Jack Harris

New UK consensus statement on core curriculum in medical ethics and lawThe most important paper in this month’s JME is not a standard paper but the new UK consensus statement on the core curriculum in medical ethics and law for medical students. The first consensus statement was published in the JME in 1998 and has been instrumental in ensuring the embedding of a common standard of teaching in these subjects across UK medical schools. 1 However, even the most hard core moral realist has to accept that, even if the fundamental principles of ethics do not change, the best way to teach it might evolve and the problems of most interest may change as the healthcare system changes. The core curriculum can therefore not be cast in stone and must be revised and updated from time to time. The current revision is the result of an extensive process involving reviews of the way …

Ted Shotter's founding of the London Medical Group 50 years ago in 1963 had several far reaching implications for medical ethics, as other papers in this issue indicate. Most significant for the joint authors of this short paper was his founding of the quarterly Journal of Medical Ethics in 1975, with Alastair Campbell as its first editor-in-chief. In 1980 Raanan Gillon began his 20-year editorship. Gillon was succeeded in 2001 by Julian Savulescu, followed by John Harris and Soren Holm in 2004, with Julian Savulescu starting his second and current term in 2011. In 2000 an additional special edition of the JME, Medical Humanities, was published, under the founding joint editorship of Martyn Evans and David Greaves. In 2003 Jane Macnaughton succeeded David Greaves as joint editor. Deborah Kirklin, under whose auspices MH became an independent journal, took over in 2008, and she was succeeded in 2013 by Sue Eckstein. This short paper offers reminiscences and reflections from the two journals’ various editors.From the start the JME was committed to clearly expressed reasoned discussion of ethical issues arising from or related to medical practice and research. In particular, both Edward Shotter and Alastair Campbell, each a cleric, were at pains to make clear that the JME was not a religious journal and that it had no sort of partisan axe to grind.Campbell's appointment as founding editor was something of a surprise, as the original intention had been to appoint a medical doctor, who could be expected to know medical practice from the inside. However, in 1972 Campbell, a Joint Secretary of the Edinburgh Medical Group, had published Moral dilemmas in medicine. …

Opponents of destructive embryo research, such as embryo rightists, as well as proponents accept that natural reproduction is permissible. There is an alternative to natural reproduction—to remain childless. John Harris began this series of articles by asking, what does a commitment to the permissibility of natural reproduction entail? Harris has argued that a commitment to the permissibility of natural reproduction entails a commitment to the permissibility of destructive embryo research. Julian Savulescu has denied this. However, there are significant areas in which our views have converged

A recent organ distribution scandal in Germany raises questions of general importance on which many thousands of lives may well depend. The scandal in Germany has produced reactions that are likely to occur whenever and wherever distribution irregularities occur and become public knowledge. After it had become known that physicians in three German hospitals were in the habit of manipulating records in order to fast-track their patients’ cases, the country experienced a decrease of available organs by a staggering 40% in October 2012. Even though this loss of trust by donors and their families is understandable, and potentially a legitimate form of protest against wrongful distribution, the withdrawal of agreement to serve as a posthumous donor in response to irregularities also inevitably results in avoidable poor outcomes for highly vulnerable individuals. In this paper, we provide a moral analysis of such dilemmas and make recommendations as to the way forward.

Fast-moving and ever-changing, stem cell science and research presents ongoing ethical and legal challenges in many countries. Each development and innovation throws up new challenges. This is the case even where new developments initially seem to solve old dilemmas. Sometimes it becomes evident that new science does not in fact solve old problems and, for that reason, the ethical issues remain. In recognition of this, this book presents innovative and creative analyses of a range of ethical and legal challenges raised by stem cell research and its potential and actual application. The editors of this collection have brought together experts from ethics and law to bring fresh perspectives on the use of and research on stem cells. The chapters in this collection range across a number of different issues in the debate on stem cells, from the ethical dilemmas of conducting stem cell research to those of the clinical application of stem cell technology. Each chapter gives an in-depth and comprehensive analysis of the ethical or legal issues at stake. The early chapters give engaging new expositions on the permissibility of using embryos in stem cell research, in particular challenging our views about how we view and OCyconstructOCO the embryo in debates regarding stem cells. Later chapters move on to actual and potential clinical uses of stem cells and present novel arguments about these.

Intuitively we feel that we ought (to attempt) to save the lives, or ameliorate the suffering, of identifiable individuals where we can. But this comes at a price. It means that there may not be any resources to save the lives of others in similar situations in the future. Or worse, there may not be enough resources left to prevent others from ending up in similar situations in the future. This chapter asks whether this is justifiable or whether we would be better served focusing on public health in the form of preventative medicine. It looks briefly at the supposed difference between benefiting individuals and benefiting populations by considering the difference between interventions aimed at ‘rescue’ and those which are preventative. It then considers the rule of rescue in the health care setting, and looks at some of the reasons stemming from this that we might have for allocating resources to rescue interventions. If these reasons do not provide adequate justification for preferring these types of interventions, then the implication is that our current mode of resource allocation may need to be revised in favour of a more public health-oriented model.

Suppose that you are soon to be a parent and you learn that there are some simple measures that you can take to make sure that your child will be healthy. In particular, suppose that by following the doctor’s advice, you can prevent your child from having a disability, you can make your child immune from a number of dangerous diseases and you can even enhance its future intelligence. All that is required for this to happen is that you (or your partner) comply with lifestyle and dietary requirements. Do you and your partner have any moral reasons (or moral obligations) to follow the doctor’s advice? Would it make a difference if, instead of following some simple dietary requirements, you consented to genetic engineering to make sure that your child was free from disabilities, healthy and with above average intelligence? In this paper we develop a framework for dealing with these questions and we suggest some directions the answers might take.

In this paper the permissibility of stem cell research on early human embryos is defended. It is argued that, in order to have moral status, an individual must have an interest in its own wellbeing. Sentience is a prerequisite for having an interest in avoiding pain, and personhood is a prerequisite for having an interest in the continuation of one's own existence. Early human embryos are not sentient and therefore they are not recipients of direct moral consideration. Early human embryos do not satisfy the requirements for personhood, but there are arguments to the effect that they should be treated as persons nonetheless. These are the arguments from potentiality, symbolic value and the principle of human dignity. These arguments are challenged in this paper and it is claimed that they offer us no good reason to believe that early human embryos should be treated as persons.

In this paper we discuss an objection to human cloning which appeals to the welfare of the child. This objection varies according to the sort of harm it is expected the clone will suffer. The three formulations of it that we will consider are: 1. Clones will be harmed by the fearful or prejudicial attitudes people may have about or towards them (H1); 2. Clones will be harmed by the demands and expectations of parents or genotype donors (H2); 3. Clones will be harmed by their own awareness of their origins, for example the knowledge that the genetic donor is a stranger (H3). We will show why these three versions of the child welfare objection do not necessarily supply compelling reasons to ban human reproductive cloning. The claim that we will develop and defend in the course of our discussion is that even if it is the case that a cloned child will suffer harms of the type H1-H3, it is none the less permissible to conceive by cloning so long as these cloning-induced welfare deficits are not such as to blight the existence of the resultant child, whoever this may be.

Knowing how to be good, or knowing how to go about trying to be good, is of immense theoretical and practical importance. And what goes for trying to be good oneself, goes also for trying to provide others with ways of being good, and for trying to make them good whether they like it or not. This is what is meant by 'moral enhancement'. John Harris explores the many proposed methodologies or technologies for moral enhancement: traditional ones like good parenting and education; newer ones like chemical or biological intervention; modifying the environment to make bad outcomes of all sorts less likely; experimentation with political and social systems. The issue of whether and to what extent moral enhancement is possible is the subject of this book.

Cloning - few words have as much potential to grip our imagination or grab the headlines. No longer the stuff of science fiction or Star Wars - it is happening now. Yet human cloning is currently banned throughout the world, and therapeutic cloning banned in many countries. In this highly controversial book, John Harris does a lot more than ask why we are so afraid of cloning. He presents a deft and informed defence of human cloning, carefully exposing the rhetorical and highly dubious arguments against it. He begins with an introduction to what a human clone is, before tackling some of the most common and frequently bizarre criticisms of cloning: Is it really wicked? Can we regulate it? What about the welfare of cloned children? Does it turn human beings into commodities? Dismissing one by one some of the myths about human cloning, in particular that it is degrading and unsafe, he astutely argues that some of our most cherished values, such as the freedom to start a family and the freedom from state control, actually support the case for human cloning. Offering a brave and lucid insight into this ethical minefield, John Harris at last shows that far from ending the diversity of human life or creating a race of super-clones, cloning has the power to improve and heal human life

Sex is not the answer to everything, though young men think it is, but it may be the answer to the intractable debate over the ethics of human embryonic stem cell research. In this paper, I advance one ethical principle that, as yet, has not received the attention its platitudinous character would seem to merit. If found acceptable, this principle would permit the beneficial use of any embryonic or fetal tissue that would, by default, be lost or destroyed. More important, I make two appeals to consistency, or to parity of reasoning, that I believe show that no one who either has used or intends to use sexual reproduction as their means of procreation, nor indeed anyone who has unprotected heterosexual intercourse, nor anyone who finds in vitro fertilization acceptable, nor anyone who believes that abortion is ever permissible can consistently object on principle to human embryo research nor to the use of embryonic stem cells for research or therapy

This paper argues that the HFEA’s recent report on sex selection abdicates its responsibility to give its own authentic advice on the matters within its remit, that it accepts arguments and conclusions that are implausible on the face of it and where they depend on empirical claims, produces no empirical evidence whatsoever, but relies on reckless speculation as to what the “facts” are likely to be. Finally, having committed itself to what I call the “democratic presumption”, that human freedom will not be constrained unless very good and powerful reasons can be produced to justify such infringement of liberty, the HFEA simply reformulates the democratic presumption as saying the opposite—namely that freedom may only be exercised if powerful justifications are produced for any exercise of liberty

There is a popular and widely accepted version of the precautionary principle which may be expressed thus: “If you are in a hole—stop digging!”. Tom Baldwin, as Deputy Chair of the Human Fertilisation and Embryology Authority , may be excused for rushing to the defence of the indefensible,1 the HFEA’s sex selection report,2 but not surely for recklessly abandoning so prudent a principle. Baldwin has many complaints about my misrepresenting the HFEA and about my supposed elitist contempt for public opinion; readers of this exchange will decide for themselves.REDRAFTING THE REPORTBaldwin begins with a piece of wishful thinking:"Harris objects that in this recommendation “an absurdly high standard of caution is employed”, since a theoretical risk is associated with almost all medical procedures. This objection is misplaced: as paragraph 142 of the report indicates, the phrase “theoretical risk” is to be understood here in the light of the earlier discussion of the risks arising from the fact that flow cytometry exposes sperm to laser energy, a procedure which is known to be liable to damage DNA."Paragraph 142 does not make that clear. It does indeed refer back to a set of earlier paragraphs but these give, if anything, an upbeat assessment of the safety of flow cytometry. Paragraph 121 states: “However whilst potentially less intrusive, and with potentially lower risk to the health of patients, flow cytometry …” .2 But even if the overall burden of the report does indicate unresolved fears, the standard is still absurdly high. However, so far from endorsing the report’s judgement that flow cytometry has “potentially lower risk to the health of patients”, Baldwin now regards the risk of flow cytometry as “serious”1:"Since the application of flow cytometry to humans is a new procedure, the risk of … "

The interests or welfare of the child are rightly central to anydiscussion of the ethics of reproduction. The problematic nature of thislegitimate concern is seldom, if ever, noticed or if it is, it ismisunderstood. A prominent example of this sort of misunderstandingoccurs in the Department of Health's recent and important `SurrogacyReview' chaired by Margaret Brazier (The Brazier Report) and thesame misunderstanding makes nonsense of at least one provision of theHuman Fertilization and Embryology Act 1990. (The HFE Act).This paper explores and hopefully resolves this misunderstandingand sets out the ways in which the idea of theinterests of the child can legitimately function inbioethics