_ Source: _Page Count 30 Millions of children worldwide could benefit from adoption. One could argue that prospective parents have a pro tanto duty to adopt rather than create children. For the sake of argument, I assume there is such a duty and focus on a pressing objection to it. Prospective parents may prefer that their children are genetically related to them. I examine eight reasons prospective parents have for preferring genetic children: for parent-child physical resemblance, for family resemblance, for (...) psychological similarity, for the sake of love, to achieve a kind of immortality, for the genetic connection itself, to be a procreator, and to experience pregnancy. I argue that, with the possible exception of the pregnancy desire, these reasons fail to defeat a duty to adopt a child rather than create one, even assuming that we do have some leeway to favor our own interests. (shrink)

Some obligations are conditional such that act A is morally optional, but if one chooses A, one is required to do act B rather than some other less valuable act C. Such conditional obligations arise frequently in research ethics, in the philosophical literature, and in real life. They are controversial: how does a morally optional act give rise to demanding requirements to do the best? Some think that the fact that a putative obligation has a conditional structure, so defined, is (...) a strike against its being a genuine obligation. I argue that conditional obligations are to be expected in a moral theory that has moral options. (shrink)

Clinicians and health researchers frequently encounter opportunities to rescue people. Rescue cases can generate a moral duty to aid those in peril. As such, bioethicists have leveraged a duty to rescue for a variety of purposes. Yet, despite its broad application, the duty to rescue is under-analyzed. In this paper, we assess the state of theorizing about the duty to rescue. There are large gaps in bioethicists’ understanding of the force, scope, and justification of the two most cited duties to (...) rescue—the individual duty of easy rescue and the institutional rule of rescue. We argue that the duty of easy rescue faces unresolved challenges regarding its force and scope, and the rule of rescue is indefensible. If the duty to rescue is to help solve ethical problems, these theoretical gaps must be addressed. We identify two further conceptions of the duty to rescue that have received less attention—an institutional duty of easy rescue and the professional duty to rescue. Both provide guidance in addressing force and scope concerns and, thereby, traction in answering the outstanding problems with the duty to rescue. We conclude by proposing and propose research priorities for developing accounts of duties to rescue in bioethics. (shrink)

Most people would agree that adoption is a good thing for children in need of a family. Yet adoption is often considered a second best or even last resort for parents in making their families. Against this assumption, I explore the unique value of adoption for prospective parents. I begin with a criticism of the selective focus on the value of adoption for only those people using assisted reproductive technologies. I focus on the value of adoption for all prospective parents, (...) reflecting on non-relative, non-procreative adoptions. First, adoption can meet the important need that a child has for a family, whereas procreation creates rather than meets needs. Second, adoption provides a morally noble opportunity to extend to a stranger benefits usually withheld for one's genetic kin. As such, adoption offers a unique possibility in which impartial concern for an other can be the starting point for a lifetime of love and care. Finally, adoptions can have transformative power over adoptive parents’ conception of family and self. In highlighting the unique value of adoption, I aim to challenge the widespread assumption that adoption has second best status to procreation. Indeed adoption can exemplify the human potential for moral compassion and impartial concern for the needs of others. (shrink)

Given recent advancements in CRISPR‐Cas9 powered genetic modification of gametes and embryos, both popular media and scientific articles are hailing CRISPR’s life‐saving, curative potential for people with serious monogenic diseases. But claims that CRISPR modification of gametes or embryos, a form of germline engineering, has therapeutic value are deeply mistaken. This article explains why reproductive uses of CRISPR, and germline engineering more generally, do not treat or save lives that would otherwise have a genetic disease. Reproductive uses of CRISPR create (...) healthy people whose existence is not inevitable in the first place. Creating healthy lives has distinct and lesser moral value from saving or curing lives that would otherwise have genetic disease. The real value in reproductive uses of CRISPR is in helping a very limited population of people have healthy, genetically related children. This diminished value cannot compete with the concerns in opposition to germline engineering, nor is it worth the investment of research money. (shrink)

Millions of children worldwide could benefit from adoption. One could argue that prospective parents have a pro tanto duty to adopt rather than create children. For the sake of argument, I assume there is such a duty and focus on a pressing objection to it. Prospective parents may prefer that their children are genetically related to them. I examine eight reasons prospective parents have for preferring genetic children: for parent-child physical resemblance, for family resemblance, for psychological similarity, for the sake (...) of love, to achieve a kind of immortality, for the genetic connection itself, to be a procreator, and to experience pregnancy. I argue that, with the possible exception of the pregnancy desire, these reasons fail to defeat a duty to adopt a child rather than create one, even assuming that we do have some leeway to favor our own interests. (shrink)

It is widely assumed that people have a moral right to procreate. This article explores recent arguments in opposition to procreation in some or all contexts. Some such views are concerned with the risks and harms of life that procreation imposes on non-consenting children. Others articulate concerns for third parties – the environmental damage or opportunity costs that procreation poses to already existing people. The article then surveys arguments that favor procreation despite the risks to the children created and third (...) parties. The best argument for procreation is based on the significant interest people have in forming the parent–child relationship. An important under-discussed middle ground is suggested – one that avoids the criticisms of the anti-natalist while fulfilling the best aims of procreation – viz. adoption. The duty to adopt is summarized and objections to it considered. Thoughtful people who deeply desire to become parents but do not wish to participate in the range of potential procreative harms should consider adoption as a first choice. (shrink)

This article argues that two forms of mitochondrial replacement therapy, maternal spindle transfer and pro-nuclear transfer, are not therapies at all because they do not treat children who are coming into existence. Rather, these technologies merely create healthy children where none was inevitable. Even if creating healthy lives has some value, it is not to be confused with the medical value of a cure or therapy. The article addresses a recent Bioethics article, ‘Mitochondrial Replacement: Ethics and Identity,’ by Wrigley, Wilkinson, (...) and Appleby, who argue that PNT is morally favorable to MST due to the Non-Identity Problem. Wrigley et al. claim that PNT, since it occurs post-conception, preserves the identity of the resulting child, whereas MST, since it occurs pre-conception, is an identity-altering technique. As such, a child born with mitochondrial disease could complain that her parents failed to use PNT, but not MST. The present article argues that the authors are mistaken: both MST and PNT are identity-affecting techniques. But this is of little matter, for we should be cautious in drawing any moral conclusions from the application of the Non-Identity Problem to cases. The article then argues that the authors are mistaken in inferring that PNT is a type of embryonic cure or therapy for children with mitochondrial disease. The article cautions against the mistaken life-saving rhetoric that is common in bioethics discussions of MRTs. (shrink)

In February 2016, the Institute of Medicine released a report, commissioned by the United States Food and Drug Administration, on the ethical and social‐policy implications of so‐called three‐parent in vitro fertilization. The IOM endorses commencement of clinical trials on three‐parent IVF, subject to some initial limitations. Also called mitochondrial replacement or transfer, three‐parent IVF is an intervention comprising two distinct procedures in which the genetic materials of three people—the DNA of the father and mother and the mitochondrial DNA of an (...) egg donor—can be used to create a child. Three‐parent IVF would enable a woman with mitochondrial disease to have a genetically related child without transmitting the disease to the child. The possibility for three‐parent children has prompted criticism from many corners. Critics have pointed to ethical issues including safety concerns and risks to children, genetic and germline engineering concerns, the potential exploitation of the third‐parent egg donor, donor anonymity and privacy, and objections to creating babies with three parents, which undermines natural and traditional conceptions of procreation. Additionally, developing the technology would involve experimenting on, manipulating, and disposing of embryos. Although the IOM report considers the ethical concerns about the value of the three‐parent IVF technology, the IOM failed to give due attention to an important objection to the development of this technology: three‐parent IVF lacks the social value necessary to make investment of public resources in it ethical.Unlike the other concerns, this objection is not based on conservativism about new reproductive technologies or default favoritism of the status quo. I argue that the technology does not meet a plausible social value standard to render public research investment into its development ethical. Proponents of three‐parent IVF make inaccurate and exaggerated claims that it will eradicate mitochondrial disease and save lives. Were these claims true, proponents would have a strong case for the social value of the technology. But three‐parent IVF alone will not eradicate mitochondrial disease, and it will not save lives. Rather, it can create healthy lives. As I discuss, the moral distinction is crucial. Most importantly, investment in three‐parent IVF comes at the opportunity cost of researching treatment for mitochondrial disease that would benefit actual, living disease sufferers. (shrink)

The independence of irrelevant alternatives is a popular and important axiom of decision theory. It states, roughly, that one’s choice from a set of options should not be influenced by the addition or removal of further, unchosen options. In recent debates, a number of authors have given putative counterexamples to it, involving intuitively rational agents who violate IIA. Generally speaking, however, these counterexamples do not tend to move IIA’s proponents. Their strategy tends to be to individuate the options that the (...) agent faces differently, so that the case no longer counts as a violation of IIA. In this paper, we examine whether this strategy succeeds. We argue that the ways of individuating options required to save IIA from the most problematic counterexamples—in particular, cases where agents violate IIA due to nonconsequentialist moral beliefs—do so only at the expense of severely compromising its central function within decision theory. (shrink)

The duty to rescue is a highly plausible and powerful ethical principle. It requires agents to assist others in extreme need in cases where doing so does not conflict with some weighty moral aim; requires little personal sacrifice; and is likely to significantly benefit the recipients.1 As a general obligation, it binds all persons simply qua persons, and it is owed to all persons simply qua persons. Clinical investigators working in low-income countries frequently encounter sick or destitute people to whom (...) they might possess a duty to rescue. Investigators may often ask themselves, what can I do, what should I do, to help? Such investigators often help people in the future by carrying out their... (shrink)

There is much philosophical literature on the duty to rescue. Individuals who encounter and could save, at relatively little cost to themselves, a person at risk of losing life or limb are morally obligated to do so. Yet little has been said about the other side of the issue. There are cases in which the need for rescue could have been reasonably avoided by the rescuee. We argue for a duty to take rescue precautions, providing an account of the circumstances (...) in which it arises. This novel duty has important implications for public policy. We apply it to the situation of some of the uninsured in the United States. Given the US clinician's duty to provide emergency care to all people regardless of ability to pay, some of the uninsured have a moral duty to purchase health insurance. We defend the duty against objections, including the possibility that a right to rescue can be waived, thus undermining a duty to take rescue precautions, that the duty of many professionals is voluntarily incurred, and that a distinction between actively assumed and passively assumed risks matters morally. (shrink)

This article argues that two forms of mitochondrial replacement therapy, maternal spindle transfer (MST) and pro‐nuclear transfer (PNT), are not therapies at all because they do not treat children who are coming into existence. Rather, these technologies merely create healthy children where none was inevitable. Even if creating healthy lives has some value, it is not to be confused with the medical value of a cure or therapy. The article addresses a recent Bioethics article, ‘Mitochondrial Replacement: Ethics and Identity,’ by (...) Wrigley, Wilkinson, and Appleby, who argue that PNT is morally favorable to MST due to the Non‐Identity Problem. Wrigley et al. claim that PNT, since it occurs post‐conception, preserves the identity of the resulting child, whereas MST, since it occurs pre‐conception, is an identity‐altering technique. As such, a child born with mitochondrial disease could complain that her parents failed to use PNT, but not MST. The present article argues that the authors are mistaken: both MST and PNT are identity‐affecting techniques. But this is of little matter, for we should be cautious in drawing any moral conclusions from the application of the Non‐Identity Problem to cases. The article then argues that the authors are mistaken in inferring that PNT is a type of embryonic cure or therapy for children with mitochondrial disease. The article cautions against the mistaken life‐saving rhetoric that is common in bioethics discussions of MRTs. (shrink)

The 2010 Patient Protection and Affordable Care Act was designed to increase health insurance coverage in the United States. Its most controversial feature is the requirement that US residents purchase health insurance. Opponents of the mandate argue that requiring people to contribute to the collective good is inconsistent with respect for individual liberty. Rather than appeal to the collective good, this Viewpoint argues for a duty to buy health insurance based on the moral duty individuals have to reduce certain burdens (...) they pose on others. When some people have a duty to rescue, others may have a duty to take rescue precautions, in this case, to purchase health insurance to cover acute and emergency care needs. Requiring that individuals meet this obligation is consistent with respect of individual liberty. (shrink)

Many “anti-vaxxers” oppose COVID-19 vaccination mandates on the grounds that they wrongfully infringe on bodily autonomy. Their view has been expressed with the slogan “My Body, My Choice,” co-opted from the pro-choice abortion rights movement. Yet, many of those same people are pro-life and support abortion restrictions that are effectively a kind of gestation mandate. Both vaccine and gestation mandates impose restrictions on bodily autonomy in order to prevent serious harms. This article evaluates the defensibility of the anti-vax pro-life position. (...) We argue that the case for opposing gestation mandates on grounds of bodily autonomy is much stronger than the case for opposing vaccine mandates—even if fetuses have full moral status. Thus, there is a deep tension in being a pro-life, COVID anti-vaxxer concerned with bodily autonomy. (shrink)

CRISPR Cas9-powered gene drive allows for the rapid alteration of malaria-causing mosquitoes to spread an infertility gene or resistance to malaria among their species. Malaria eradication would be a great boon to human health. But many are concerned with driving genetic changes through a natural species. This chapter catalogs objections to the use of gene drive in mosquitoes for eradicating malaria. In-principle objections to gene drive use are not compelling. The most urgent concerns are related to the safety of the (...) technology for the environment and human health. Philosophers play a critical role in working along scientists to develop risk/benefit models that weigh the reasons for and against gene drive to eradicate malaria based on our best scientific knowledge and rigorous normative reasoning. (shrink)

ABSTRACT In his innovative and thought-provoking Why Worry About Future Generations? Samuel Scheffler argues that the value of many of our present-day projects depends upon the existence of future generations, and this gives us one major reason to care about their fate. I raise questions about this ‘Value Dependence Thesis’ by comparing an imminent human extinction scenario to the case of imminent individual death. If an imminently dying individual can still find much value in their remaining life, then why should (...) it be any different for humanity facing imminent extinction? Scheffler anticipates this kind of argument; I respond to his objection to this analogy. I also raise a concern about the value of meliorative projects as providing reason in favor of continued human existence. While meliorative projects have instrumental value contingent on the existence of future generations, this value does not count in favor of their existing. Despite raising these concerns, I agree with Scheffler that many of our actual activities presuppose the survival of humanity and that we are antecedently interested in and committed to their survival. Moreover, Scheffler’s novel approach offers us a creative, sophisticated, and rich resource for developing the ethics of future generations. (shrink)