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

What we think about equality as a value will influence how we think genetic interventions should be regulated. In this paper I utilise the taxonomy of equality put forth by Derek Parfit and apply this to the issue of genetic interventions. I argue that Telic Egalitarianism is untenable and that Deontic Egalitarianism collapses into the Priority View. The Priority View maintains that it is morally more important to benefit those who are worse off. Once this precision has been given to the concerns egalitarians have a number of diverse issues must be considered before determining what the just regulation of genetic interventions would be. Consideration must be given to the current situation of the current situation of the least advantaged, the fiscal realities behind genetic interventions, the budget constraints on other programmes egalitarians believe should receive scarce public funds and the interconnected nature of genetic information. These considerations might lead egalitarians to abandon what they take to be the obvious policy recommendations for them to endorse regarding the regulation of genetic therapies and enhancements.

It is widely agreed, claims John Horton, “that the core of the concept of toleration is the refusal, where one has the power to do so, to prohibit or seriously interfere with conduct one finds objectionable”.1 Liberals champion toleration as one of the main political virtues of a just society. The tolerant society is one which protects a diverse array of fundamental freedoms ranging from freedom of conscience and religion to freedom of expression and freedom of association. Secure in the knowledge that the constitution guarantees these various freedoms, citizens can freely pursue the lifestyles they find most fulfilling, regardless of the fact that the majority of people may or may not find their..

Richard Moon's The Constitutional Protection of Freedom of Expression is an insightful and comprehensive study of the right to freedom of expression in Canadian constitutional law. Moon begins by stressing the importance of the distinction between freedom of expression as a moral or political ideal and as a constitutional right. The former certainly informs the latter. But the general structure of constitutional adjudication will also play an important role in determining how these issues are resolved and this may, in turn, influence our understanding of the right as a moral and political ideal. Moon focuses on the most important Canadian freedom of expression decisions which cover a wide range of topics from the regulation of racist expression and pornography to access to state and private property

Political philosophers have recently begun to take seriously methodological questions concerning what a theoretical examination of political ideals is suppose to accomplish and how effective theorising in ideal theory is in securing those aims. Andrew Mason and G.A. Cohen, for example, believe that the fundamental principles of justice are logically independent of issues of feasibility and questions about human nature. Their position contrasts sharply with political theorists like John Dunn and Joseph Carens who believe that normative theorising must be integrated with an appreciation of the empirical realities of one’s society. Rather than bracket questions of feasibility and human nature, empirically-oriented political theorists believe that real, non- ideal considerations must be taken seriously when deriving normative theories of justice.1 And some justice-theorists, most notably John Rawls, attempt to.

Cambridge Quarterly of Healthcare Ethics. What values and principles should inform the regulation of new human genetic technologies? To adequately answer this question we need an account of genetic justice. That is, an account of what constitutes a fair distribution of genetic endowments that influence our expected life-time acquisition of natural primary goods. These are goods that every rational person has an interest in. The decisions we now make regarding the regulation of human genetic technologies will determine how quickly and effectively these benefits are brought into existence, as well as who receives these benefits. In this paper I argue that a necessary condition of a defensible account of genetic justice is that it must track genetic complexity. Genetic complexity encompasses phenomena such as polygenetic traits, gene-gene interactions and complex environmental influences. More specifically, I argue that pluralistic prioritarianism is a theoretical position well-suited for tracking genetic complexity

“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

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’

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’

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.

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