Mitochondrial replacement techniques have the potential to allow prospective parents who are at risk of passing on debilitating or even life-threatening mitochondrial disorders to have healthy children to whom they are genetically related. Ethical concerns have however been raised about these techniques. This article focuses on one aspect of the ethical debate, the question of whether there is any moral difference between the two types of MRT proposed: Pronuclear Transfer and Maternal Spindle Transfer. It examines how questions of identity impact (...) on the ethical evaluation of each technique and argues that there is an important difference between the two. PNT, it is argued, is a form of therapy based on embryo modification while MST is, instead, an instance of selective reproduction. The article's main ethical conclusion is that, in some circumstances, there is a stronger obligation to use PNT than MST. (shrink)

Non-Identity arguments have a pervasive but sometimes counter-intuitive grip on certain key areas in ethics. As a result, there has been limited success in supporting the alternative view that our choices concerning future generations can be considered harmful on any sort of person-affecting principle. However, as the Non-Identity Problem relies overtly on certain metaphysical assumptions, plausible alternatives to these foundations can substantially undermine the Non-Identity argument itself. In this paper, I show how the pervasive force and nature of Non-Identity arguments (...) rely upon a specific adoption of a theory of modality and identity and how adopting an alternative account of modality can be used to reject many conclusions formed through Non-Identity type arguments. By using Lewis’s counterpart-theoretic account to understand ways we might have been, I outline the basis of a modal account of harm that incorporates a person-affecting aspect. This, in turn, has significant implications for ethical decision-making in areas such as reproductive choice and the welfare of future generations. (shrink)

The classification of techniques used in mitochondrial donation, including their role as purported germ-line gene therapies, is far from clear. These techniques exhibit characteristics typical of a variety of classifications that have been used in both scientific and bioethics scholarship. This raises two connected questions, which we address in this paper: how should we classify mitochondrial donation techniques?; and what ethical implications surround such a classification? First, we outline how methods of genetic intervention, such as germ-line gene therapy, are typically (...) defined or classified. We then consider whether techniques of mitochondrial donation fit into these, whether they might do so with some refinement of these categories, or whether they require some other approach to classification. To answer the second question, we discuss the relationship between classification and several key ethical issues arising from mitochondrial donation. We conclude that the properties characteristic of mitochondrial inheritance mean that most mitochondrial donation techniques belong to a new sub-class of genetic modification, which we call ‘conditionally inheritable genomic modification’. (shrink)

The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a (...) satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories. (shrink)

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a (...) sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

The Mental Capacity Act 2005 has provided unified scope in the British medical system for proxy consent with regard to medical decisions, in the form of a lasting power of attorney. While the intentions are to increase the autonomous decision making powers of those unable to consent, the author of this paper argues that the whole notion of proxy consent collapses into a paternalistic judgement regarding the other person’s best interests and that the new legislation introduces only an advisor, not (...) a proxy with the moral authority to make treatment decisions on behalf of another. The criticism is threefold. First, there is good empirical evidence that people are poor proxy decision makers as regards accurately representing other people’s desires and wishes, and this is therefore a pragmatically inadequate method of gaining consent. Second, philosophical theory explaining how we represent other people’s thought processes indicates that we are unlikely ever to achieve accurate simulations of others’ wishes in making a proxy decision. Third, even if we could accurately simulate other people’s beliefs and wishes, the current construction of proxy consent in the Mental Capacity Act means that it has no significant ethical authority to match that of autonomous decision making. Instead, it is governed by a professional, paternalistic, best-interests judgement that undermines the intended role of a proxy decision maker. The author argues in favour of clearly adopting the paternalistic best-interests option and viewing the proxy as solely an advisor to the professional medical team in helping make best-interests judgements. (shrink)

The Liverpool Care Pathway for the Dying has recently been the topic of substantial media interest and also been subject to the independent Neuberger Review. This review has identified clear failings in some areas of care and recommended the Liverpool Care Pathway be phased out. I argue that while the evidence gathered of poor incidences of practice by the Review is of genuine concern for end of life care, the inferences drawn from this evidence are inconsistent with the causes for (...) the concern. Seeking to end an approach that is widely seen as best practice and which can genuinely deliver high quality care because of negative impressions that have been formed from failing to implement it properly is not a good basis for radically overhauling our approach to end of life care. I conclude that improvements in training, communication, and ethical decision-making, without the added demand to end the Liverpool Care Pathway would have resulted in a genuine advance in end of life care. (shrink)

Sustaining hope in patients is an important element of health care, allowing improvement in patient welfare and quality of life. However in the palliative care context, with patients who are terminally ill, it might seem that in order to maintain hope the palliative care practitioner would sometimes have to deceive the patient about the full nature or prospects of their condition by providing a ‘false hope’. This possibility creates an ethical tension in palliative practice, where the beneficent desire to improve (...) patient welfare through sustaining hope appears to be in conflict with an autonomy-based requirement not to deceive patients about their condition. In order to resolve this ethical tension, we provide an analysis of the concept of hope and argue that there is at least one conception – the ‘absolute’ conception of hope – which when properly understood allows practitioners to foster hope in terminally-ill patients while avoiding any need to deceive them about their condition. Practitioners therefore do not need to shy away from using the language of hope in the palliative setting, as on this understanding of hope it can be used in a way that both promotes patient welfare and respects patient autonomy. (shrink)

Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) essentialist arguments for the necessity (...) of origin. I offer an alternative account of modal harms based on counterpart theory such as that offered by David Lewis (1986). On this account, individuals can make legitimate harm claims in regard to pre-conception choices made in determining their genetic constitution by appeal to their counterparts across possible worlds. (shrink)

Parfit’s (1984) Non-Identity Problem provides a strong line of argument that we cannot be harmed by pre-conception choices or actions. I argue that we can no longer appeal to the Non-Identity problem in order to justify using pre-conception genetic screening and selection techniques as a harmless tool to determine the genetic constitution of future individuals. My criticism of the Non-Identity problem is based on a rejection of the metaphysical foundations of Parfit’s argument - Kripke’s (1980) essentialist arguments for the necessity (...) of origin. I offer an alternative account of modal harms based on counterpart theory such as that offered by David Lewis (1986). On this account, individuals can make legitimate harm claims in regard to pre-conception choices made in determining their genetic constitution by appeal to their counterparts across possible worlds. (shrink)

This paper examines the potential for abstracting propositions – an as yet untested way of defending the realist thesis that propositions as abstract entities exist. I motivate why we should want to abstract propositions and make clear, by basing an account on the neo-Fregean programme in arithmetic, what ontological and epistemological advantages a realist can gain from this. I then raise a series of problems for the abstraction that ultimately have serious repercussions for realism about propositions in general. I first (...) identify problems about the number of entities able to be abstracted using these techniques. I then focus on how issues of language relativity result in problems akin to the Caesar problem in arithmetic by exposing circularity and modal concern over the status of the criterion of identity for propositions. (shrink)

Over the past decades, public trust in medical professionals has steadily declined. This decline of trust and its replacement by ever tighter regulations is increasingly frustrating physicians. However, most discussions of trust are either abstract philosophical discussions or social science investigations not easily accessible to clinicians. The authors, one a surgeon-turned-philosopher, the other an analytical philosopher working in medical ethics, joined their expertise to write a book which straddles the gap between the practical and theoretical. Using an approach grounded in (...) the methods of conceptual analysis found in analytical philosophy which also draws from approaches to medical diagnosis, the authors have conceived an internally coherent and comprehensive definition of trust to help elucidate the concept and explain its decline in the medical context. This book should appeal to all interested in the ongoing debate about the decline of trust - be it as medical professionals, medical ethicists, medical lawyers, or philosophers. (shrink)

Volume 20, Issue 8, August 2020, Page 27-29.

The standard by which we apply decision-making for those unable to do so for themselves is an important practical ethical issue with substantial implications for the treatment and welfare of such individuals. The approach to proxy or surrogate decision-making based upon substituted judgement is often seen as the ideal standard to aim for but suffers from a need to provide a clear account of how to determine the validity of the proxy's judgements. Proponents have responded to this demand by providing (...) the truth-conditions for the substituted judgement in terms of counterfactual reasoning using a possible worlds semantics. In this paper, I show how these underpinnings fail to support the substituted judgement approach as a reasonable standard for decision-making. Firstly, I show how this counterfactual element has been poorly interpreted. I then explain how various accounts have failed to reflect problems and limitations associated with providing an interpretation of their truth-conditions using counterfactuals. Finally, I argue that, even when we attend to the initial problems of providing a counterfactual analysis, it still deeply problematic as a means of determining the validity of substituted judgements for two main reasons. Firstly, making determinate judgements as to the truth-value of these judgements will often not be possible and, secondly, there is a strong requirement when interpreting many counterfactual claims to charitably accede to their being true. I conclude that substituted judgements, as interpreted through counterfactual reasoning and possible worlds semantics, do not therefore provide an adequate standard for surrogate decision-making. (shrink)

IntroductionExtended decision -making through the use of proxy decision -makers has been enshrined in a range of International Codes, Professional Guidance and Statute,For example, the UK Mental Capacity Act section 9.1; The General Medical Council ; the US National Guardianship Association ; Nuffield Council on Bioethics ; CIOMS-WHO section 6. Court cases such as Re Quinlan in the US have also contributed to establishing the groundings for the legal status of the proxy, albeit in terms of who might be suitable (...) as a proxy in cases where there was no clear appointment of them by a still competent individual. and is now widely seen as a useful means through which we can exercise control over decisions that affect our lives when we have lost capacity to make these decisions for ourselves.I will here limit myself to discussion of proxy consent for adults appointed prior to the loss of competence by the person they are acting as proxy for. The issue of p. (shrink)

NThere are many problems with Levi and Green’s (2010) suggestion that a computer-based decision aid will overcome the major objections to advance directives (ADs). We focus on just two here. First, we argue that the key assumption underlying Levi and Green’s paper, that autonomy always ought to take priority over other values, is false. Second, we argue that the paper misses the point of the most telling objections to the use of ADs: they lack the relevant moral authority to determine (...) treatments. It is not that they are merely subject to a set of contingent problems related to capturing the wishes of individuals or being open to misinterpretation by others.We conclude that the plug should be pulled on Levi and Green’s computer-based proposal. (shrink)

We argue that the way in which the concept of expertise is understood and invoked has prevented progress in the debate as to whether moral philosophers can be said to be ‘moral experts’. We offer an account of expertise that draws on the role of tacit knowledge in order to provide a basis upon which the debate can progress. Our analysis consists of three parts. In the first part we highlight two specific problems in the way that the concept of (...) expertise has been invoked in the moral expertise debate, namely the understanding of expertise as an exclusive concept and the conflation of expertise with the idea of ‘authority’. In the second part we suggest an alternative way of approaching the concept of expertise. This is based on Collins and Evans’ sociological theory of expertises. This theory provides a valuable analytical framework for thinking about claims to expertise and for drawing the kinds of distinctions which allow for different kinds of moral expertises and competencies. In the final part, we show how the application of this theory helps to avoid some of the problematic conclusions which theorists have arrived at to date and provides a common platform for debate. Ultimately, it permits the argument to be made that moral philosophers could be considered specialist members of an expert community of moral decision-makers. (shrink)

In this paper I provide an account of the metaphysical foundations of mental illness in terms of a realism debate. I motivate the importance of such metaphysical analysis as a means of avoiding some intractable problems that beset discussion of the concept of mental illness. I apply aspects of the framework developed by Crispin Wright for realism debates in order to examine the ontological commitments to mental illness as a property that humans may exhibit and to examine the various arguments (...) that realists and anti-realists can use to defend their position on mental illness. I pay particular attention to characterising Szasz's account of mental illness as that of an anti-realist error-theory and present ways in which a realist may counter such a position. Ultimately I argue that in order to hold a realist position on mental illness one would have to adopt some form of realism towards values, such as moral realism. (shrink)

In considering the debate about the meaning of ‘disease’, the positions are generally presented as falling into two categories: naturalist, e.g., Boorse, and normativist, e.g., Engelhardt and many others. This division is too coarse, and obscures much of what is going on in this debate. I therefore propose that accounts of the meaning of ‘disease’ be assessed according to Hare's (1997) taxonomy of evaluative terms. Such an analysis will allow us to better understand both individual positions and their interrelationships. Most (...) importantly, it will show that it is unlikely that there is a single unique disease-concept at issue. Rather, different authors are, for the most part, considering different concepts. (shrink)

Two notable limitations exist on the use of personhood arguments in establishing moral status. Firstly, although the attribution of personhood may give us sufficient reason to grant something moral status, it is not a necessary condition. Secondly, even if a person is that which has the ‘highest’ moral status, this does not mean that any interests of a person are justifiable grounds to kill something that has a ‘lower’ moral status. Additional justification is needed to overcome a basic wrongness associated (...) with killing something possessing moral status. There are clear arguments already available in this regard in the case of a foetus that are not available in the case of a newborn infant. Hence, there is scope to consistently hold that abortion may be permissible but that after-birth abortion may not be permissible. (shrink)

Deriving ethical conclusions from arguments that rely heavily on metaphysical foundations, as Parfit (1984) does in generating his Nonidentity Problem, is an approach fraught with problems. Sparrow...

The syllabus presented here is designed for use in the training of researchers and research ethics committee members throughout the European Union and beyond. It is intended to be accessible to scientific and lay readers, including those with no previous experience of ethical theory and analysis. The syllabus will cover key issues in the ethics of research involving human participants, including the ethical issues associated with new technologies.

This volume forms part of a series exploring key issues in ethics, law and society, published in association with the Cardiff Centre for Ethics, Law and Society. The collection is a celebration of the approach and values embraced within previous volumes in the series. The works collectively address new technological, social, and regulatory developments and the fresh ethical dilemmas these pose, but quite critically, also compel an urgent revisiting of social and legal issues that were once the subject of controversy (...) but which have fallen out of the line of sight of academics, politicians and policy-makers. Bringing together selected papers, the editors seek to make apparent the thematic links between contributions in presenting works written by a group of international experts in response to specific ethical issues, including topics on the ethics of care, theorising ethics, body politics and governance; as such, the collection is multidisciplinary in approach, seeks to appeal to a broad audience and provides a valuable resource for all those concerned with contemporary ethical issues. This fifth and final volume bring the series to a close and is dedicated to the memory of Dr Jennifer Gunning. (shrink)

The overall collection we present in Volume V constitutes a celebration of the approach and values embraced within previous volumes. While those acquainted with previous volumes of Ethics, Law & Society will note some marked differences in how we have gone about the work of editing, our hope is that the approach we bring is seen as enriching the work, and building on what has been a highly successful series. To a large degree, however, it has not been possible to (...) emulate what our rather formidable predecessors have achieved, even if many of the concerns which Jenny and Søren had embraced in previous volumes have continued purchase and find their natural home here too. Jenny and Søren, both prominent bioethicists, not only encouraged contributions which explored ethical and regulatory perspectives around the body, genetic technologies, life sciences and the life course, but also sought to embrace far broader concerns relating to the environment, conflict and war, and to issues which are every bit as crucial to our lived experience, such as the use and management of information. All of these concerns relate to our experience of being human and as such, it seems arbitrary – if one is genuinely concerned with social flourishing – to prioritize the kinds of concerns for inclusion in any given collection to specific themes. (shrink)

This volume forms part of a series exploring key issues in ethics, law and society, published in association with the Cardiff Centre for Ethics, Law and Society. The collection is a celebration of the approach and values embraced within previous volumes in the series. The works collectively address new technological, social, and regulatory developments and the fresh ethical dilemmas these pose, but quite critically, also compel an urgent revisiting of social and legal issues that were once the subject of controversy (...) but which have fallen out of the line of sight of academics, politicians and policy-makers. Bringing together selected papers, the editors seek to make apparent the thematic links between contributions in presenting works written by a group of international experts in response to specific ethical issues, including topics on the ethics of care, theorising ethics, body politics and governance; as such, the collection is multidisciplinary in approach, seeks to appeal to a broad audience and provides a valuable resource for all those concerned with contemporary ethical issues. This fifth and final volume bring the series to a close and is dedicated to the memory of Dr Jennifer Gunning. (shrink)

Innovation is a key driver of care provision in assisted reproductive technologies (ART). ART providers offer a range of add‐on interventions, aiming to augment standard in vitro fertilization protocols and improve the chances of a live birth. Particularly in the context of commercial provision, an ever‐increasing array of add‐ons are marketed to ART patients, even when evidence to support them is equivocal. A defining feature of ART is hope—hope that a cycle will lead to a baby or that another test (...) or intervention will make a difference. Yet such hope also leaves ART patients vulnerable in a variety of ways. This article argues that previous attempts to safeguard ART patients have neglected how the use of add‐ons in commercial ART can exploit patients’ hopes. Commercial providers of ART should provide add‐ons only free of charge, under a suitable research protocol. (shrink)

Hope takes on a particularly important role in end of life situations. Sustaining hope can have considerable benefits for the quality of life and any prospect of a good death for the dying. However, it has proved difficult to adequately account for hope when dying, particularly in some of the more extreme end of life situations. Standard secular accounts of hope struggle to establish how the fostering of hope may be possible in such situations. This leads to a practical ethical (...) dilemma for those caring for the dying, the ‘paradox of hope’, whereby one can either help maintain the welfare of the dying by generating a misleading ‘false hope’ or maintain truthfulness and concede that hope is not possible. These two problems combine to leave individuals the prospect of dying in terrible circumstances facing only despair. To address this, I argue that we should look beyond standard intentional or dispositional accounts of hope in such cases and treat hope as a cluster concept. Rather than appeal to a unitary conception, what we precisely mean by ‘hope’ may therefore vary depending on the context of use. I outline an account of hope based on Marcel’s account of ‘absolute’ hope but offering an alternative, secular foundation based on solidarity that can explain how hope when dying in extreme circumstances is possible. Hence, where the more familiar accounts break-down in these circumstances, ‘hope talk’ may still be possible if it is seen as relying on this conception of hope. (shrink)

People have understandable concerns over what happens to their bodies, both during their life and after they die. Consent to organ donation is often perceived as an altruistic decision made by individuals prior to their death so that others can benefit from use of their organs once they have died. More recently, live organ donation has also been possible, where an individual chooses to donate an organ or body tissue that will not result in their death (such as a kidney). (...) Although these live organ donations can be purely altruistic, they are usually done to benefit a close family member. An additional complicating factor with both kinds of donation is whether forms of extended decision-making can be used as a means of consent. This is where instructions are issued through some form of advance directive giving specific written instructions as to donation or by appointing a proxy surrogate decision-maker to determine such issues. In the case of deceased donation, there is a question as to whether an advance directive can override the wishes of family members. In the case of live organ donation, there is a largely untested concern as to whether advance directives or surrogates can provide acceptable consent to donation when an individual, though still alive, has lost the capacity to consent for themselves. In this paper, I will focus predominantly on the second of these issues concerning live organ donation and the challenges this poses for donors who have lost capacity to consent. I argue that the limitations on advance directives and surrogate decision-making mean that they can only give us an indication of preference and cannot serve as an authoritative consent where there is any dispute over donation. Instead, in turns out that family members have a significant and usually determinate role to play in these decisions. Although I am focusing on organ donation, the implications for this potentially extend to the use of other tissues and even gametes, which could be used for reproductive purposes. (shrink)

Many materialist ontologies characterize the existence of everyday, middle-sized objects as reducible to collections or mereological sums of smaller, more fundamental particle constituents. Baker would have it otherwise and has set out a defence of her Constitution View of ontology that takes everyday objects to be irreducibly real and of a vast array of kinds.Motivating an interest in the metaphysics of everyday objects is not obviously straightforward when contemporary metaphysics is filled with attempts to answer seemingly more challenging questions about (...) the existence of disputed classes of objects, such as abstracta, or very specific, unusual phenomena such as holes, rather than the mundane case of these middle-sized concreta. Yet this is Baker's point: that many kinds of ordinary objects have been overlooked by philosophers to the point where we lack an adequate account of their significance in our practices and attitudes. Moreover, in a climate of metaphysics often governed by those of a strong eliminitivist inclination with a preference for Quinean desert landscapes, the advocating of an almost indulgent ontological pluralism is enough to make this book worth reading.Those familiar with Baker's work will not be surprised that this approach to ontology is grounded from her perspective of ‘Practical Realism’. This view – partly a legacy of Aristotle, partly of G. E. …. (shrink)