John Harris

When things go wrong with assisted reproduction we should look at what’s best for everyone in the particular circumstancesA RTBs, as we must now call them, are becoming more and more frequent. In the recent United Kingdom case Mr and Mrs A, a “white” couple, gave birth to twins described as “black”. The mix up apparently occurred because a Mr and Mrs B, a “black” couple, were being treated in the same clinic and Mrs A’s eggs were fertilised with Mr B’s sperm. Mr and Mrs A love the twins and wish to keep them and the facts seem to be that Mrs A is the genetic mother of the twins but her partner is not the genetic father. Under English law, in assisted reproduction, the woman who gives birth to the child is the legal mother and this is true also in cases of surrogacy. I think there is no doubt in this case that English law has taken the right path and that it would be unconscionable to contemplate taking a child away from the woman who had undergone the risks and pains of pregnancy and childbirth and the bonding process that goes along with that when she wishes to keep the child particularly when there is no substantial and pressing evidence that she would be an unsafe parent. I argued this in my book The Value of Life4 and I think it is still true. So in this case justice, morality, and decency are served by confirming Mr and Mrs A as the parents of the children. Since in English law there is some ambiguity over paternity and how that is to be assigned and since Mr A is apparently not the genetic father, I think it is important …

Cadaver organs should be automatically availableThe shortage of donor organs and tissue for transplantation constitutes an acute emergency which demands radical rethinking of our policies and radical measures. While estimates vary and are difficult to arrive at there is no doubt that the donor organ shortage costs literally hundreds of thousands of lives every year. “In the world as a whole there are an estimated 700 000 patients on dialysis . . .. In India alone 100 000 new patients present with kidney failure each year” . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . 27 000 patients die annually from liver disease . . .. In Western Europe as a whole 40 000 patients await a kidney but only . . . 10 000 kidneys”1 become available. Nobody knows how many people fail to make it onto the waiting lists and fail to register in the statistics. “As of 24th November 2002 in the United Kingdom 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.”2Conscious of the terrible and unnecessary tragedy that figures like these represent I have been advocating for more than 20 years now some radical measures to stem this appalling waste of human life. The measure which is the subject of Hamer and Rivlin’s paper 3 concerns the automatic availability of all cadaver organs—a measure, which I first advocated publicly in 1983.4THE AUTOMATIC AVAILABILITY OF DONOR ORGANSWe need to begin by being clear about just what it is I propose and why. At the moment in the United Kingdom we …

This paper discusses the role of consent in decision making generally and its role in end of life decisions in particular. It outlines a conception of autonomy which explains and justifies the role of consent in decision making and criticises some misapplications of the idea of consent, particular the role of fictitious or “proxy” consents.Where the inevitable outcome of a decision must be that a human individual will die and where that individual is a person who can consent, then that decision is ethical if and only if the individual consents. In very rare and extreme cases such a decision will be ethical in the absence of consent where it would be massively cruel not to end life in order to prevent suffering which is in no other way preventable.Where, however, the human individual is not a person, as is the case with abortion, the death of infants like Mary , or in the very rare and extreme cases of those who have ceased to be persons like Tony Bland, such decisions are governed by the ethics of ending the lives of non-persons

Two groups of scientists have just announced what is being described as a leap forward in human stem cell research.1–3 Both have found ways of producing what are being called “induced pluripotent cells” , stem cells that they hope will demonstrate the same key properties of regeneration and unrestricted differentiation that human embryonic stem cells possess, but which are derived from skin cells not from embryos. In simple terms, these scientists have succeeded in reprogramming skin cells to behave like hESCs.Stem cell research has been hailed as one of the most important and exciting areas of science, because it is believed that these types of cells will not only play an important part in regenerative medicine, but also yield valuable scientific information. These latest developments in cell reprogramming represent a milestone for stem cell science. No longer does the paradigm of irreversible cell specialisation hold true; instead, almost any type of cell might have the potential to become any other.The advent of techniques for producing these iPCs has also been hailed as an ethical breakthrough. Up until now, the production of hESCs has required a process which involves the destruction of embryos. Many of these embryos are available as by-products of IVF; but in addition, the process of somatic cell nuclear transfer to produce cloned embryonic stem cells requires a supply of human oocytes, which must currently be harvested from female donors at no insignificant cost. In a nutshell, iPCs seem to enable us to produce “embryo-free” human pluripotent stem cells, and in a “gender-neutral” way—that is, without the need for human oocytes.The response from the scientific community, ethical commentators and the public has, however, reflected an inherent confusion over the ethical significance of this research. The anti-embryo …

ABSTRACT Principles of justice and equality demand that HIV seropositive individuals and those with AIDS should not be discriminated against in any area of social provision. If social policy on AIDS is constructed in terms of reciprocal obligations, that is if obligations to the HIV seropositive individual and obligations of the HIV seropositive individual are given equal weight, the civil rights of HIV seropositive individuals may be secured and this may create a climate in which HIV seropositive individuals will more readily notify partners, and others at risk of infection, of their HIV status. It is conceivable that such a climate could facilitate greater control of the spread of HIV/aids.

Human rights are universally acknowledged to be important, although they are, of course, by no means universally respected. This universality has helped to combat racism and sexism and other arbitrary and vicious forms of discrimination. Unfortunately, as we shall see, the universality of human rights is both too universal and not universal enough. It is time to take the “human” out of human rights. Indeed, it is very probable that in the future there will be no more humans as we know them now, because the further evolution of our species, either Darwinian or more likely determined by human choices, will, we must hope, result in the emergence of new sorts of beings better able to cope with the intellectual and physical challenges of the future. One example of the ways in which this is already happening is the sorts of cognitive enhancement that are already coming on stream. Another is signaled by stem cell research and the birth of regenerative medicine

The principle that each individual is entitled to an equal opportunity to benefit from any public health care system, and that this entitlement is proportionate neither to the size of their chance of benefitting, nor to the quality of the benefit, nor to the length of lifetime remaining in which that benefit may be enjoyed, runs counter to most current thinking about the allocation of resources for health care. It is my contention that any system of prioritisation of the resources available for healthcare or of rationing such resources must be governed by this principle. This can have apparently paradoxical conclusions in that it can seem wasteful to give someone with a very slim chance of a lifesaving treatment the same priority as someone with a much better chance. In an important and thoughtful recent paper, Julian Savulescu has concentrated on this apparent weakness and has argued for a particular conception of the good or benefit to be achieved by a healthcare system which purports to demonstrate the inadequacies of an equal opportunities approach to prioritisation and to replace it with an altogether better account. This paper will show that a rational ‘reasons based consequentialism’ is more in line with the equal opportunities approach, which I defended some time ago in these pages, than with that of Savulescu. I shall then examine more closely the conception of equal opportunities in health care and show that if we give weight to an individual's reasons, and what is expected to be good for them, we will opt for exactly the equality based account of distributive justice that I have recommended.

People have a powerful interest in geneticprivacy and its associated claim to ignorance,and some equally powerful desires to beshielded from disturbing information are oftenvoiced. We argue, however, that there is nosuch thing as a right to remain in ignorance,where a right is understood as an entitlementthat trumps competing claims. This doesnot of course mean that information must alwaysbe forced upon unwilling recipients, only thatthere is no prima facie entitlement to beprotected from true or honest information aboutoneself. Any claims to be shielded frominformation about the self must compete onequal terms with claims based in the rights andinterests of others. In balancing the weightand importance of rival considerations aboutgiving or withholding information, if rightsclaims have any place, rights are more likelyto be defensible on the side of honestcommunication of information rather than indefence of ignorance. The right to free speechand the right to decline to acceptresponsibility to take decisions for othersimposed by those others seem to us moreplausible candidates for fully fledged rightsin this field than any purported right toignorance. Finally, and most importantly, ifthe right to autonomy is invoked, a properunderstanding of the distinction between claimsto liberty and claims to autonomy show that theprinciple of autonomy, as it is understood incontemporary social ethics and English law,supports the giving rather than the withholdingof information in most circumstances

The panic occasioned by the birth of Dolly sent international and national bodies and their representatives scurrying for principles with which to allay imagined public anxiety. It is instructive to note that principles are things of which such people and bodies so often seem to be bereft. The search for appropriate principles turned out to be difficult since so many aspects of the Dolly case were unprecedented. In the end, some fascinating examples of more or less plausible candidates for the status of moral principles were identified; central to many of them is the idea of human dignity and how it might be affected by human mitotic reproduction

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

ABSTRACTThis paper restates some of the principal arguments against an automatic preference for the young as advocated by Kappel and Sandøe, arguments many of which have been extant for over a decade but which Kappel and Sandøe largely ignore. It then goes on to demonstrate that Kappel and Sandøe's “indifference test” fails to do the work required of it because it can be met by unacceptable conceptions of justice. The paper develops a number of new arguments against what I have called “ageist” preferences for the young or for those with long life expectancy. Finally I show that Kappel and Sandøe must believe that murdering older people is less morally wrong than murdering the young and that people relying on arguments such as theirs will have to accept the moral respectability of killing the innocent in order to maximise units of lifetime

In his ‘Moral Enhancement, Freedom, and What We Value in Moral Behaviour’,1 David DeGrazia sets out to defend moral bioenhancement from a number of critics, me prominently among them. Here he sets out his stall: "Many scholars doubt what I assert: that there is nothing inherently wrong with MB. Some doubt this on the basis of a conviction that there is something inherently wrong with biomedical enhancement technologies in general. Chief among their objections are the charges that biomedical enhancement is unnatural, use of biomedical enhancements evinces an insufficient appreciation for human “giftedness”, and biomedical enhancements pose a threat to personal identity. Elsewhere I have attempted to neutralize these objections. Here I will address a set of concerns that are directed at MB in particular and appeal to the nature and value of human freedom."Let me make clear at once that I do not believe there is anything inherently wrong with MB. I have been an advocate for human enhancement for over 30 years writing four books defending such enhancements.2–⇓4 The most recent of these published in 2007 covers much the same ground as Allen Buchanan's 2011 book cited by DeGrazia,5 but, unlike Buchanan, I do not define enhancements in terms of the intention or the motivation of those who produce them but rather in terms of their effect. I must also make clear that, like DeGrazia, I have also, for a very long time, attempted to neutralise objections 1–3 listed in the above passage.2–⇓4DeGrazia introduces his critique of my approach like this: "I will construe Harris’ argument and similar arguments as directed entirely at motivation-based MB—though I will hereafter omit the qualifier, “motivation-based.” (Certainly, these arguments do not apply to embryo selection, which … "

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.

This paper sets out to discuss what precisely is meant by ‘‘benefit" when we talk of the requirement that the health care system concern itself with health gain or with maximizing beneficial health care. In particular I argue that in discharging the duty to do what is most beneficial we need to choose between rival conceptions of what is meant by beneficial. One is the patient's conception of benefit and the second is the provider's or funder's conception of benefit. I argue that it is the patient's conception of benefit which is paramount and that if this is followed it commits us to a conception of patient care which must be blind to prognosis in so far as prognosis is thought to bear upon issues of prioritisation or resource allocation

On both sides of the debate on the use of embryos in stem cell research, and in reproductive technologies more generally, rhetoric and symbolic images have been evoked to influence public opinion. Human embryos themselves are described as either “very small human beings” or “small clusters of cells.” The intentions behind the use of these phrases are clear. One description suggests that embryos are already members of our community and share with us a right to life or at least respectful treatment, whereas the other focuses on the differences between embryos and adult human beings with normal capacities, that is, their lack of sentience and of personal identity. The research on stem cells has been nicknamed “Frankenstein science” or presented as “research that could stop Parkinson disease.” Again, one description reminds us of scary science-fiction scenarios where the scientist is guilty of “playing God,” whereas the other description highlights the worth and potential benefits of the research outcomes

I have argued that because human sexual reproduction inevitably involves the creation and destruction of embryos, it is a problematic activity for those who believe that the embryo is “one of us.” Or, if it is not a problematic activity, then neither is the creation and destruction of embryos for a purpose of comparable moral seriousness—the development of lifesaving therapy, for example. I assume that, whereas it is possible for the very first act of unprotected intercourse to result in a live human baby, and hence not in a given case cause any embryo loss, this is a rare event and that, statistically, for every live birth from three to five embryos must be created only to die. For dramatic effect, I assume that five is a reasonable figure, giving each embryo a 20% chance of survival; however, nothing in the argument depends on any specific figures being correct. a

The continuing debate between Persson and Savulescu and myself over moral enhancement concerns two dimensions of a very large question. The large question is: what exactly makes something a moral enhancement? This large question needs a book length study and this I provide in my How to be Good, Oxford 2016.. In their latest paper Moral Bioenhancement, Freedom and Reason take my book as their point of departure and the first dimension of the big question they address is one that emphasizes a distinction, not highlighted in their original 2008 paper, between a moral enhancement that will ensure an improvement in morality and one that will simply make people more motivated to be moral. The second issue concerns whether anything that would be a “moral enhancement” properly so called, could involve denying moral agents the very possibility of autonomously choosing to try to be good. In this response, although P&S cover a number of other related issues, I shall concentrate on these two points.

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