Daniel Rodger

One objection to xenotransplantation is that it will require the large-scale breeding, raising and killing of genetically modified pigs. The pigs will need to be raised in designated pathogen-free facilities and undergo a range of medical tests before having their organs removed and being euthanised. As a result, they will have significantly shortened life expectancies, will experience pain and suffering and be subject to a degree of social and environmental deprivation. To minimise the impact of these factors, we propose the following option for consideration—ethically defensible xenotransplantation should entail the use of genetic disenhancementifit becomes possible to do so and if that pain and suffering cannot be eliminated by other means. Despite not being a morally ideal ‘solution’, itismorally better to prevent unavoidable pain until a viable non-animal alternative becomes available.

Preclinical xenotransplantation research using genetically engineered pigs has begun to show some promising results and could one day offer a scalable means of addressing organ shortage. While it is a fundamental tenet of ethical human subject research that participants have a right to withdraw from research once enrolled, several scholars have argued that the right to withdraw from xenotransplant research should be suspended because of the public health risks posed by xenozoonotic transmission. Here, we present a comprehensive critical evaluation of the claim that xenotransplant recipients should be required to waive their right to withdraw from lifelong biosurveillance. We conclude that if xenotransplantation requires participants to waive their right to withdraw, then clinical trials may not be justifiable, given the ethical and legal obstacles involved with doing so. Consequently, if clinical trials are permitted with a right to withdraw, then they may pose a significant public health risk.

Xenotransplant patient selection recommendations restrict clinical trial participation to seriously ill patients for whom alternative therapies are unavailable or who will likely die while waiting for an allotransplant. Despite a scholarly consensus that this is advisable, we propose to examine this restriction. We offer three lines of criticism: (1) The risk–benefit calculation may well be unfavorable for seriously ill patients and society; (2) the guidelines conflict with criteria for equitable patient selection; and (3) the selection of seriously ill patients may compromise informed consent. We conclude by highlighting how the current guidance reveals a tension between the societal values of justice and beneficence.

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.

Formal clinical trials of pig-to-human organ transplant—known as xenotransplantation—may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there have been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical–ethical account of xenotransplantation and details if or how viewpoints have shifted over time.

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research.

In this commentary, I will consider the implications of the argument made by Christopher Stratman in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, I argue that virtually everything we already know about unintended pregnancies, abortion and adoption does not prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion, then there will be no radical transformation of the practice of abortion. Second, abortion is already associated with stigma, and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the foetus to the human subject of the artificial womb—the gestateling, therefore creating a new category of killing—gestaticide. However, this would only reorient the debate rather than end it.

There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that genetically-engineered pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for nurses and allied health professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and economic issues associated with xenotransplantation. Finally, we summarise the literature on the attitudes of healthcare professionals toward xenotransplantation.

Arguments that claim opponents of abortion are inconsistent in some manner are becoming increasingly prevalent both in academic and public discourse. For example, it is common to claim that they spend considerable time and resources to oppose induced abortion, but show little concern regarding the far greater numbers of naturally occurring intrauterine deaths (miscarriages). Critics argue that if abortion opponents took their beliefs about the value of embryos and fetuses seriously, they would invest more time and resources combating these naturally occurring deaths than those caused by induced abortion. The implication is that abortion opponents do not take their beliefs about embryos and fetuses seriously—and so why should anyone else? These “inconsistency arguments”, as we have called them, have considerable intuitive appeal: showing that someone is living inconsistently or holding beliefs that seem prima facie inconsistent seems to many to undermine those beliefs. However, upon closer examination, these arguments become less convincing. In short, we show that the inconsistency arguments we are aware of are severely flawed, and so, if critics wish to continue their criticism, they should abandon inconsistency arguments in favor of other styles of argument. We will proceed in four stages. First, we describe the basic form of inconsistency arguments against abortion opponents. Second, we outline specific instances of the inconsistency argument that have been advanced. Third, we outline specific responses to these arguments, noting ways in which responses also conform to set patterns. Finally, we assess the debate and suggest how it might progress in productive ways.

William Simkulet has recently criticised Colgrove et al ’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion act in ways inconsistent with their underlying beliefs about human fetuses. Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al ’s reasons for rejecting inconsistency arguments remain intact.

This book provides extensive and critical engagement with some of the most recent and compelling arguments favoring abortion choice. It features original essays from leading and emerging philosophers, bioethicists and medical professionals that present philosophically sophisticated and novel arguments against abortion choice. The chapters in this book are divided into three thematic sections. The first set of essays focuses primarily on unborn human individuals--zygotes, embryos and fetuses. In these chapters it is argued, for example, that human organisms begin to exist at conception and that zygotes, embryos and fetuses are persons. These chapters also explore questions about whether or not zygotes, embryos and fetuses are part of their mothers' bodies. The second set of essays focuses primarily on elective abortion and the debates surrounding it. These chapters consider whether or not opponents of abortion are commonly hypocritical, how opponents of abortion should think about adoption, how emerging technologies may affect the current debate and whether or not those participating in the debate should rely on analogies to support their case. Finally, the third set of essays shifts focus from the legal and moral status of elective abortion to its place in medical practice. In these chapters it is argued that elective abortion embodies a kind of ableism, and that elective abortion is medically unnecessary, harmful to women's mental health and that telemedicine abortion poses significant risks to women's health. Agency, Pregnancy and Persons offers an up-to-date examination of unborn human beings, the debates surrounding elective abortion and the place of elective abortion within medical practice. It will be of interest to medical professionals and those who work in philosophy, bioethics and medical ethics alike.

Perioperative staff are frequently exposed to surgical smoke or plume created by using heat-generating devices like diathermy and lasers. This is a concern due to mounting evidence that this exposure can be harmful with no safe level of exposure yet identified. First, I briefly summarise the problem posed by surgical smoke exposure and highlight that many healthcare organisations are not sufficiently satisfying their legal and ethical responsibilities to protect their staff from potential harm. Second, I explore the ethical case for compulsory smoke evacuation systems using the principlist framework and its four ethical principles – autonomy, beneficence, nonmaleficence, and justice. I then consider some objections and argue that surgical smoke evacuation systems – when indicated – should be made compulsory.

William Simkulet has recently criticised Colgrove et al’s defence against what they have called inconsistency arguments—arguments that claim opponents of abortion (OAs) act in ways inconsistent with their underlying beliefs about human fetuses (eg, that human fetuses are persons at conception). Colgrove et al presented three objections to inconsistency arguments, which Simkulet argues are unconvincing. Further, he maintains that OAs who hold that the fetus is a person at conception fail to act on important issues such as the plight of frozen embryos, poverty and spontaneous abortion. Thus, they are morally negligent. In response, we argue that Simkulet has targeted a very narrow group of OAs, and so his criticisms are inapplicable to most OAs. We then explain why his responses to each of Colgrove et al’s objections do not succeed, even for this restricted group. Finally, we note that Simkulet fails to provide evidence for his claims regarding OAs’ supposed failures to act, and we show that OAs veritably do invest resources into these important issues. We conclude that Colgrove et al’s reasons for rejecting inconsistency arguments (en masse) remain intact.

The 14-day rule restricts the culturing of human embryos in vitro for the purposes of scientific research for no longer than 14 days. Since researchers recently developed the capability to exceed the 14-day limit, pressure to modify the rule has started to build. Sophia McCully argues that the limit should be extended to 28 days, listing numerous potential benefits of doing so. We contend that McCully has not engaged with the main reasons why the Warnock Committee set such a limit, and these still remain valid. As a result, her case for an extension of the 14-day rule is not persuasive.

The development of artificial womb technology is proceeding rapidly and will present important ethical and theological challenges for Christians. While there has been extensive secular discourse on artificial wombs in recent years, there has been little Christian engagement with this topic. There are broadly two primary uses of artificial womb technology—ectogestation as a form of enhanced neonatal care, where some of the gestation period takes place in an artificial womb, and ectogenesis, where the entire gestation period is within an artificial womb. Ectogestation for the latter weeks or months of pregnancy could be possible within a decade or so, while ectogenesis for humans is far more speculative. Ectogestation is likely to significantly decrease maternal and neonatal morbidity and mortality, and so there is a strong case for supporting its development. Ectogenesis, however, may bring a number of challenges, including the commodification of children, and the pathologizing of pregnancy and childbirth. Its long-term effects on those who are created through this process are also unknown. In the event that it becomes ubiquitous, we may also find the central theological significance of pregnancy and birth diminished. The dilemma for Christians is that the development of ectogestation seems likely to normalise the use of artificial gestation, and, in time, pave the way for ectogenesis

Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to respect patients’ dietary preferences and then use animal-derived medicines or medical devices on them without their informed consent. I then address several anticipated objections and conclude that the continued failure to address this issue is an ethical blind spot that warrants applying the principles of respect for autonomy and informed consent consistently. There are no data in this work.

Pro-life advocates commonly argue that fetuses have the moral status of persons, and an accompanying right to life, a view most pro-choice advocates deny. A difficulty for this pro-life position has been Judith Jarvis Thomson’s violinist analogy, in which she argues that even if the fetus is a person, abortion is often permissible because a pregnant woman is not obliged to continue to offer her body as life support. Here, we outline the moral theories underlying public health ethics, and examine the COVID-19 pandemic as an example of public health considerations overriding individual rights. We argue that if fetuses are regarded as persons, then abortion is of such prevalence in society that it also constitutes a significant public health crisis. We show that on public health considerations, we are justified in overriding individual rights to bodily autonomy by prohibiting abortion. We conclude that in a society that values public health, abortion can only be tolerated if fetuses are not regarded as persons.

Prabhpal Singh has recently defended a relational account of the difference in moral status between fetuses and newborns as a way of explaining why abortion is permissible and infanticide is not. He claims that only a newborn can stand in a parent–child relation, not a fetus, and this relation has a moral dimension that bestows moral value. We challenge Singh’s reasoning, arguing that the case he presents is unconvincing. We suggest that the parent–child relation is better understood as an extension of an existing relationship formed during the gestational period. The change in this relation at birth is not sufficient to justify the radical change in moral status required to rule out infanticide while accepting the permissibility of abortion. Given that the moral status of orphans is also problematic under Singh’s account, we conclude that Singh has not shown that a newborn has greater moral worth than a fetus.

Opponents of abortion are often described as ‘inconsistent’ (hypocrites) in terms of their beliefs, actions and/or priorities. They are alleged to do too little to combat spontaneous abortion, they should be adopting cryopreserved embryos with greater frequency and so on. These types of arguments—which we call ‘inconsistency arguments’—conform to a common pattern. Each specifies what consistent opponents of abortion would do (or believe), asserts that they fail to act (or believe) accordingly and concludes that they are inconsistent. Here, we show that inconsistency arguments fail en masse. In short, inconsistency arguments typically face four problems. First, they usually fail to account for diversity among opponents of abortion. Second, they rely on inferences about consistency based on isolated beliefs shared by some opponents of abortion (and these inferences often do not survive once we consider other beliefs opponents of abortion tend to hold). Third, inconsistency arguments usually ignore the diverse ways in which opponents of abortion might act on their beliefs. Fourth, inconsistency arguments criticise groups of people without threatening their beliefs (eg, that abortion is immoral). Setting these problems aside, even supposing inconsistency arguments are successful, they hardly matter. In fact, in the two best-case scenarios—where inconsistency arguments succeed—they either encourage millions of people to make the world a (much) worse place (from the critic’s perspective) or promote epistemically and morally irresponsible practices. We conclude that a more valuable discussion would be had by focusing on the arguments made by opponents of abortion rather than opponents themselves.

The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of defenders of conscientious objection—being expected to participate in the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected.

The rapid development of artificial womb technologies means that we must consider if and when it is permissible to kill the human subject of ectogestation—recently termed a ‘gestateling’ by Elizabeth Chloe Romanis—prior to ‘birth’. We describe the act of deliberately killing the gestateling as gestaticide, and argue that there are good reasons to maintain that gestaticide is morally equivalent to infanticide, which we consider to be morally impermissible. First, we argue that gestaticide is harder to justify than abortion, primarily because the gestateling is completely independent of its biological parents. Second, we argue that gestaticide is morally equivalent to infanticide. To demonstrate this, we explain that gestatelings are born in a straightforward sense, which entails that killing them is infanticide. However, to strengthen our overall claim, we also show that if gestatelings are not considered to have been born, killing them is still equivalent to killing neonates with congenital anomalies and disabilities, which again is infanticide. We conclude by considering how our discussion of gestaticide has implications for the permissibility of withdrawing life-sustaining treatment from gestatelings.

In this commentary, I will consider the implications of the argument made by Christopher Stratman (2020) in ‘Ectogestation and the Problem of Abortion’. Clearly, the possibility of ectogestation will have some effect on the ethical debate on abortion. However, I have become increasingly sceptical that the possibility of ectogestation will transform the problem of abortion. Here, I outline some of my reasons to justify this scepticism. First, that virtually everything we already know about unintended pregnancies, abortion and adoption does not prima facie support the assumption that a large shift to ectogestation would occur. Moreover, if ectogestation does not lead to significant restrictions to abortion then there is unlikely to be any radical transformation of the practice of abortion. Second, abortion is already associated with stigma and so the presence of ectogestation would need to create additional stigma to modify behaviour. Finally, I argue that ectogestation shifts the debate away from the fetus to the human subject of the artificial womb—the gestateling. Therefore, creating a new category of killing—gestaticide—and this would only reorient the debate rather than end it.

To determine when the life of a human organism begins, Mark T. Brown has developed the somatic integration definition of life. Derived from diagnostic criteria for human death, Brown’s account requires the presence of a life‐regulation internal control system for an entity to be considered a living organism. According to Brown, the earliest point at which a developing human could satisfy this requirement is at the beginning of the fetal stage, and so the embryo is not regarded as a living human organism. This, Brown claims, has significant bioethical implications for both abortion and embryo experimentation. Here, we dispute the cogency of Brown’s derivation. Diagnostic criteria for death are used to determine when an organism irreversibly ceases functioning as an integrated whole, and may vary significantly depending on how developed the organism is. Brown’s definition is derived from a specific definition of death applicable to postnatal human beings, which is insufficient for generating a general definition for human organismal life. We have also examined the bioethical implications of Brown’s view, and have concluded that they are not as significant as he believes. Whether the embryo is classified as a human organism is of peripheral interest—a far more morally relevant question is whether the embryo is a biological individual with an identity that is capable of persisting during development.

Florence Ashley has responded to our response to ‘Gatekeeping hormone replacement therapy for transgender patients is dehumanising.’ Ashley criticises some of our objections to their view that patients seeking hormone replacement therapy (HRT) for gender dysphoria should not have to undergo a prior psychological assessment. Here we clarify our objections, most importantly that concerning the parity between cosmetic surgery and the sort of intervention Ashley has in mind. Firstly, we show Ashley’s criticism of our comparison is insubstantial. We then examine their comments regarding the analogy between abortion and HRT, and the language of informed consent. We also scrutinize the data upon which Ashley relies to defend the claim that informed consent without assessment always yields positive outcomes, finding this conclusion to be overstated. Finally, even if Ashley’s arguments were vindicated, the claim that the gatekeeping of HRT is motivated by hostility towards transgender people remains unsupported.