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

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

In this paper I argue that political liberalism is not the “minimalist liberalism” characterised by Michael Sandel and that it does not support the vision of public life characteristic of the procedural republic. I defend this claim by developing two points. The first concerns Rawls's account of public reason. Drawing from examples in Canadian free speech jurisprudence I show how restrictions on commercial advertising, obscenity and hate propaganda can be justified by political values. Secondly, political liberalism also attends to the identity, and not just the interests, of its citizens. It attempts to cultivate certain virtues of character. But it does so in a way that does not entail the acceptance of a comprehensive or perfectionist doctrine. Rawls's defence of neutrality of aim does not mean the state should be neutral towards all the views its citizens espouse. I conclude that political liberalism shares little with the doctrine Sandel claims is embedded in American law.

Recent advances in genetic research pose many complex problems for moral and political philosophers. On the one hand, these advances promise great things. Genetic enhancement techniques might allow us to prevent or cure a variety of debilitating diseases. But on the other hand, talk about intervening in people's genetic make-up conjures up memories of the sinister episodes of past eugenic movements. Such movements violated the most basic principles of justice. How can society capitalize on the benefits of genetic intervention and yet avoid the injustices of past eugenic movements? What basic moral principles should guide public policy and individual choice concerning the use of genetic interventions? These important questions are tackled by Allen Buchanan, Dan Brock, Norman Daniels, and Daniel Wikler in From Chance to Choice: Genetics and Justice. This book brings together the thoughts of leading scholars in the field and is likely to set the agenda for serious debate on this topic.

In the newly emerging debates about genetics and justice three distinct principles have begun to emerge concerning what the distributive aim of genetic interventions should be. These principles are: genetic equality, a genetic decent minimum, and the genetic difference principle. In this paper, I examine the rationale of each of these principles and argue that genetic equality and a genetic decent minimum are ill-equipped to tackle what I call the currency problem and the problem of weight. The genetic difference principle is the most promising of the three principles and I develop this principle so that it takes seriously the concerns of just health care and distributive justice in general. Given the strains on public funds for other important social programmes, the costs of pursuing genetic interventions and the nature of genetic interventions, I conclude that a more lax interpretation of the genetic difference principle is appropriate. This interpretation stipulates that genetic inequalities should be arranged so that they are to the greatest reasonable benefit of the least advantaged. Such a proposal is consistent with prioritarianism and provides some practical guidance for non-ideal societies–that is, societies that do not have the endless amount of resources needed to satisfy every requirement of justice.

Why does the world have the pattern of patriarchy it currently possesses? Why have patriarchal practices and institutions evolved and changed in the ways they have tended to over time in human societies? This paper explores these general questions by integrating a feminist analysis of patriarchy with the central insights of the functionalist interpretation of historical materialism advanced by G. A. Cohen. The paper has two central aspirations: first, to help narrow the divide between analytical Marxism and feminism by redressing the former's neglect of the important role female labor has played, and continues to play, in shaping human history. Second, by developing the functionalist account of historical materialism in order to take patriarchy seriously, we can derive useful insights for diagnosing the emancipatory challenges that women face in the world today. The degree and form of patriarchy present in any particular society is determined by the productive forces it has had at its disposal. According to historical materialism, technological, material, and medical advances that ease the pressures on high fertility rates (such as the sanitation revolution, vaccinations, birth control, and so on) are the real driving forces behind the positive modulations to patriarchy witnessed in the twentieth century.