Colin Farrelly

Folkbiology refers to people’s everyday understanding of the biological world. The early twentieth-century pioneers of public health C.-E.A Winslow (1877–1957), and his mentor H. Biggs (1859–1923), conceptualized public health as the ‘purchasable’ science of preventing disease and death from unfavorable economic and living conditions. Their ideas were foundational in shaping public health’s strategy of a ‘war against disease’ (Winslow, 1903), a strategy that was very successful in preventing the early-life mortality risks from infectious diseases, and was eventually extended to combating the chronic diseases of late life (like cancer). However, the initial framing of public health, through the lens of sanitation science, was predicated upon folkbiological premises that geroscience must abate in order to direct public health interventions toward the goal of improving the quality of life for older persons in the twenty-first century. Three folkbiological premises of sanitation science’s ‘war against disease’ are identified and critiqued: (i) the belief that health is the ‘normal’ condition of the human mechanism and disease ‘unnecessary’; (ii) the belief that the proximate causes of disease are the only modifiable risk factors public health interventions can alter; and (iii) the belief that the rate of biological aging is universal.

In this paper I argue that the account of deliberative democracy advanced by Amy Gutmann and Dennis Thompson (1996, 2004) is a useful normative theory that can help enhance our deliberations about public policy in morally pluralistic societies. More specifically, I illustrate how the prescriptions of deliberative democracy can be applied to the issue of regulating non-medical uses of pre-implantation genetic diagnosis (PGD), such as gender selection. Deliberative democracy does not aim to win a philosophical debate among rival first-order theories, such as libertarianism, egalitarianism or feminism. Rather, it advances a second-order analysis that strives to help us determine what would constitute a reasonable balance between the conflicting fundamental values that arise in the context of regulating PGD. I outline a theoretical model (called the Reasonable Genetic Intervention Model) that brings these issues to the fore. Such a model incorporates the concern for both procedural and substantive principles; and it does so in way that takes provisionality seriously

The recent case of German siblings Patrick Stübing and his sister Susan Karolewski has reignited debate over the criminalisation of sexual intercourse among consanguine descendants. The primary justification for criminalising incest is the purported increased risk of genetic disabilities among offspring, but is criminalising sexual intercourse an empirically sound and proportionate response to this increased risk? To answer this question we must consider the specifics of the harm in question and the magnitude of the harms of the intervention. The example of incest law has important implications for liberal societies. If we can justify imprisoning consenting adults for choosing partners who will increase the risk of having children with disabilities, then we set a troubling precedent for all couples who may pass on genetic disorders to their children

John Davis (_New Methuselahs_: _The Ethics of Life_ _Extension_, The MIT Press, Cambridge, 2018) advances a novel ethical analysis of longevity science that employs a three-fold methodology of examining the impact of life extension technologies on three distinct groups: the “Haves”, the “Have-nots” and the “Will-nots”. In this essay, I critically examine the egalitarian analysis Davis deploys with respect to its ability to help us theorize about the moral significance of an applied gerontological intervention. Rather than focusing on futuristic scenarios of radical life extension, I offer a rival egalitarian analysis that takes seriously (1) the health vulnerabilities of today’s aging populations, (2) the health inequalities of the “aging status quo” and, (3) the prospects for the fair diffusion of an aging intervention over the not-so-distant future. Despite my reservations about Davis’s focus on “life-extension” vs. increasing the human “healthspan”, I agree with his central conclusion that an aging intervention would be, on balance, a good thing and that we should fund such research aggressively. But, I make an even stronger case and conjecture that an intervention that slows down the rate of molecular and cellular decline from the inborn aging process will likely be one of the most important public health advancements of the twenty-first century. This is so because aging is the most prevalent risk factor for chronic disease, frailty and disability, and it is estimated that there will be over 2 billion persons age > 60 by the year 2050.

Imagination and idealism are particularly important creative epistemic virtues for the medical sciences if we hope to improve the health of the world’s ageing population. To date, imagination and idealism within the medical sciences have been dominated by a paradigm of disease control, a paradigm which has realised significant, but also limited, success. Disease control proved particularly successful in mitigating the early-life mortality risks from infectious diseases, but it has proved less successful when applied to the chronic diseases of late life (like cancer). The time is ripe for the emergence and prominence of a supplementary medical research paradigm, the paradigm of ‘healthy ageing’ which prioritises the goal of rate (of ageing) control rather than disease control. This is the difference between extending the human healthspan versus extending survival by managing (or trying to eliminate) the multi-morbidities, frailty and disability currently prevalent in late life. The idealism of the disease control paradigm is myopic because it ignores the health constraints imposed by the inborn ageing process itself, a biological reality which is already inflicting significant economic and disease burdens on the world’s ageing populations. Unless the medical sciences retard the rate of biological ageing, these problems will continue to be amplified as larger numbers of persons survive into late life.

: This paper explores some of the challenges raised by human genetic interventions for debates about distributive justice, focusing on the challenges that face prioritarian theories of justice and their relation to the argument advanced by Ronald Lindsay elsewhere in this issue of the Kennedy Institute of Ethics Journal. Also examined are the implications of germ-line genetic enhancements for intergenerational justice, and an argument is given against Fritz Allhoff's conclusion, found in this issue as well, that such enhancements are morally permissible if and only if they augment primary goods

Where does the aspiration to retard human ageing fit in the ‘big picture’ of medical necessities and the requirements of just healthcare? Is there a duty to retard human ageing? And if so, how much should we invest in the basic science that studies the biology of ageing and could lead to interventions that modify the biological processes of human ageing? I consider two prominent accounts of equality and just healthcare – Norman Daniels's application of the principle of fair equality of opportunity and Ronald Dworkin's account of equality of resources – and conclude that, once suitably amended and revised, both actually support the conclusion that anti-ageing research is important and could lead to interventions that ought to be considered ‘medical necessities’

“Three Wishes” is an exercise in what could be called interactive philosophy. It challenges the reader to discern for herself what lessons we can take from the fable, rather than explicitly laying these out beforehand. Engaging in this intellectual exercise should prove fruitful as it compels one to reflect critically upon the interconnection between distinct laudable goals as well as appreciate the role that perceived feasibility constraints play in our determination of what the fundamental principles of distributive justice are and how they should be ordered

Theories of distributive justice tend to focus on the issue of what constitutes a fair division of 'external' goods and opportunities; things like wealth and income, opportunities for education and basic liberties and rights. However, rapid advances in the biomedical sciences have ushered in a new era, one where the 'genetic lottery of life' can be directly influenced by humans in ways that would have been considered science fiction only a few decades ago. How should theories of justice be modified to take seriously the prospect of new biotechnologies, especially given the health challenges posed by global aging? Colin Farrelly addresses a host of topics, ranging from gene therapy and preimplantation genetic diagnosis, to an 'anti-aging' intervention and the creation and evolution of patriarchy. This book aims to foster the interdisciplinary dialogue needed to ensure we think rationally and cogently about science and science policy in the twenty-first century.

Deliberative democrats conceive of the democratic process as a transformative process, one that requires citizens to participate in authentic deliberation with others rather than engaging in the strategic behaviour characteristic of existing democratic practices. Current practices often pit factions of society against one another in a struggle to win or retain political power. The moralized conception of democracy defended by deliberative democrats is one that emphasizes the importance of being open-minded, reasonable and accommodating. These civic virtues are necessary if we are to treat others as equals when decisions are made concerning the use of political power, power that will influence the life prospects of everyone. Deliberative democrats are thus concerned with the normative legitimacy of a democratic decision; this legitimacy depends ‘on the degree to which those affected by it have been included in the decision-making processes and have had the opportunity to influence the outcomes’

In this article I critically examine Adam Moore’s claim that the threshold for overriding intangible property rights and privacy rights is higher, in relation to genetic enhancement techniques and sensitive personal information, than is commonly suggested. I argue that Moore fails to see how important advances in genetic research are to social justice. Once this point is emphasised one sees that the issue of how formidable overriding these rights are is open to much debate. There are strong reasons, on grounds of social justice, for thinking the importance of such rights is likely to be diminished in the interests of ensuring a more just distribution of genes essential to pursuing what John Rawls calls a person’s ”rational plan of life’

In “Institutions and the Demands of Justice,” Liam Murphy ~1999! makes a distinction between two approaches to normative political theory. He labels these two positions “dualism” and “monism.” The former maintains that “the two practical problems of institutional design and personal conduct require, at the fundamental level, two different kinds of practical principle” ~1999: 254!. The most influential proponent of dualism is John Rawls. In A Theory of Justice Rawls defends his theory of “justice as fairness,” which recognizes a division of responsibility between the principles that apply to the main social, economic and political institutions of society, and the principles that apply to individuals. Institutions are to be arranged so that citizens’ basic rights and liberties are protected and social and economic inequalities are to the greatest benefit of the least advantaged and attached to offices and positions open to all under conditions of fair equality of opportunity. The principles that apply to individuals include various principles of natural duty, as well as the principle of fairness. These principles impose on citizens a diverse array of duties and obligations, such as the duties of mutual respect and mutual aid

Distributive justice concerns the fair distribution of the benefits and burdens of social cooperation. Opposition to higher rates of taxation, or even existing levels of taxation, are often made on grounds that such taxes are unfair burdens. This fairness argument can be given a number of further, more specific, formulations. Libertarians like Robert Nozick, for example, argue that taxation of income is unfair because it violates individual rights. Libertarians invoke an entitlement argument which presumes that the appropriate baseline of property rights is pretax income. Others take issue with specific policies that are supported by taxation, such as welfare provisions, and argue that welfare reform is necessary as tax burdens are only legitimate when they satisfy some form of reciprocity thesis. In this review article I critically assess these arguments. The recent publication of The Cost of Rights: Why Liberty Depends on Taxes, The Myth of Ownership: Taxes and Justice, and The Civic Minimum: On the Rights and Obligations of Economic Citizenship help shed some light on each of these different arguments that are often invoked in defence of tax cuts. These three books are a welcome addition to debates about distributive justice as they help bridge the gap between normative theory and public policy. In addition to raising doubts about the arguments that taxation is unfair, I examine themes that raise important questions about taxation and justice- private property, welfare reform and inheritance. An examination of these themes should make it clear that the real challenge facing justice-theorists is to take scarcity seriously and thus I emphasis the shortcomings of simply endorsing a ‘cost-blind’ rights-oriented conception of justice. Such a conception of justice currently dominates debates in normative political theory.

Mathias Risse’s On Global Justice is a unique and important contribution to the growing literature on global justice. Risse’s approach to a variety of topics, ranging from domestic justice and common ownership of the earth, to immigration, human rights, climate change, and labour rights, is one that conceives of global justice as a philosophical problem. In this commentary I focus on a number of reservations I have about approaching global justice as a philosophical rather than an inherently practical problem. To his credit Risse does acknowledge at various stages of the book that a good deal of the applied terrain he ventures into presupposes complex and contentious empirical assumptions. A greater emphasis on those points would, I believe, helpfully reveal the shortcomings of tackling intellectual property rights by appealing to Hugo Grotius’s stance on the ownership of seas, or the shortcomings of tackling health by invoking the language of human rights without acknowledging and addressing the constraints and challenges of promoting health in an aging world.

Those who subscribe to a prudential conception of practical reason do not believe that there is a conflict between other-regarding and self-regarding norms as the former are held to be founded on the latter. Moral conduct, they maintain, is always rationally justifiable. The reasons we should fulfil the demands of other-regarding norms are the same as those we have for fulfilling self-regarding norms. David Brink has put forth an interesting and novel account of this approach to practical reason which he calls ‘metaphysical egoism’. Metaphysical egoism requires that we modify our pre-theoretical understandings of self-interest on metaphysical grounds. I critically assess Brink’s argument and claim that metaphysical egoism does not adequately function as a motive or guide for action. It is susceptible to many of the same problems which strategic egoism faces.

The world's aging populations face novel health challenges never experienced before in human history. The moral landscape thus needs to adapt to reflect this novel empirical reality. In this paper I take for granted one basic moral principle advanced by Peter Singer and explore the implications that empirical considerations from demography, evolutionary biology, and biogerontology have for the way we conceive of fulfilling this principle at the operational level. After bringing to the fore a number of considerations that Singer ignores, such as the probability that nonintervention will result in harm and the likelihood that different kinds of extrinsic and intrinsic harms can be prevented, I argue that the aspiration to extend the human biological warranty period (by retarding the rate of aging) is a pressing moral imperative for the twenty-first century. In the final sections I briefly address some standard objections raised against life extension and conclude that, while there may be some legitimate concerns worth addressing, they are not compelling enough to provide a rational basis for forfeiting the potential health and economic benefits that could be realized by extending the biological warranty period

In this paper I argue that the virtue ethics tradition can enhance the moral discourse on the ethics of prenatal genetic enhancements in distinctive and valuable ways. Virtue ethics prescribes we adopt a much more provisional stance on the issue of the moral permissibility of prenatal genetic enhancements. A stance that places great care on differentiating between the different stakes involved with developing different phenotypes in our children and the different possible means (environmental vs. genetic manipulation) available to parents for pursuing legitimate concerns of parental love and virtue. Key components of the virtue ethics account of morality, such as the Aristotelian account of happiness, love and the doctrine of the mean, provide an adequate basis for rejecting the claim that it is morally impermissible for parents to pursue (safe and effective) prenatal enhancements. Furthermore, there is good reason to believe that a virtue ethics account of morality could actually support the stronger claim that utilising such interventions can (in certain contexts) be morally required