Robert Sparrow

One day soon it may be possible to replace a failing heart, liver, or kidney with a long-lasting mechanical replacement or perhaps even with a 3-D printed version based on the patient's own tissue. Such artificial organs could make transplant waiting lists and immunosuppression a thing of the past. Supposing that this happens, what will the ongoing care of people with these implants involve? In particular, how will the need to maintain the functioning of artificial organs over an extended period affect patients and their doctors and the responsibilities of those who manufacture such devices? Drawing on lessons from the history of the cardiac pacemaker, this article offers an initial survey of the ethical issues posed by the need to maintain and service artificial organs. We briefly outline the nature and history of cardiac pacemakers, with a particular focus on the need for technical support, maintenance, and replacement of these devices. Drawing on the existing medical literature and on our conversations and correspondence with cardiologists, regulators, and manufacturers, we describe five sources of ethical issues associated with pacemaker maintenance: the location of the devices inside the human body, such that maintenance generates surgical risks; the complexity of the devices, which increases the risk of harms to patients as well as introducing potential injustices in access to treatment; the role of software—particularly software that can be remotely accessed—in the functioning of the devices, which generates privacy and security issues; the impact of continual development and improvement of the device; and the influence of commercial interests in the context of a medical device market in which there are several competing products. Finally, we offer some initial suggestions as to how these questions should be answered.

Concern for “reproductive liberty” suggests that decisions about embryos should normally be made by the persons who would be the genetic parents of the child that would be brought into existence if the embryo were brought to term. Therapeutic cloning would involve creating and destroying an embryo, which, if brought to term, would be the offspring of the genetic parents of the person undergoing therapy. I argue that central arguments in debates about parenthood and genetics therefore suggest that therapeutic cloning would be prima facie unethical unless it occurred with the consent of the parents of the person being cloned. Alternatively, if therapeutic cloning is thought to be legitimate, this undermines the case for some uses of reproductive cloning by implying that the genetic relation it establishes between clones and DNA donors does not carry the same moral weight as it does in cases of normal reproduction

In this paper, I explore the “expressivist critique” of the use of prenatal testing to select against the birth of persons with impairments. I begin by setting out the expressivist critique and then highlighting, through an investigation of an influential objection to this critique, the ways in which both critics and proponents of the use of technologies of genetic selection negotiate a difficult set of dilemmas surrounding the relationship between genes and identity. I suggest that we may be able to advance the debate about these technologies by becoming more aware of the ways in which this debate is itself in part a political contestation over this relationship. Ultimately, I will argue, the real force of the expressivist objection lies in its capacity to draw our attention to political questions about the role of the state and about relationships between different social groups rather than between parents and prospective children. That is to say, crucial issues, when evaluating the force of this criticism, turn out to be: the nature of the institutions which determine how decisions about prenatal selection are made; and how we think of each other, that is, what we take to be the defining characteristics of human beings. Paradoxically, arguments about the ethics of the “sorting society”, both supportive and critical, are an important arena in which these institutions and these ideas about identity are contested and shaped. An increased awareness of the reflexive nature of the process of debating these issues may assist us in better negotiating them.

If, as a number of writers have predicted, the computers of the future will possess intelligence and capacities that exceed our own then it seems as though they will be worthy of a moral respect at least equal to, and perhaps greater than, human beings. In this paper I propose a test to determine when we have reached that point. Inspired by Alan Turing’s (1950) original “Turing test”, which argued that we would be justified in conceding that machines could think if they could fill the role of a person in a conversation, I propose a test for when computers have achieved moral standing by asking when a computer might take the place of a human being in a moral dilemma, such as a “triage” situation in which a choice must be made as to which of two human lives to save. We will know that machines have achieved moral standing comparable to a human when the replacement of one of these people with an artificial intelligence leaves the character of the dilemma intact. That is, when we might sometimes judge that it is reasonable to preserve the continuing existence of a machine over the life of a human being. This is the “Turing Triage Test”. I argue that if personhood is understood as a matter of possessing a set of important cognitive capacities then it seems likely that future AIs will be able to pass this test. However this conclusion serves as a reductio of this account of the nature of persons. I set out an alternative account of the nature of persons, which places the concept of a person at the centre of an interdependent network of moral and affective responses, such as remorse, grief and sympathy. I argue that according to this second, superior, account of the nature of persons, machines will be unable to pass the Turing Triage Test until they possess bodies and faces with expressive capacities akin to those of the human form

In this paper I examine what I take to be the best case for reproductive human cloning, as a medical procedure designed to overcome infertility, and argue that it founders on an irresolvable tension in the attitude towards the importance of being ‘genetically related’ to our children implied in the desire to clone. Except in the case where couples are cloning a child they have previously conceived naturally, cloning is unable to establish the right sort of genetic relation to make couples the parents of their cloned child. If anybody is the genetic parent of a cloned child it is the natural parent(s) of the DNA donor. Paradoxically, in order to resist the claims of the parents of the donor to the cloned child, the argument for human reproductive cloning must place more weight on the intention to parent a child, than we do in cases of ordinary reproduction. It must insist that the parental relation is established by the intentions of the couple who bring a clone into the world and not by their genetic relation to the child. The emphasis placed on intention as establishing the parental relationship works to undermine the justification for cloning in the first place. For cloning to play a useful role as a reproductive technology, it must allow couples to become parents who could do so no other way. However, to the extent that intention is sufficient to establish parenthood, adoption or surrogacy, which are existing alternatives to cloning, will serve equally well to allow couples to become parents.

The phenomenon of “dirty hands” is often held to be endemic to political life. Success in politics—it has been argued—requires a willingness to sacrifice our moral principles in order to pursue worthwhile goals. I argue that the tension between morality and politics goes deeper than this. The very existence of “politics” requires that morality is routinely violated because political community, within which political discourse is possible, is based on denying the moral claims of non-members. Political community requires borders and borders require keeping outsiders out. Yet there is no justification that we can provide to someone outside of our political community as to why they are denied membership. The price of political community is therefore the unjust exclusion of others. In a world characterised by the movement of peoples as a result of large-scale and systematic international injustices, this exclusion often involves acts that violate important obligations of compassion and respect. Thus, “we” are the barbarians my title refers to. In order for political community to exist, we must act like barbarians at the gates. A problem of “dirty hands” therefore lies at the very foundation of political community.

This paper criticises John Harris's attempts to defend an account of a ‘harmed condition’ that can stand independently of intuitions about what is ‘normal’. I argue that because Homo sapiens is a sexually dimorphic species, determining whether a particular individual is in a harmed condition or not will sometimes require making reference to the normal capacities of their sex. Consequently, Harris's account is unable to play the role he intends for it in debates about the ethics of human enhancement.

‘Liberal eugenics’ has emerged as the most popular position amongst philosophers writing in the contemporary debate about the ethics of human enhancement. This position has been most clearly articulated by Nicholas Agar, who argues that the ‘new’ liberal eugenics can avoid the repugnant consequences associated with eugenics in the past. Agar suggests that parents should be free to make only those interventions into the genetics of their children that will benefit them no matter what way of life they grow up to endorse. I argue that Agar's attempt to distinguish the new from the old eugenics fails. Once we start to consciously determine the genetics of future persons, we will not be able to avoid controversial assumptions about the relative worth of different life plans. Liberal eugenicists therefore confront the horns of a dilemma. Whichever way they try to resolve it, the consequences of widespread use of technologies of genetic selection are likely to look more like the old eugenics than defenders of the new eugenics have acknowledged