Iain Brassington

This paper examines medicine’s use of technology in a manner from a standpoint inspired by Heidegger’s thinking on technology. In the first part of the paper, I shall suggest an interpretation of Heidegger’s thinking on the topic, and attempt to show why he associates modern technology with danger. However, I shall also claim that there is little evidence that medicine’s appropriation of modern technology is dangerous in Heidegger’s sense, although there is no prima facie reason why it mightn’t be. The explanation for this, I claim, is ethical. There is an initial attraction to the thought that Heidegger’s thought echoes Kantian moral thinking, but I shall dismiss this. Instead, I shall suggest that the considerations that make modern technology dangerous for Heidegger are simply not in the character — the ethos — of medicine properly understood. This is because there is a distinction to be drawn between chronological and historical modernity, and that even up-to-date medicine, empowered by technology, retains in its ethos crucial aspects of a historically pre-modern understanding of technology. A large part of the latter half of the paper will be concerned with explaining the difference.

Motivated by Lord Joffe’s Assisted Dying for the Terminally Ill Bill, but with one eye on any possible future legislation, I consider the justifications that might be offered for limiting assistance in dying to those who are suffering unbearably from terminal illness. I argue that the terminal illness criterion and the unbearable suffering criterion are not morally defensible separately: that a person need be neither terminally ill (or ill at all), nor suffering unbearably (or suffering at all) to have a right to assisted dying. Indeed: I shall suggest that the unbearable suffering criterion undermines the Bill (or any proposal like it) wholesale. On the other hand, the criteria taken together are defensible, and this defence would be built on a concern for the protection of the vulnerable. However, I also claim that this implies that the law might justifiably—and maybe even properly—aim to prevent a person from gaining access to that to which they have a serious moral right. This seems paradoxical, and, towards the end of the paper, I seek to tease apart the paradox.

An agent who takes his own life acts in violation of the moral law, according to Kant; suicide, and, by extension, assisted suicide are therefore wrong. By a similar argument, and with a few important exceptions, killing is wrong; implicitly, then, voluntary euthanasia is also wrong. Kant's conclusions are uncompelling and his argument in these matters is undermined on considering other areas of his thought. Kant, in forbidding suicide and euthanasia, is conflating respect for persons and respect for people, and assuming that, in killing a person (either oneself or another), we are thereby undermining personhood. But an argument along these lines is faulty according to Kant's own standards. There is no reason why Kantians have to accept that self-killing and euthanasia are contrary to the moral law. Even if some Kantians adhere to this doctrine, others can reject it.

Questions about information inform many debates in bioethics. One of the reasons for this is that at least some level of information is taken by many to be a prerequisite of valid consent. For others, autonomy in the widest sense presupposes information, because one cannot be in control of one’s life without at least some insight into what it could turn out to contain. Yet not everyone shares this view, and there is a debate about whether or not there is a right to remain in ignorance of one’s medical, and especially genetic, information. It is notable, though, that this debate leaves unexamined the assumption that, if a person wants information, he is entitled to it. This paper examines the assumption, specifically in relation to genetics, where learning facts about oneself may reveal facts about other people, particularly one’s close relatives. This may be taken as a violation of their privacy, and since privacy is something that we normally think should be respected, it is worth asking whether one ought to abjure the opportunity to obtain genetic information for the sake of privacy. In effect, there may be an argument to be made not just for a right to remain in ignorance, but for a duty to do so.

Face transplantation—or, more properly, facial allograft transplantation —generates much public interest and academic debate. In this paper, we suggest that it is up to opponents of FAT to make the case for its impermissibility. We allow that there is a number of apparently strong arguments that might be deployed against FAT. However, all but one of these turn out not to be compelling after examination. The remaining argument is not so easily dismissed—but its central point is fairly workaday and certainly does not tell us anything about FAT in particular. Therefore, qua argument about facial transplant surgery, it fails to hit its target. Overall, we conclude that a compelling case against FAT remains to be made.

Hidalgo's paper is a clear and powerful contribution to a topic of ongoing concern.1 It should be taken seriously by anyone who worries that there is something seriously wrong with the flow of medical expertise from the poor countries of the South to the rich countries of the North because it forces open the question of just what that wrongness is supposed to be. Being unable to identify the moral problem about migration will not make the problem about poor health in the South go away, of course: and it might be that, if we are genuinely concerned to keep expertise in the South, we simply have to face up to the possibility of subsidising the wages …

It is not unknown for participants in discussions of ethics to prefix their claims with a profession of their religious faith—to say, for instance, “Well, I’m a Christian/Muslim/whatever, so I think that …”. Other participants in the debate may well worry about how to respond without the risk of giving offence or appearing ad hominem. Within a teaching environment, the worry may be even more acute. Nevertheless, it is suggested in this paper that such worries should not be allowed to impede debate; moreover, a teacher who let such prefixes pass without critique would be considered a poor teacher. In fact, a kind of duty for a teacher of ethics is to be contrary and to play the apostate

John Harris suggests that participation in or support for research, particularly medical research, is a moral duty. One kind of defence of this position rests on an appeal to the past, and produces two arguments. The first of these arguments is that it is unfair to accept the benefits of research without contributing something back in the form of support for, or participation in, research. A second argument is that we have a social duty to maintain those practices and institutions that sustain us, such as those which contribute to medical knowledge. This argument is related to the first, but it does not rely so heavily on fairness. Another kind of defence of the duty to research rests on an appeal to the future benefits of research: research is an effective way to discharge a duty to rescue others from serious illness or death, therefore we have a duty to research. I suggest that all three of Harris' lines fail to provide a compelling duty to research and spell out why. Moreover, not only do the lines of argument fail in their own terms: in combination, they turn out to be antagonistic to the very position that Harris wants to defend. While it is not my intention here to deny that there might be a duty to research, I claim that Harris' argument for the existence of such a duty is not the best way to establish it.

In 2005, John Harris published a paper in the Journal of Medical Ethics in which he claimed that there was a duty to support scientific research. With Sarah Chan, he defended his claims against criticisms in this journal in 2008. In this paper I examine the defence, and claim that it is not powerful. Although he has established a slightly stronger position, it is not clear that the defence is sufficiently strong to show that there is a duty to support scientific research. Important questions about fairness, about rescue, and about the relationship between reasons and obligations to act can still be raised; and these questions are important enough to destabilize the defence.