Richard B. Gibson

Xenotransplantation has the potential to alter the U.S. transplant system in profound ways. However, this emerging “spare parts” solution spearheaded by biotechnology companies raises concerns about its impact on the organ shortage, healthcare systems, population health, and health inequalities. We contend that xenotransplantation may have limited benefits in improving health, could prove prohibitively expensive for many, and may divert resources away from proven public health measures. Additionally, it carries the risk of perpetuating stigma. Xenotransplantation may thereby exacerbate existing healthcare inequities across racial, ethnic, socio‐economic, and geographic lines. To mitigate these risks, we contend that public health expert input is integral for xenotransplant policy development and outreach and that this underscores the importance of federal government investment in transplant infrastructure.

Kögel et al propose a multicriteria alternative to the standard early clinical selection method for xenotransplantation trials. As they note, existing recommendations for inclusion criteria indicate that only the most seriously ill—those lacking any viable alternative—should be considered for xenotransplantation. Rather than basing selection on, to put it indelicately, a Hail Mary in the face of certain death, Kögel et al recommend a selection system based on four ethical criteria: medical need, capacity to benefit, patient choice and compliance (the latter being an exclusion criterion). Taken together, they paint a picture of an ethically ideal first-in-human xenotransplantation clinical trial participant: someone ‘in need of a heart replacement with a good capacity to benefit from a xenotransplantation who [has] a choice in terms of alternative potentially life-sustaining treatment options.’1 In other words, they argue that potential xenotransplantation organ recipients (they specify heart, but said criteria would apply to any vital organ recipient) should not be facing their imminent demise as this would inherently constrain that person’s freedom of choice, thus rendering them vulnerable. Instead, Kögel et al argue that trial participants should be selected from groups possessing genuine alternatives to xenotransplantation but opt to receive an animal organ. Now, their concern regarding the presence of coercion in the context of what is an experimental medical intervention is fully justified, as is their claim that those facing limited viable choices at the end of their lives are an inherently vulnerable population. Autonomy and consent are largely uncontroversial bedrocks on which most medical and research ethics theories are built. We are, all of us, familiar with the horrors from history—both distant and recent—where participant consent has taken …

The use of smart mouthguards in contact sports like rugby aims to enhance player safety by providing real-time data on head impacts. These devices, equipped with sensors, measure collision force and frequency, potentially identifying concussions that might go unnoticed during gameplay. The idea is that such enhanced monitoring will enable teams, physicians and other stakeholders to better protect players from the effects of on-pitch injury through immediate detection of head trauma and the long-term provision of player data. While we welcome the move towards a better understanding of the potential harm that contact sports athletes may experience, introducing a new avenue through which information about player performance and health can be collected brings several areas of ethical concern absent from traditional mouthguards. In this paper, we consider four noteworthy areas: device and data efficacy, player choice, the inherent issues of such data’s existence and the harmful consequences of this data’s usage and exposure. We argue that failing to identify and address the risks associated with smart mouthguards’ employment in the elite sporting sphere not only risks the mistreatment and misapplication of player data but may also jeopardise the acceptability of a novel health monitoring method that has the potential to prevent long-term debilitating diseases.

Rodger et al argue for the disenhancement of animals intended for xenotransplantation; that is, the transference of tissues or organs from one species to another. The crux of their claim is that the conditions necessary to facilitate xenotransplantation will be hostile to those subjected to them. Thus, to minimise the suffering of living under such conditions, ‘ethically defensible xenotransplantation should entail the use of genetic disenhancement if it becomes possible to do so and if that pain and suffering cannot be eliminated by other means.’1 In other words, if we can eliminate or meaningfully reduce the suffering of animals destined for xenotransplantation by obliterating their experiential capacity and lacking a less contentious method to achieve the same result, we should do so. When isolated, this argument is compelling. Suffering is terrible and should be avoided. Additionally, when we have the option to reduce another’s suffering—be that human, animal or otherwise—there are strong prima facie arguments that we should do so. This point is reinforced when we collectively are responsible for that suffering, as would be the case with xenotransplantation, and it is true regardless of how justified we are in causing that suffering. Thus, on the restrictive terms of Rodger et al ’s argument, I agree with them. We should eliminate, or if not possible, reduce, suffering wherever we can, and this applies to animals too. Having said that, when situated in the xenotransplantation context, issues with their proposal …

In her paper, Robinson asserts that if one is convinced by the arguments assigning personhood according to a threshold criterion, one should also be open to the potential for a secondary personhood threshold, satisfied when one is pregnant, which confers temporary enhanced moral status. Rather than grounding such a claim on a fetus’s possession, or lack thereof, of personhood, Robinson argues that the pregnant person’s status as a ‘unique being’ is enough to satisfy the requirements of such an additional personhood classification. 1 She justifies her claim via three arguments: (1) that the pregnant person is, in fact, more than a singular individual; (2) that pregnant people play a critical role in the human race’s continuation and (3) that the significant harms and burdens to which pregnant people have been exposed to historically and contemporary requires counterbalancing with enhanced protections. Unfortunately, despite Robinson’s best efforts, she does not...

As biological organisms, we age and, eventually, die. However, age’s deteriorating effects may not be universal. Some theoretical entities, due to their synthetic composition, could exist independently from aging—artificial general intelligence (AGI). With adequate resource access, an AGI could theoretically be ageless and would be, in some sense, immortal. Yet, this need not be inevitable. Designers could imbue AGIs with artificial mortality via an internal shut-off point. The question, though, is, should they? Should researchers curtail an AGI’s potentially endless lifespan by deliberately making it mortal? It is this question that this article explores. First, it considers what type of AGI is under discussion before outlining how such beings could be ageless. Then, after clarifying the type of immortality under discussion and arguing that imbuing an AGI with synthetic aging would be person-affecting, the article explores four core conundrums: (i) deliberately causing a morally significant being’s death; (ii) immortality’s associated harms; (iii) concerns about immortality’s unequal assignment; and (iv) the danger of immortal AGI overlords. The article concludes that while prudence requires we create an aging AGI, in the face of the material harm such an action would constitute, this is an insufficient reason to justify doing so.

In her controversial paper, Anna Smajdor proposes that brain-dead people could be used as gestation units for prospective parents unable or unwilling to undertake the act themselves—what she terms whole body gestational donation (WBGD). She explores the ethical issues of such an idea and, comparing it with traditional organ donation, asserts that such deceased surrogacy could be a way of outsourcing pregnancy’s harms to a populace unable to be affected by them. She argues that if the prospect is unacceptable, this may reveal some underlying problems with traditional cadaveric organ donation. Smajdor’s analysis, however, overlooks several problems arising from WBGD. This paper provides an account of those issues and argues that, in addition to WBGD being viscerally unpleasant, it is also ethically unviable. The paper starts by providing an account of WBGD before acknowledging its negative response within traditional and social media. After arguing that such cursory and gut reactions are insufficient to reject the proposal outright, this paper then provides three concerns regarding WBGD omitted by Smajdor: (i) the co-opting of life-saving organs for reproduction, (ii) the discrepancy between using cadaveric organs to save a life versus creating one, and (iii) the universalization of feminist concerns regarding reproductive body commodification. The paper concludes by tentatively agreeing with Smajdor that considering WBGD may help reveal vulnerable assumptions regarding organ donation and surrogacy, but that the significant ethical issues raised may prove insurmountable and make the intervention—thought experiment or otherwise—untenable.

Describing someone as disabled means evaluating their relationship with their environment, body, and self. Such descriptions pivot on the person’s perceived limitations due to their atypical embodiment. However, impairments are not inherently pathological, nor are disabilities necessarily deviations from biological normality, a discrepancy often articulated in science fiction via the presentation of radically altered environments. In such settings, non-impaired individuals can be shown to be unsuited to the world they find themselves in. One prime example of this comes courtesy of H. G. Wells’s “The Country of the Blind.” This paper demonstrates science fiction’s capacity to decouple disability’s normative quality from classical medical models stemming from the medical Enlightenment movement by challenging the idea of the biologically normal. It first provides a brief account of disability before exploring the concept of medical normality. It then problematizes the biologically consistent being, arguing that health is only understandable when environmentally situated. Next, the paper provides an overview of “The Country of the Blind” before analyzing how it challenges the idea of biological normality, framing it as a social product rather than a universal constant. Finally, the paper concludes that science fiction narratives effectively interrogate our world’s seemingly consistent trends by envisioning (un)desirable alternatives.

The following paper examines the cyberpunk transhumanist graphic novel Transmetropolitan through the theoretical lens of disability studies to demonstrate how science fiction, and in particular this series, illustrate and can influence how we think about disability, impairment and difference. While Transmetropolitan is most often read as a scathing political and social satire about abuse of power and the danger of political apathy, the comic series also provides readers with representations of impairment and the source of disability as understood by the Social Model of Disability (SMD). Focusing on the setting and fictional world in which Transmetropolitan takes place, as well as key events and illustration styling, this paper demonstrates that the narrative in this work encompasses many of the same theoretical underpinnings and criticisms of society’s ignorance of the cause of disability as the SMD does. This paper aims, by demonstrating how Transmetropolitan can be read as an allegory for the disabling potential of society as experienced by individuals with impairments, to prompt readers into thinking more creatively about how narratives, seemingly unconcerned with disability, are informed and can be understood via disability theory.

Interventions are medically necessary when they are vital in achieving the goal of medicine. However, with varying perspectives comes varying views on what interventions are (un)necessary and, thus, what potential treatment options are available for those suffering from the myriad of conditions, pathologies and disorders afflicting humanity. Medical necessity's teleological nature is perhaps best illustrated in cases where there is debate over using contentious medical interventions as a last resort. For example, whether it is appropriate for those suffering from body integrity dysphoria to receive healthy limb amputations. This paper explores how one's perception of medicine's goal underpins whether interventions are necessary or unnecessary, using the controversial topic of therapeutic amputation as an example. By contrasting ‘classical’ amputations with their more contentious counterparts, it highlights how the idea of medical necessity influences and restrains clinical decision-making. The paper starts by giving an account of body integrity dysphoria, focusing on the debate concerning elective amputation's justifiability. It then introduces Georges Canguilhem's vitalist theory of health, paying particular attention to his emphasis on adaptability. Then, this paper uses his theory as a lens through which to evaluate the appropriateness of therapeutic amputation as a medically necessary procedure. Ultimately, the paper highlights how the label of medical necessity is withheld from potential therapeutic interventions because they fail to conform to pre-established ideas of medicine's purpose and that by doing so, potential harm befalls those who are left with no effective treatments and must look for solutions in the non-clinical world.

Opponents of the provision of therapeutic, healthy limb amputation in Body Integrity Identity Disorder cases argue that such surgeries stand in contrast to the goal of medical practice – that of health restoration and maintenance. This paper refutes such a conclusion via an appeal to the nuanced and reflective model of health proposed by Georges Canguilhem. The paper examines the conceptual entanglement of the statistically common with the normatively desirable, arguing that a healthy body can take multiple forms, including that of an amputee, provided that such a form enables the continuing ability to initiate new norms of existence. It concludes that the practice of healthy limb amputation in cases of Body Integrity Identity Disorder is not only compatible with the goal of medicine but is potentially the only method of achieving this goal in the face of a complex and often mischaracterized disorder.

In their 2008 paper, Persson and Savulescu suggest that for moral bioenhancement (MBE) to be effective at eliminating the danger of ‘ultimate harm’ the intervention would need to be compulsory. This is because those most in need of MBE would be least likely to undergo the intervention voluntarily. By drawing on concepts and theories from epidemiology, this paper will suggest that MBE may not need to be universal and compulsory to be effective at significantly improving the collective moral standing of a human populace and reducing the threat of ultimate harm. It will identify similarities between the mechanisms that allow biological contagions (such as a virus) and behaviours (such as those concerned with ethical and unethical actions) to develop, spread, and be reinforced within a population. It will then go onto suggest that, just as with the epidemiological principle of herd immunity, if enough people underwent MBE to reach a minimum threshold then the incidence and spread of immoral behaviours could be significantly reduced, even in those who have not received MBE.