Principlism has been advocated as an approach to resolving concrete cases and issues in bioethics, but critics have pointed out that a main problem for principlism is its lack of a method for assigning priorities to conflicting ethical principles. A version of principlism referred to as 'specified principlism' has been put forward in an attempt to overcome this problem. However, none of the advocates of specified principlism have attempted to demonstrate that the method actually works in resolving detailed clinical cases. (...) This paper shows that when one tries to use it, specified principlism fails to provide practical assistance in deciding how to resolve concrete cases. Proponents of specified principlism have attempted to defend it by arguing that it is superior to casuistry, but it can be shown that their arguments are faulty. Because of these reasons, specified principlism should not be considered a leading contender in the search for methods of making justifiable decisions in clinical cases. (shrink)

Don Marquis has put forward a non-religious argument against abortion based on what he claims is a morally relevant similarity between killing adult human beings and killing fetuses. He asserts that killing adults is wrong because it deprives them of their valuable futures. He points out that a fetus’s future includes everything that is in an adult’s future, given that fetuses naturally develop into adults. Thus, according to Marquis, killing a fetus deprives it of the same sort of valuable future (...) that an adult is deprived of in being killed and this makes abortion seriously wrong. Commentators have raised a number of objections to Marquis’s argument, to which he has satisfactorily responded. In this paper, difficulties with Marquis’s argument that have not been considered by previous commentators are pointed out. A main thesis of this paper is that Marquis does not adequately defend his argument against several important objections that he himself has raised. These new considerations support the view that Marquis’s argument is unsuccessful. (shrink)

Some have argued that embryos and fetuses have the moral status of personhood because of certain criteria that are satisfied during gestation. However, these attempts to base personhood during gestation on intrinsic characteristics have uniformly been unsuccessful. Within a secular framework, another approach to establishing a moral standing for embryos and fetuses is to argue that we ought to confer some moral status upon them. There appear to be two main approaches to defending conferred moral standing; namely, consequentialist and contractarian (...) arguments. This article puts forward a consequentialist argument for the conferred moral standing of preembryos, embryos, fetuses, and infants. It states and defends an original version of the commonlyheld view that moral standing increases during gestation. It also explores the implications of this viewpoint for several issues: what is involved in showing ‘respect’ for preembryos; and whether it is permissible to create preembryos solely for research. (shrink)

Although there are important moral arguments against cloning human beings, it has been suggested that there might be exceptional cases in which cloning humans would be ethically permissible. One type of supposed exceptional case involves infertile couples who want to have children by cloning. This paper explores whether cloning would be ethically permissible in infertility cases and the separate question of whether we should have a policy allowing cloning in such cases. One caveat should be stated at the beginning, however. (...) After the cloning of a sheep in Scotland, scientists pointed out that using the same technique to clone humans would, at present, involve substantial risks of producing children with birth defects. This concern over safety gives compelling support to the view that it would be wrong to attempt human cloning now. Thus, we do not reach the debate about exceptional cases unless the issue of safety can be set aside. I ask the reader to consider the possibility that in the future humans could be cloned without a significantly elevated risk of birth defects from the cloning process itself. The remainder of this paper assumes, for sake of argument, that cloning technology has advanced to that point. Given this assumption, would cloning in the infertility cases be ethically permissible, and should it be legally permitted? (shrink)

Various theories have been put forward in an attempt to explain what makes moral judgments justifiable. One of the main theories currently advocated in bioethics is a form of coherentism known as wide reflective equilibrium. In this paper, I argue that wide reflective equilibrium is not a satisfactory approach for justifying moral beliefs and propositions. A long-standing theoretical problem for reflective equilibrium has not been adequately resolved, and, as a result, the main arguments for wide reflective equilibrium are unsuccessful. Moreover, (...) practical problems that arise in using the method of wide reflective equilibrium undermine the idea that it is a viable approach for justifying moral judgments about cases and policies. Given that wide reflective equilibrium is the most prominent version of coherentism, these considerations call into question the coherentist approach to justification in bioethics. (shrink)

Casuistic methods of reasoning in medical ethics have been criticized by a number of authors. At least five main objections to casuistry have been put forward: (1) it requires a uniformity of views that is not present in contemporary pluralistic society; (2) it cannot achieve consensus on controversial issues; (3) it is unable to examine critically intuitions about cases; (4) it yields different conclusions about cases when alternative paradigms are chosen; and (5) it cannot articulate the grounds of its conclusions. (...) Two main versions of casuistry have been put forward, and the responses to these objections depend in part on which version one is defending. Jonsen has advocated a version modeled on the approach to casuistry used by moral theologians in the 15th and 16th century, involving comparison of the case at hand with a single paradigm and a lineup of cases. The present author has advocated another version, drawn from experience with cases in clinical ethics, which involves comparing the case at hand with two or more paradigms. Four of the five objections are unsuccessful when directed against Jonsen'sapproach, and all of them are unsuccessful when directed against the approach involving comparison with two or more paradigms. (shrink)

Some defenders of the view that there is a common morality have conceived such morality as being universal, in the sense of extending across all cultures and times. Those who deny the existence of such a common morality often argue that the universality claim is implausible. Defense of common morality must take account of the distinction between descriptive and normative claims that there is a common morality. This essay considers these claims separately and identifies the nature of the arguments for (...) each claim. It argues that the claim that there is a universal common morality in the descriptive sense has not been successfully defended to date. It maintains that the claim that there is a common morality in the normative sense need not be understood as universalist. This paper advocates the concept of group specific common morality, including country-specific versions. It suggests that both the descriptive and the normative claims that there are country-specific common moralities are plausible, and that a country-specific normative common morality could provide the basis for a country's bioethics. (shrink)

Several methods have been reported for extracting sperm from a man after he dies or enters a persistent vegetative state. Although such sperm retrieval could be performed for nonprocreative purposes, such as research, in this paper I focus on cases involving procreative intent. Since 1980, more than ninety cases have occurred in which family members requested sperm retrieval from patients who died or were irreversibly unconscious, with the intent that a wife, girlfriend, or other woman would be inseminated. Recently, the (...) first report of pregnancy and birth following postmortem sperm retrieval appeared in the media.In these cases, death or PVS typically is caused by anoxic injuries, trauma, or rapidly progressing infections. (shrink)

Several methods have been reported for extracting sperm from a man after he dies or enters a persistent vegetative state. Although such sperm retrieval could be performed for nonprocreative purposes, such as research, in this paper I focus on cases involving procreative intent. Since 1980, more than ninety cases have occurred in which family members requested sperm retrieval from patients who died or were irreversibly unconscious, with the intent that a wife, girlfriend, or other woman would be inseminated. Recently, the (...) first report of pregnancy and birth following postmortem sperm retrieval appeared in the media.In these cases, death or PVS typically is caused by anoxic injuries, trauma, or rapidly progressing infections. (shrink)

In my essay, a critique of “the best secular argument against abortion” I reconstructed and criticised two versions of Don Marquis’s well-known argument against abortion. In critiquing the version I call the “essence argument”, I presented counterexamples to one of the premises in that argument. In this issue of the journal, Ezio Di Nucci takes note of the fact that I used the term “valuable future” in the premise but used the term “future like ours” in the counterexamples. Because the (...) terms are different, Di Nucci claimed that my counterexamples had no bearing on the premise and are therefore unsuccessful. The main error in Di Nucci’s objection is a failure to acknowledge that Marquis uses the terms “valuable future” and “future like ours” interchangeably. For the purpose of reconstructing Marquis’s argument, the term “valuable future” is to be taken in a sense that means the same as “future like ours”. Once this point is recognised, Di Nucci’s objection falls apart. (shrink)

Although there is widespread opposition to reproductive cloning, some have argued that its use by infertile couples to have genetically related children would be ethically justifiable. Others have suggested that lesbian or gay couples might wish to use cloning to have genetically related children. Most of the main objections to human reproductive cloning are based on the child’s lack of unique nuclear DNA. In the future, it may be possible safely to create children using cloning combined with genetic modifications, so (...) that they have unique nuclear DNA. The genetic modifications could be aimed at giving such children genetic characteristics of both members of the couple concerned. Thus, cloning combined with genetic modification could be appealing to infertile, lesbian, or gay couples who seek genetically related children who have genetic characteristics of both members. In such scenarios, the various objections to human reproductive cloning that are based on the lack of genetic uniqueness would no longer be applicable. The author argues that it would be ethically justifiable for such couples to create children in this manner, assuming these techniques could be used safely. (shrink)

Ethical controversy over transplantation of human fetal tissue has arisen because the source of tissue is induced abortions. Opposition to such transplants has been based on various arguments, including the following: rightful informed consent cannot be obtained for use of fetal tissue from induced abortions, and fetal tissue transplantation might result in an increase in the number of abortions. These arguments were not accepted by the National Institutes of Health (NIH) Human Fetal Tissue Transplantation Research Panel. The majority opinion of (...) the panel stated that abortion and fetal tissue use are entirely separate issues, and that tissue use is ethically acceptable because it can be morally insulated from the issue of abortion. In support of this view, panel members and others have replied to the arguments put forward by opponents of fetal tissue use. However, replies to the two arguments mentioned above have been unsatisfactory, and the shortcomings of those replies are identified herein. Examination of the arguments pro and con suggests that fetal tissue use cannot be completely insulated from the issue of abortion. Thus, in seeking an ethical justification for fetal tissue transplantation we must consider reasons other than those put forward by the NIH panel. In this paper it is argued that whatever wrong is involved in using fetal tissue from induced abortions must be balanced against the benefits for patients, and it is on this basis that fetal tissue transplantation can be ethically justified. (shrink)

(2001). How Should IVF Programs Handle Initial Disclosure of Information to Prospective Ovum Donors? The American Journal of Bioethics: Vol. 1, No. 4, pp. 23-25.

Obstetricians face difficult decisions when the interests of fetus and mother conflict. An example is the problem of choosing the delivery method when labour begins prematurely and the fetus is breech. Vaginal delivery involves risks for the breech fetus of brain damage or death caused by umbilical cord compression and head entrapment. Caesarean section might avoid these dangers but involves risks for the mother, including infection, haemorrhage and even death in a small percentage of cases. If a caesarean section is (...) performed the infant might die anyway, due to complications of prematurity. Thus, decisions about delivery method involve balancing the risks to mother and fetus. Uncertainty about the frequency of fetal injuries in vaginal breech deliveries adds to the difficulty of these decisions. (shrink)

In an earlier essay in this journal I critiqued Don Marquis's well-known argument against abortion. I distinguished two versions of Marquis's argument, which I refer to as ‘the essence argument’ and ‘the sufficient condition argument’. I presented two counterexamples showing that the essence argument was mistaken, and I argued that the sufficient condition argument should be rejected because Marquis had not adequately responded to an important objection to it. In response to my critique, Marquis put forward in this journal a (...) revised version of his argument. In his modified approach he no longer advocates the essence argument and he offers a new version of the sufficient condition argument. In the current essay, I discuss how Marquis's revised argument deals with my original objections, and I argue that his new sufficient condition argument is unsuccessful. (shrink)

In this case, one should expect that providing hydration sufficient to maintain fluid balance would tend to prolong the dying process. In a well-known case at Johns Hopkins University, fluids (and feedings) were withheld from a newborn with anomalies, and the infant died after 15 days, compared to three weeks in the present case, in which fluids were given. In the famous Baby Doe case, fluids and nutrition were withheld and the infant lived only six days. In the case at (...) hand, prolonging the dying process risks causing suffering for the infant from various complications that can arise, and it adds to the emotional burden on the family. We learned from the Johns Hopkins case that prolonged dying is also emotionally difficult for the nurses and other health professionals caring for the infant. (shrink)

The first reported case of postmortem sperm retrieval occurred in 1978, involving a man who became brain dead after a motor vehicle accident and whose wife requested removal of his sperm so that she could be artificially inseminated. Physicians performed the retrieval by surgically excising the ducts that transport sperm from the testes and removing sperm from them. Since that time, several other methods for retrieving sperm from such patients have been reported, and at least 141 cases have been documented (...) in which requests were made for removal of sperm from men who were dead or irreversibly unconscious. Moreover, there have been several reports of pregnancies and births resulting from assisted reproduction using sperm retrieved in such cases. (shrink)

Various arguments have been given against positive euthanasia, but little attention has been given to the question of whether these arguments are uniformly effective in all contexts. There appears to be a range of cases, involving non-voluntary killing of irreversibly unconscious patients, in which these arguments do not succeed. Various reasons have been given in support of positive killing in such cases. It can be argued that there is a range of cases for which a policy of allowing positive killing (...) is morally required. However, currently there are legal obstacles to implementing such a policy. (shrink)

A theory of knowledge.-- Elucidations.-- L'être et le devenir.-- Voltaire on free will.-- A creed for sceptics.