D. G. H. Jones

Enhancement encompasses many procedures, but frequently one does not know what counts as therapy, and therefore are unclear when one is moving into enhancement. To address this issue the role of research and therapy is considered in the management of cystic fibrosis. What is the “best possible life” for a child with the “wrong” genetic make-up? Options facing prospective parents are considered, including what enhancement might mean in these circumstances. Issues that emerge include the unclear distinction between certain of the options, resource issues, liberty of the parents against liberty of the children, what counts as normal, and the social and political consequences of utilizing biomedical technologies. Underlying many of these issues is the question of the freedom of those who have been enhanced.

The fundamental stance of the paper by Gareth Jones is that too little attention has been paid to the ethical issues arising from on-going and only partially successful treatment on vulnerable patients with Parkinson’s disease. The nature of the underlying optimism in this and other research approaches is only in part scientifically driven; the other contributor is scientifically uninformed hype, with its lack of testable hypotheses. The experience with neural grafting is relevant since considerable emphasis is currently being placed on injecting stem cells into the brain to “cure” neurodegenerative conditions. However, care has to be exercised that hope is not extinguished. The hazard of confusing clinical trial and medical care is highlighted, while the place of public participation in decision-making is raised. The consequences of neural complexity permeate every discussion including the problems raised by uncontrolled hype. Neuroethics needs to be seen more within the context of clinical ethics.

Neuroethics traditionally pays little attention to neural degeneration and regeneration, areas central to much of current neuroscience. Underlying these interests is the ongoing plasticity of the mature brain, and the ability of stem cells to produce new neurons in adult life. Against this background there have been many attempts to tackle the motor deficits of Parkinson’s disease using neural grafts. The succession of clinical trials since the late 1980s is traced to assess the extent to which symptoms are alleviated by implanting fetal midbrain grafts. The results are ambivalent with some limited improvements in some patients. The part played by a paradigm of optimism is highlighted, while ongoing problems revolve around clinical equipoise, and the place of controls. Deep brain stimulation raises questions of authenticity and alienation. Both approaches to treatment point to the importance for ethics of an appreciation of fundamental understanding of brain connectivity, complexity, and ongoing neurogenesis.

Issues surrounding human embryos are poignant and profound. Should research be conducted on them? Should they be discarded? Should they be donated to infertile couples? The Warnock Report was a landmark in providing guidelines limiting experimentation on human embryos to the first 14 days after fertilization, at which time implantation of the embryo is complete and the primitive streak has appeared.2 However, these embryological features were not considered sufficiently distinctive to bestow upon this 14‐day period a separate classification. This situation changed when, in 1986, Anne McLaren suggested the use of the terms ‘pre‐embryo’ or ‘conceptus' to designate “the entire product of the fertilized egg up to the end of the implantation stage” and the term ’embryo‘ for “that small part of the pre‐embryo or conceptus, first distinguishable at the primitive streak stage, that later develops into the foetus.”3 In this paper we look critically at the term ‘pre‐embryo’, and we shall present the case for an alternative set of terms, namely, embryo‐placenta and embryo‐fetus. We consider this latter to be biologically‐based terminology, that does not have any connotation of restricted moral value as the term pre‐embryo does for some.

The Viewpoint article expressed the feelings of unease often encountered at the display of human corpses in museums, whether relating to prehistoric or recent times. The reasons frequently stem from what is seen as a lack of respect for the remains of another human being. In this instance, the underlying concerns are that the corpses are displayed naked, along with lack of consent from anyone with an interest in them. While these are legitimate queries, ethical interests extend further afield to include whether the corpses are identifiable, are prehistoric or recent, and the existence of living descendants. Additional interests include the uses to which corpses are put, namely, research, teaching and/or public displays.In recent years, it has become commonplace to hear of human remains that had been held for many years by universities or museums being repatriated to indigenous people groups in America, Australia and New Zealand for subsequent reburial.1 ,2 However, the debate regarding the ethical uses to which dead bodies may be put has taken a surprising turn in recent years with the extremely popular, highly publicised, public displays of dissected and plastinated whole body cadavers.3Over the years, most people have had few misgivings looking at the remains of prehistoric individuals, or Egyptian mummies.i Attitudes towards viewing mummies have been shaped by the perception that prehistoric remains are located outside our immediate social relationships, and so, have often been considered as anatomical objects rather than the remains of people-now-dead. In other words, their anonymity appears to protect both the corpses …

The furore over the retention of organs at postmortem examination, without adequate consent, has led to a reassessment of the justification for, and circumstances surrounding, the retention of any human material after postmortem examinations and operations. This brings into focus the large amount of human material stored in various archives and museums, much of which is not identifiable and was accumulated many years ago, under unknown circumstances. Such anonymous archival material could be disposed of, used for teaching, used for research, or remain in storage. We argue that there are no ethical grounds for disposing of the material, or for storing it in the absence of a teaching or research rationale. Nevertheless, with stringent safeguards, it can be used even in the absence of consent in research and teaching. Regulations are required to control the storage of all such human material, along the lines of regulations governing anatomy body bequests.

Speaking for the Dead is an incisive examination of the controversial issues surrounding the use of human cadavers in scientific research. Fully revised and updated to include recent developments in this area, this new edition incorporates the repeated organ scandals in the UK, body parts scandals in the United States, and the abuses of bodies in China.As many more techniques become available for the manipulation of human cadavers, Gareth Jones' clearly written and informative examination will make a significant contribution to the ongoing debate surrounding Bioethics.

Embryo research is currently not allowed in New Zealand, although it is not prohibited by the Human Assisted Reproductive Technology Act. The unusualness of this legislative stance is accentuated by the ready availability of in vitro fertilization and pre-implantation genetic diagnosis, both of which are deemed to be established procedures. Embryo research could, in principle, be approved by the Minister of Health acting on a recommendation by the Advisory Committee on Assisted Reproductive Technology. No Minister of Health has as yet accepted such a recommendation from ACART. Before making such a recommendation, ACART has to consult widely and has to take account of religious and cultural considerations. Religious input has been diverse and has not pointed unequivocally either for or against embryo research, although a large number of submissions to ACART objected to any destruction of embryos, with some of this input opposing IVF and PGD as well as embryo research. Unfortunately, many submissions were little more than assertions that could not readily be integrated into ACART’s decision-making processes. A dialogue model undertaken by Māori groups could provide a productive way forward by which religious and cultural voices could make themselves better heard in a pluralist society. However, this will only work if those with religious perspectives are prepared to accept that there is more than one religious viewpoint on embryo research.

There exists a serious shortage of organs for transplantation in China, more so than in most Western countries. Confucianism has been commonly used as the cultural and ethical reason to explain the reluctance of Chinese and other East-Asian people to donate organs for medical purposes. It is asserted that the Confucian emphasis on xiao (filial piety) requires individuals to ensure body intactness at death. However, based on the original texts of classical Confucianism and other primary materials, we refute this popular view. We base our position on the related Confucian norms of filial piety and ren (humaneness, humanity or benevolence), the tension between differentiated love and universal love, and belief in the goodness of human nature. In light of this, we argue that the Confucian ethical outlook actually calls for organ donation at an individual level, and supports an opt-out (presumed consent) system at the level of social policy. Furthermore, because the popular view is based on a number of dominant but misleading modes of thinking about cultural differences, our revisionist account of Confucian moral duties regarding organ donation has implications for developing a more adequate transcultural and global bioethics. These will be discussed and expanded upon.

Accounts from the humanities which focus on describing the nature of whole body plastinates are examined. We argue that this literature shows that plastinates do not clearly occupy standard cultural binary categories of interior or exterior, real or fake, dead or alive, bodies or persons, self or other and argue that Noël Carroll’s structural framework for horrific monsters unites the various accounts of the contradictory or ambiguous nature of plastinates while also showing how plastinates differ from horrific fictional monsters. In doing so, it offers an account of the varied reactions of those responding to exhibitions of plastinated whole bodies