Thomas Douglas

It is commonly thought that when a patient is unable to make a treatment decision for herself, patient autonomy should be respected by consulting the views of a patient surrogate, normally either the next-of-kin or a person previously designated by the patient. On one view, the task of this surrogate is to make the treatment decision that the patient would have made if competent. But this so-called ‘substituted judgment standard’ (SJS) has come in for has come in for a good deal of criticism recently. For instance, some question whether surrogates are able to reliably predict what the patient would have chosen. Others wonder how respecting a patient's counter-factual, rather than actual, choices is supposed to respect her autonomy. Such concerns have lead some to reject the SJS and argue for alternative characterisations of the role of surrogate decision-makers.

It is plausible that we have moral reasons to become better at conforming to our moral reasons. However, it is not always clear what means to greater moral conformity we should adopt. John Harris has recently argued that we have reason to adopt traditional, deliberative means in preference to means that alter our affective or conative states directly—that is, without engaging our deliberative faculties. One of Harris’ concerns about direct means is that they would produce only a superficial kind of moral improvement. Though they might increase our moral conformity, there is some deeper kind of moral improvement that they would fail to produce, or would produce to a lesser degree than more traditional means. I consider whether this concern might be justified by appeal to the concept of moral worth. I assess three attempts to show that, even where they were equally effective at increasing one’s moral conformity, direct interventions would be less conducive to moral worth than typical deliberative alternatives. Each of these attempts is inspired by Kant’s views on moral worth. Each, I argue, fails

This chapter reviews recent philosophical and neuroethical literature on the morality of moral neuroenhancements. It first briefly outlines the main moral arguments that have been made concerning moral status neuroenhancements. These are neurointerventions that would augment the moral status of human persons. It then surveys recent debate regarding moral desirability neuroenhancements: neurointerventions that augment that the moral desirability of human character traits, motives or conduct. This debate has contested, among other claims (i) Ingmar Persson and Julian Savulescu’s contention that there is a moral imperative to pursue the development of moral desirability neuroenhancements, (ii) Thomas Douglas’ claim that voluntarily undergoing moral desirability neuroenhancements would often be morally permissible, and (iii) David DeGrazia’s claim that moral desirability neuroenhancements would often be morally desirable. The chapter discusses a number of concerns that have been raised regarding moral desirability neuroenhancements, including concerns that they would restrict freedom, would produce only a superficial kind of moral improvement, would rely on technologies that are liable to be misused, and would frequently misfire, resulting in moral deterioration rather than moral improvement.

Selection against embryos that are predisposed to develop disabilities is one of the less controversial uses of embryo selection technologies. Many bio-conservatives argue that while the use of ESTs to select for non-disease-related traits, such as height and eye-colour, should be banned, their use to avoid disease and disability should be permitted. Nevertheless, there remains significant opposition, particularly from the disability rights movement, to the use of ESTs to select against disability. In this article we examine whether and why the state could be justified in restricting the use of ESTs to select against disability. We first outline the challenge posed by proponents of ‘liberal eugenics’. Liberal eugenicists challenge those who defend restrictions on the use of ESTs to show why the use of these technologies would create a harm of the type and magnitude required to justify coercive measures. We argue that this challenge could be met by adverting to the risk of harms to future persons that would result from a loss of certain forms of cognitive diversity. We suggest that this risk establishes a pro tanto case for restricting selection against some disabilities, including dyslexia and Asperger's syndrome.

David DeGrazia tentatively defends what he calls the Interests Model of moral status (see page 135).1 On this model all sentient beings have the same moral status, though some are owed more than others in virtue of having more or stronger interests. The proponent of this model can accept, say, that one should normally save the life of a human in preference to that of a dog. But she denies that we should save the human because he has higher moral status. Instead, the human should be saved because he has more at stake—he may, for example, have a stronger interest in continued existence. In defending the Interests Model, DeGrazia cuts against the grain of recent theorising on moral status, which has instead favoured what he calls the Respect Model.

Opponents of biomedical enhancement often claim that, even if such enhancement would benefit the enhanced, it would harm others. But this objection looks unpersuasive when the enhancement in question is a moral enhancement — an enhancement that will expectably leave the enhanced person with morally better motives than she had previously. In this article I (1) describe one type of psychological alteration that would plausibly qualify as a moral enhancement, (2) argue that we will, in the medium-term future, probably be able to induce such alterations via biomedical intervention, and (3) defend future engagement in such moral enhancements against possible objections. My aim is to present this kind of moral enhancement as a counter-example to the view that biomedical enhancement is always morally impermissible.

The last 12 years have seen historically high levels of interest in biosecurity among life scientists, science policymakers, and academic experts on science and security policy. This interest was triggered by the 9/11 terrorist attacks, the ‘anthrax letters’ attack of the same year, and two virology papers, published early last decade, that were thought to raise serious biosecurity concerns.1 Ethicists have come relatively late to the game, but, in recent years, a lively debate has developed on ethical issues raised by biosecurity policy, and, more generally, on the ethics of producing and disseminating ‘dangerous’ biomedical knowledge. Unsurprisingly, this debate has taken on increased sense of urgency over the last 18 months as the journals Science and Nature, the United States National Science Advisory Board for Biosecurity, and the World Health Organization, among others, have been considering whether and how to publish two academic papers reporting means of enhancing the transmissibility of H5N1 influenza, or ‘bird flu’ .We hope that this issue of the Journal of Medical Ethics will substantially advance the emerging ethical debate in this area. The issue features five articles on the ethics of biosecurity: a feature article, by Allen Buchanan and Maureen Kelley ; three brief replies to this article, by Michael Selgelid , Thomas May , and Nicholas King ; and a stand-alone paper by Nicholas Evans , which discusses the recent H5N1 controversy and analyses the appeals to scientific freedom that have been made by some of its protagonists. In this ‘concise argument’, I can, regrettably, comment only on the Buchanan and Kelley piece.Buchanan and Kelley on the framing of the biosecurity debateBuchanan and Kelley aim to broaden and reframe the existing debate on biosecurity. They begin by noting that "science policy … "

One role of research ethics committees is to assess the ethics of proposed health research. In some countries, RECs are also instructed to assess its legality. However, in other countries they are explicitly instructed not to do so. In this paper, I defend the claim that public policy should instruct RECs not to assess the legality of proposed research . I initially defend a presumption in favour of the Claim, citing reasons for making research institutions solely responsible for assessing the legality of their own research. I then consider three arguments against the Claim which may over-ride this presumption—namely, that policy should instruct RECs to assess the legality of research because doing so would minimise the costs of assessing the legality of research, whether research is legal may partly determine whether it is ethical and whether research is legal may constitute evidence for whether it is ethical. I reject the first two arguments and note that whether the third succeeds depends on the answer to a more fundamental question about the appropriate nature of REC ethical deliberation. I end with a brief discussion of this question, tentatively concluding that the third argument also fails

Nicholas Agar argues, that enhancement technologies could be used to create post-persons—beings of higher moral status than ordinary persons—and that it would be wrong to create such beings.1 I am sympathetic to the first claim. However, I wish to take issue with the second.Agar's second claim is grounded on the prediction that the creation of post-persons would, with at least moderate probability, harm those who remain mere persons. The harm that Agar has in mind here is a kind of meta-harm: the harm of being made more susceptible to being permissibly harmed—more liable to harm. Agar suggests that, if post-persons existed, mere persons could frequently be permissibly sacrificed in order to provide benefits to the post-persons. For instance, perhaps they could be permissibly used in lethal medical experiments designed to develop medical treatments for post-persons. By contrast, he suggests that mere persons typically cannot be permissibly sacrificed to provide benefits to other mere persons. He thus claims that mere persons would be more liable to sacrifice if post-persons existed than they are in the absence of post-persons. The creation of post-persons would make them worse off in at least this one respect.Agar then argues that, since this meta-harm imposed on mere persons would not be compensated, it would be wrong to create post-persons. It is here that I believe his argument begins to go awry. According to the concept of compensation that Agar deploys , a harm imposed on X is compensated just in …

Existing debate on procreative selection focuses on the well-being of the future child. However, selection decisions can also have significant effects on the well-being of others. Moreover, these effects may run in opposing directions; some traits conducive to the well-being of the selected child may be harmful to others, whereas other traits that limit the child’s well-being may preserve or increase that of others. Prominent selection principles defended to date instruct parents to select a child, of the possible children they could have, likely to have a good (or nonbad) life, but they do not instruct parents to independently take the well-being of others into account. We refer to these principles as individualistic selection principles. We propose a new selection principle—Procreative Altruism—according to which parents have significant moral reason to select a child whose existence can be expected to contribute more to (or detract less from) the well-being of others than any alternative child they could have. We present the case for adopting Procreative Altruism alongside any of the major individualistic selection principles proposed to date and defend this two-principle model against a range of objections