Peter Herissone-Kelly

Is there any justification for the common practice of allocating expensive medical resources to rescue a few from rare diseases, when those resources could be used to treat devastating diseases that affect the many? Does the use of Prozac and other anti-depressants make us inauthentic beings? Is it immoral and irrational to have children? What is the force of examples and counterexamples in bioethics? What are the relevance of moral intuition and the role of empirical evidence in bioethical argument? What notion of “function” underlies accounts of the distinction between normality and disease and between therapy and enhancement? Is there an inherent conflict between research aimed at therapy and research aimed at gaining knowledge, such that the very notion of “therapeutic research” is an oxymoron? The twenty-one chapters in this volume strive, through the use of high quality argument and analysis, to get a good deal clearer concerning a range of issues _in _bioethics, and a range of issues_ about _bioethics. The essays are provocative, indeed, some quite radical and disturbing, as they call into question many common methodological and substantive assumptions in bioethics.

This chapter aims to show that prospective parents are not bound in their reproductive decision making by a principle of procreative beneficence. That is, they have no obligation (as Julian Savulescu, the principle’s originator, famously thinks they have) to choose the possible child, from a range of possible children they might have, who is likely to lead the best life. I will summarise and clarify the content of previous papers of mine, in which I argue that since the sorts of considerations that underlie the principle of procreative beneficence do not constitute reasons when viewed from a perspective that it is fitting and appropriate for a prospective parent to take up, there can be no requirement for prospective parents to be moved by those considerations.

The claim that the answers we give to many of the central questions in genethics will depend crucially upon the particular rationality we adopt in addressing them is central to Matti Häyry’s thorough and admirably fair-minded book, Rationality and the Genetic Challenge. That claim implies, of course, that there exists a plurality of rationalities, or discrete styles of reasoning, that can be deployed when considering concrete moral problems. This, indeed, is Häyry’s position. Although he believes that there are certain features definitive of any type of thinking that can accurately be labeled rational, he maintains that nothing about that set of features compels us to conclude that there is a single rationality. What is more, and significantly for the way in which Häyry’s book develops, there is no Archimedean point from which we are licensed to pronounce one flavor of rational deliberation to be intrinsically superior to any other or to be justified to the exclusion of all others. To this belief that “there are many divergent rationalities, all of which can be simultaneously valid,” we can perhaps give the name “the Doctrine of the Plurality of Rationalities” or, for short, “DPR.”

Rebecca Bennett, in a recent paper dismissing Julian Savulescu's principle of procreative beneficence, advances both a negative and a positive thesis. The negative thesis holds that the principle's theoretical foundation – the notion of impersonal harm or non-person-affecting wrong – is indefensible. Therefore, there can be no obligations of the sort that the principle asserts. The positive thesis, on the other hand, attempts to plug an explanatory gap that arises once the principle has been rejected. That is, it holds that the intuitions of those who adhere to the principle are not genuine moral intuitions, but instead simply give voice to mere (non-moral) preferences. This paper, while agreeing that Savulescu's principle does not express a genuine moral obligation, takes issue with both of Bennett's theses. It is suggested that the argument for the negative thesis is either weak or question-begging, while there is insufficient reason to suppose the positive thesis true

Rebecca Bennett, in a recent paper dismissing Julian Savulescu's principle of procreative beneficence, advances both a negative and a positive thesis. The negative thesis holds that the principle's theoretical foundation – the notion of impersonal harm or non‐person‐affecting wrong – is indefensible. Therefore, there can be no obligations of the sort that the principle asserts. The positive thesis, on the other hand, attempts to plug an explanatory gap that arises once the principle has been rejected. That is, it holds that the intuitions of those who adhere to the principle are not genuine moral intuitions, but instead simply give voice to mere (non‐moral) preferences.This paper, while agreeing that Savulescu's principle does not express a genuine moral obligation, takes issue with both of Bennett's theses. It is suggested that the argument for the negative thesis is either weak or question‐begging, while there is insufficient reason to suppose the positive thesis true.

Tom Beauchamp and James Childress have always maintained that their four principles approach (otherwise known as principlism) is a globally applicable framework for biomedical ethics. This claim is grounded in their belief that the principles of respect for autonomy, non-maleficence, beneficence and justice form part of a 'common morality', or collection of very general norms to which everyone who is committed to morality subscribes. The difficulty, however, has always been how to demonstrate, at least in the absence of a full-blooded analysis of the concept of morality, whether the four principles are foundational, and so globally applicable, in this way. In the recently published sixth edition of Principles of Biomedical Ethics, an imaginative and non-question-begging empirical method of determining the common morality's norms is suggested. In this paper, I outline this method, before arguing that it is difficult to see how it might be thought to achieve its purpose.

The Mental Capacity Act 2005 came into force in England and Wales in 2007. Its primary purpose is to provide “a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves.” Examples of such people are those with dementia, learning disabilities, mental health problems, and so on. The Act also gives those who currently have capacity a legal framework within which they can make arrangements for a time when they may come to lack it. Toward this end, it allows for them to make advance decisions or to appoint proxy decision makers with lasting powers of attorney

In recent decades, scientists have begun to identify the brain processes and neurochemicals associated with the different stages of love, including the all-important stage of attachment. Experimental findings—readily seized upon by those bioethicists who want to urge that we sometimes have good reason pharmaceutically to enhance flagging relationships—are presented as demonstrating that attachment is regulated and strengthened by the neuropeptides oxytocin and vasopressin. I shall argue, however, that often what the experimental data in fact show is only that exogenous administration of such chemicals can control and intensify the trappings of attachment, not attachment itself. That this is sometimes overlooked by both scientists and ethicists, is due to attachment being miscategorised as a set of feelings or a drive, rather than as a disposition to think about, feel toward, and behave toward its object in certain distinctive ways.

Recent research in neurochemistry has shown there to be a number of chemical compounds that are implicated in the patterns of lust, attraction, and attachment that undergird romantic love. For example, there is evidence that the phenomenon of attachment is associated with the action of oxytocin and vasopressin. There is therefore some reason to suppose that patterns of lust, attraction, and attachment could be regulated via manipulation of these substances in the brain: in other words, by their use as 'love drugs'. A growing bioethical literature asks searching questions about this prospect, and especially about the use of such drugs to enhance or reignite attachment in flagging relationships. This Element examines some of the central arguments on the topic, and sounds a note of caution. It urges that there are reasons to think the states of attachment produced or facilitated by the use of such drugs would not be desirable.

This open access book offers insights into the development of the ground-breaking Global Code of Conduct for Research in Resource-Poor Settings (GCC) and the San Code of Research Ethics. Using a new, intuitive moral framework predicated on fairness, respect, care and honesty, both codes target ethics dumping – the export of unethical research practices from a high-income setting to a lower- or middle-income setting. The book is a rich resource of information and argument for any research stakeholder who opposes double standards in research. It will be indispensable for applicants to European Union framework programmes, as the GCC is now a mandatory reference document for EU funding

Julian Savulescu has given clear expression to a principle—that of “procreative beneficence”—which underlies the thought of many contemporary writers on bioethics. The principle of procreative beneficence holds that parents or single reproducers are at least prima facie obliged to select the child, out of a range of possible children they might have, who will be likely to lead the best life. My aim in this paper is to argue that prospective parents, just by dint of their being prospective parents, are in fact not obliged to act on PPB. That is, there is something about their filling the role of prospective parents that exempts them from selecting the child with the best life. I urge that it is more realistic to view prospective parents as bound by a principle of acceptable outlook, which holds that they ought not to select children whose lives will contain an unacceptable amount of suffering

In my paper “Parental Love and the Ethics of Sex Selection,” published in the previous issue of the Cambridge Quarterly of Healthcare Ethics, I set out to determine whether a plausible argument could be constructed in support of a common intuition about the ethics of sex selection. The intuition in question is that sex selection for nonmedical reasons is incompatible with a proper parental love: that is, with the sort of love that a parent ought to have for her child or, equivalently, with the sort of love that someone accurately describable as a good parent will have for her child. I concluded that there is a prima facie compelling argument that fits the bill, though I did little more than introduce and set that argument out. In the current paper, my aim will be to subject it to closer scrutiny, by considering a number of possible objections to it. I will start by asking why the argument should be thought to apply only to sex selection for nonmedical reasons and not to cases in which selection is employed in order to prevent the birth of children with serious sex-linked genetic conditions

In 2003, the United Kingdom's Human Fertilisation and Embryology Authority published a report entitled Sex Selection: Options for Regulation. The report outlined the findings of a 2-year review of available sex selection techniques and recommended that the United Kingdom ought not to permit any regulated technique to be used other than for medical reasons. In so doing, it reflected the widespread opinion—repeatedly expressed in the public consultations that formed the cornerstone of the HFEA's review—that there is something ethically unacceptable, or at least ethically suspect, about sex selection for nonmedical, or “social,” reasons

Readers of the Cambridge Quarterly of Healthcare Ethics need hardly be told that each year a huge amount of very valuable work in bioethics is carried out in the academic's study and the university seminar room and appears in the pages of specialist, restricted-readership journals. However, if it is to be as effective, relevant, and influential as it deserves to be, there arguably comes a point when this work needs to leave the confines of the academy and engage the wider public. This perhaps happens less often than it should

Bioethicists currently working in the United Kingdom demonstrate—as indeed do the very best of their colleagues internationally—an eagerness to engage in two extremely different but complementary approaches to their subject. First, they readily become involved in discussions of concrete bioethical issues that are of great concern to the medical profession, legislators, and the wider U.K. public. Second, perhaps because they recognize the importance of the “first-order” questions that exercise the public imagination, they show themselves commendably willing to turn their critical gaze onto the very methods and frameworks they use to address those questions. The first approach we can properly call “bioethical,” whereas we might term the second approach “metabioethical.”

In the Transcendental Aesthetic, Kant famously makes the following startling claim, which we can call the transcendental ideality thesis concerning the nature of space, or, for ease of reference in what follows, simply “TI”: Der Raum stellt gar keine Eigenschaft irgend einiger Dinge an sich, oder sie in ihrem Verhältniß auf einander vor, d.i. keine Bestimmung derselben, die an Gegenständen selbst haftete, und welche bliebe, wenn man auch von allen subjectiven Bedingungen der Anschauung abstrahirte.

This book explores the many connections that bioethical thinking has with social reality. Bioethics, if it is to be effective, must engage with and address the actualities of modern life: policies, regulations, markets, opinions, and technological advances. In these original contributions fifteen notable scholars working in the North West of England take on this challenge. The series Values in Bioethics makes available original philosophical books in all areas of bioethics, including medical and nursing ethics, health care ethics, research ethics, environmental ethics, and global bioethics.

This paper argues against Julian Savulescu's principle of procreative beneficence. It maintains that prospective parents have no obligation at all to choose the child, out of a range of possible children, who is likely to lead the best life. This is because a standpoint that the author labels "the internal perspective" is a perfectly appropriate one for parents to adopt when thinking about their own future children. It is only policy makers who are obliged to take up an opposing standpoint--"the external perspective"--and to be motivated by the sorts of "better for" judgements that that perspective delivers

This book outlines and circumvents two serious problems that appear to attach to Kant’s moral philosophy, or more precisely to the model of rational agency that underlies that moral philosophy: the problem of experiential incongruence and the problem of misdirected moral attention. The book’s central contention is that both these problems can be sidestepped. In order to demonstrate this, it argues for an entirely novel reading of Kant’s views on action and moral motivation. In addressing the two main problems in Kant’s moral philosophy, the book explains how the first problem arises because the central elements of Kant’s theory of action seem not to square with our lived experience of agency, and moral agency in particular. For example, the idea that moral deliberation invariably takes the form of testing personal policies against the Categorical Imperative seems at odds with the phenomenology of such reasoning, as does the claim that all our actions proceed from explicitly adopted general policies, or maxims. It then goes on to discuss the second problem showing how it is a result of Kant’s apparent claim that when an agent acts from duty, her reason for doing so is that her maxim is lawlike. This seems to put the moral agent’s attention in the wrong place: on the nature of her own maxims, rather than on the world of other people and morally salient situations. The book shows how its proposed novel reading of Kant’s views ultimately paints an unfamiliar but appealing picture of the Kantian good-willed agent as much more embedded in and engaged with the world than has traditionally been supposed.

In my paper “Parental Love and the Ethics of Sex Selection,” published in the previous issue of the Cambridge Quarterly of Healthcare Ethics, I set out to determine whether a plausible argument could be constructed in support of a common intuition about the ethics of sex selection. The intuition in question is that sex selection for nonmedical reasons is incompatible with a proper parental love: that is, with the sort of love that a parent ought to have for her child or, equivalently, with the sort of love that someone accurately describable as a good parent will have for her child. I concluded that there is a prima facie compelling argument that fits the bill, though I did little more than introduce and set that argument out. In the current paper, my aim will be to subject it to closer scrutiny, by considering a number of possible objections to it. I will start by asking why the argument should be thought to apply only to sex selection for nonmedical reasons and not to cases in which selection is employed in order to prevent the birth of children with serious sex-linked genetic conditions.

Tom Beauchamp and James Childress are confident that their four principles—respect for autonomy, beneficence, non-maleficence, and justice—are globally applicable to the sorts of issues that arise in biomedical ethics, in part because those principles form part of the common morality (a set of general norms to which all morally committed persons subscribe). Inevitably, however, the question arises of how the principlist ought to respond when presented with apparent counter-examples to this thesis. I examine a number of strategies the principlist might adopt in order to retain common morality theory in the face of supposed counter-examples. I conclude that only a strategy that takes a non-realist view of the common morality’s principles is viable. Unfortunately, such a view is likely not to appeal to the principlist.