to and substantiates the arguments against physician-assisted suicide and euthanasia. In this commentary, I will 1. Briefly examine whether the comparison between expressivism at the beginning and at the end holds. 2. Scrutinise whether there is a trickle down-effect of expressivism at the (...) end of life on other arguments against PAS/E. 3. Examine one version of the expressivist argument that is not discussed by Reed both at the beginning and at the end of life. Although Phil Reed certainly advances the expressivist debate, it is not clear that the objections to the expressivist argument are so different at the end compared with the beginning of life or that this adds to and substantiates the arguments against physician assisted suicide and euthanasia. Moreover, it is not obvious that the traditional objections to the expressivist argument, for example, that there is no message, no sender, and no receiver, have such a strong bite – neither at the beginning nor at the end of life. Biotechnologies are normative in many ways. We implement them normatively to obtain certain goals. At the same time, they facilitate certain actions and establish practices which form our norms and values, either intended or unintended. In either case, we need to pay attention to them, as …. (shrink)

Given that biases can distort bioethics work, it has received surprisingly little and fragmented attention compared to in other fields of research. This article provides an overview of potentially relevant biases in bioethics, such as cognitive biases, affective biases, imperatives, and moral biases. Special attention is given to moral biases, which are discussed in terms of (1) Framings, (2) Moral theory bias, (3) Analysis bias, (4) Argumentation bias, and (5) Decision bias. While the overview is not exhaustive and the taxonomy (...) by no means is absolute, it provides initial guidance with respect to assessing the relevance of various biases for specific kinds of bioethics work. One reason why we should identify and address biases in bioethics is that it can help us assess and improve the quality of bioethics work. (shrink)

In many countries, prenatal testing for certain fetal abnormalities is offered via publicly funded screening programs. The concept of reproductive autonomy is regarded as providing a justificatory basis for many such programs. The purpose of this study is to re‐examine the normative basis of public prenatal screening for fetal abnormalities by changing our perspective from that of autonomy to obligation. After clarifying the understanding of autonomy adopted in the justification for public prenatal screening programs, we identify two problems concerning this (...) justification: first, the extent to which the government is obliged to meet this demand is not evident; and, second, it is not clear whether the provision of public screening is the most appropriate way to promote autonomy. Next, to tackle these problems, we focus on Onora O’Neill’s argument of rights and obligations. Drawing on this argument, we show that, in addressing the problems above, it is important to change our normative perspective from rights or autonomy to obligation. Our argument will show that since the government does not have an incontrovertibly fundamental obligation to promote autonomy, this obligation needs to be constrained in terms of compatibility with other fundamental obligations. In addition, even if a government is obliged to promote autonomy to some degree, there could be more appropriate means to achieve it than providing public prenatal screening; therefore, it is not necessary for government obligations to extend to the provision of public prenatal screening. (shrink)

With the recent advancements in scientific comprehension of genetics and the decipherment of complex techniques for editing human genomes, liberal eugenics—eugenic ideal premised on the liberal values of autonomy and pluralism that leaves reproductive choices to parents rather than anachronistic statist authoritarian interventions—has inevitably become a polarising conundrum in contemporary liberal societies as to its utility and destructiveness. Focusing on one species of liberal eugenics—namely, genome editing interventions—I contend that liberal eugenics could be harmful—harm herein construed as that which undermines (...) the salient liberal values of equality, autonomy, and pluralism—since it is itself antithetical to the bases of the liberal society. This contention is based upon three premises: first, that individuals are rather seldom rational decision-makers such that leaving all reproductive choices to the whims of individual parents would be immensely counterproductive to future offspring’s right to open future; second, that liberal eugenics—much like its authoritarian antecedent—could intersect with myriad identities, including race, class, sex, disability, and sexual orientation in ways that might exacerbate social divisions, marginalise different groups, and engender homogeneity; and third, that it undermines individual autonomy of the future person as a member of the liberal community, particularly if their capacities and abilities are tailored to fit parents’ specific life projects and putatively reasonable conceptions of the good. The underscored potential malaises of liberal eugenics should, I argue, be discursively negotiated between parents and the state via the development of robust general laws that regulate heritable genome editing interventions to ensure that the welfare of the future persons is prioritised and that the liberal commitment to autonomy is immune to antiliberal perversions. (shrink)

With increased frequency, reproductive technologies are placing prospective parents in the position of choosing whether to bring a disabled child into the world. The most well-known objection to the act of “selecting against disability” is known as the Expressivist Argument. The argument claims that such acts express a negative or disrespectful message about disabled people and that one has a moral reason to avoid sending such messages. We have two primary aims in this essay. The first is to critically examine (...) the standard Expressivist Argument, which we analyze in terms of the expression of ableist attitudes. We distinguish three interpretations of the argument and argue that each version faces serious objections. Our second aim is to articulate two closely related arguments that also pertain to expressed ableist attitudes. The Expressive Harms Argument maintains that there is a moral reason to avoid actions that give rise to the perception of ableist attitudes in cases where this is likely to have negative consequences for disabled people. The Ableist Motivation Argument speaks against selecting against disability in cases where one would be motivated by ableist attitudes. While these two arguments face various objections, we seek to establish that they are more promising than the most natural interpretations of the Expressivist Argument. (shrink)

Asking pregnant women to pay for non-invasive prenatal testing out of pocket leads to unequal access across socioeconomic strata. To avoid these social justice issues, first-trimester prenatal screening should be publicly funded in countries such as the Netherlands, with universal coverage healthcare systems that offer all other antenatal care services and screening programmes free of charge. In this reply, we offer three additional reasons for public funding of NIPT. First, NIPT may not primarily have medical utility for women and children, (...) but rather offers relevant information and reproductive options, and thus serves important autonomy interests of women. Second, public funding of NIPT can be justified because it results in a reduction of collectively borne costs associated with care and support for children with chromosomal abnormalities. It is important to note that this is not an argument for individual women to take part in screening or to terminate an affected pregnancy. However, it is a legitimate argument in policy making regarding funding arrangements for screening programmes. Finally, public funding would help to amend current misunderstandings among pregnant women, and thus to support informed consent for first-trimester prenatal screening. (shrink)

The scope of noninvasive prenatal testing (NIPT) could expand in the future to include detailed analysis of the fetal genome. This will allow for the testing for virtually any trait with a genetic contribution, including “non-medical” traits. Here we discuss the potential use of NIPT for these traits. We outline a scenario which highlights possible inconsistencies with ethical decision-making. We then discuss the case against permitting these uses. The objections include practical problems; increasing inequities; increasing the burden of choice; negative (...) impacts on the child, family, and society; and issues with implementation. We then outline the case for permitting the use of NIPT for these traits. These include arguments for reproductive liberty and autonomy; questioning the labeling of traits as “non-medical”; and the principle of procreative beneficence. This summary of the case for and against can serve as a basis for the development of a consistent and coherent ethical framework. (shrink)

Many disabled individuals adamantly oppose medical assistance in dying, quite rightly referencing pervasive ableism and, euthanasia’s dark history in the Aktion T4 program of Nazi Germany in which...