Sarah Chan

This book examines, through a multi-disciplinary lens, the possibilities offered by relationships and family forms that challenge the nuclear family ideal, and some of the arguments that recommend or disqualify these as legitimate units in our societies. That children should be conceived naturally, born to and raised by their two young, heterosexual, married to each other, genetic parents; that this relationship between parents is also the ideal relationship between romantic or sexual partners; and that romance and sexual intimacy ought to be at the core of our closest personal relationships - all these elements converge towards the ideal of the nuclear family. The authors consider a range of relationship and family structures that depart from this ideal: polyamory and polygamy, single and polyparenting, parenting by gay and lesbian couples, as well as families created through current and prospective modes of assisted human reproduction such as surrogate motherhood, donor insemination, and reproductive cloning.

The ethics of psychiatry The ethics of psychiatry is one of the areas of medical ethics where the overlap between medical ethics and philosophy of medicine is largest. This is illustrated by two papers in the current issue of the JME. Charlotte Blease discusses whether it is “… ever right to prescribe placebos to patients in clinical practice?” in the context of prescribing for patients with severe depression . Would such prescriptions for instance amount to morally problematic deception? In an intricate analysis she points out that the answer to the question depends on a range of complex conceptual distinctions that will be familiar to scholars in philosophy of medicine. One very significant issue that is raised is that well-being is not synonymous with a realistic assessment of oneself or one's circumstances. Most of us who are not depressed have positive illusions about ourselves and this may even …

John Harris has previously proposed that there is a moral duty to participate in scientific research. This concept has recently been challenged by Iain Brassington, who asserts that the principles cited by Harris in support of the duty to research fail to establish its existence. In this paper we address these criticisms and provide new arguments for the existence of a moral obligation to research participation. This obligation, we argue, arises from two separate but related principles. The principle of fairness obliges us to support the social institutions which sustain us, of which research is one; while the principle of beneficence, or the duty of rescue, imposes upon us a duty to prevent harm to others, including by supporting potentially beneficial, even life-saving research. We argue that both these lines of argument support the duty to research, and explore further aspects of this duty, such as to whom it is owed and how it might be discharged.

Much bioethical discussion has been devoted to the subject of human enhancement through various technological means such as genetic modification. Although many of the same technologies could be, indeed in many cases already have been, applied to non-human animals, there has been very little consideration of the concept of “animal enhancement”, at least not in those specific terms. This paper addresses the notion of animal enhancement and the ethical issues surrounding it. A definition of animal enhancement is proposed that provides a framework within which to consider these issues; and it is argued that if human enhancement can be considered to be a moral obligation, so too can animal enhancement

Recent ethical and legal challenges have arisen concerning the rights of individuals over their IVF embryos, leading to questions about how, when the wishes of parents regarding their embryos conflict, such situations ought to be resolved. A notion commonly invoked in relation to frozen embryo disputes is that of reproductive rights: a right to have (or not to have) children. This has sometimes been interpreted to mean a right to have, or not to have, one's own genetic children. But can such rights legitimately be asserted to give rise to claims over embryos? We examine the question of property in genetic material as applied to gametes and embryos, and whether rights over genetic information extend to grant control over IVF embryos. In particular we consider the purported right not to have one's own genetically related children from a property-based perspective. We argue that even if we concede that such (property) rights do exist, those rights become limited in scope and application upon engaging in reproduction. We want to show that once an IVF embryo is created for the purpose of reproduction, any right not to have genetically-related children that may be based in property rights over genetic information is ceded. There is thus no right to prevent one's IVF embryos from being brought to birth on the basis of a right to avoid having one's own genetic children. Although there may be reproductive rights over gametes and embryos, these are not grounded in genetic information.

The prospect of using genome technologies to modify the human germline has raised profound moral disagreement but also emphasizes the need for wide-ranging discussion and a well-informed policy response. The Hinxton Group brought together scientists, ethicists, policymakers, and journal editors for an international, interdisciplinary meeting on this subject. This consensus statement formulated by the group calls for support of genome editing research and the development of a scientific roadmap for safety and efficacy; recognizes the ethical challenges involved in clinical reproductive applications of genome editing but, importantly, rejects the idea that human reproductive germline modification is necessarily morally unacceptable; and highlights the importance of meaningful engagement in discussions of genome editing and the development of regulation and oversight mechanisms to govern future uses of such technologies.

Moral enhancement is a topic that has sparked much current interest in the world of bioethics. The possibility of making people ‘better,’ not just in the conventional enhancement sense of improving health and other desirable qualities and capacities, but by making them somehow more moral, more decent, altogether better people, has attracted attention from both advocates 1 2 and sceptics 3 alike. The concept of moral enhancement, however, is fraught with difficult questions, theoretical and practical. What does it actually mean to be ‘more moral’? How would moral enhancement be defined and would it necessarily, as some have claimed, make the world a better or safer place? How would or could such enhancement be achieved safely and without undue constraint on personal liberty and autonomy? On this subject, a recent paper by Crockett et al 4 investigating the effects of the neurotransmitter serotonin on moral decision-making provides an intriguing scientific basis for examining what might or might not constitute moral enhancement. The study involved treatment with citalopram, a drug that increases the action of serotonin in the brain, and subsequent analysis of participants' decision-making behaviour in two different situations involving moral dilemmas: the well-known ‘Trolley Problem’ 5 and the ‘Ultimatum Game’. 6 The researchers found that citalopram promoted what they call ‘prosocial behaviour’, increasing the participants' aversion to causing direct harm to others: in the first scenario, they were less likely to select the option that required killing one in order to save five, and in the second, less likely to reject unfair offers at the expense of others. The Crockett study is fascinating both for its insight into human behaviour and because it appears to demonstrate that, at least on some accounts of moral behaviour, serotonin may in fact be a …

The legitimacy of embryo research, use, and destruction is among the most important issues facing contemporary bioethics. In the preceding paper, Ingmar Persson and Julian Savulescu took up an argument of John Harris and tried to find some new ways of avoiding its dramatic consequences. They noted that: “John Harris has argued that if … it is morally permissible to engage in reproduction … despite knowledge that a large number of embryos will fail to implant and quickly die, then … it is morally permissible to produce embryos for other purposes that involve killing them, for instance, to harvest stem cells” and suggest that this argument fails

Animals, in the age of biotechnology, are the subjects of a myriad of scientific procedures, interventions, and modifications. They are created, altered, and experimented upon—often with highly beneficial outcomes for humans in terms of knowledge gained and applied, yet not without concern also for the effects upon the experimental subjects themselves: consideration of the use of animals in research remains an intensely debated topic. Concerns for animal welfare in scientific research have, however, been primarily directed at harm to and suffering of animal subjects and their prevention. Little attention has been paid to the benefits research might potentially produce for animals themselves and the interests that some animals may therefore have in the furtherance of particular avenues of science

Biomedical research involving human participants is highly regulated and subject to stringent ethical requirements. Clinical research ethics, regulation and policy have tended to focus almost exclusively on the protection of participants' interests against harms that might result from taking part in research. Less consideration, however, has been given to the interests that patients may themselves have in research participation, even in trials that may be beyond the bounds of current clinical research practice. In this paper, we consider the case of a suggested extension to clinical trial protocols to explore the ethics of participation in ‘risky’ research. We argue that patients may have a strong interest in taking part in research, and that even when greater-than-usual risks may be present, such research can be both ethically and scientifically justified. Finally, we suggest that there might be scope in some cases to assert a right to participate in research, and that the possibility of such a right merits further consideration

More impetus needs to be placed on cord blood donationIn July, the Royal College of Obstetricians and Gynaecologists released a report on the uses and the potential perils of umbilical cord blood collection.1 This report has had the positive effect of drawing attention to what has hitherto been an under addressed topic of medical research and ethics. However, the focus and recommendations of the report say little about one important aspect of cord blood usage—research. Such an omission, although understandable from an organisation primarily concerned with maternal and neonatal health, may nevertheless have implications for the broader applicability of the report’s recommendations, outside the immediate arena of patient care.The RCOG report deals with various aspects of cord blood collection and use—the harvesting procedure itself; cord blood transplantation treatment, either as an autologous cell transplant or as a donation for community use; and whether cord blood banking for personal use should be permitted or encouraged as a privately funded commercial enterprise. It also makes note of some of the legal and ethical issues surrounding cord blood and tissue banking more generally, concerns that will be of increasing importance as more biobanks are established worldwide. A large part of the report deals with concerns on neonatal and maternal safety and whether cord blood collection may pose a risk. These concerns may be valid and certainly, the health of mothers and children should not be compromised. The guidance provided by this report in relation to the collection procedure will undoubtedly assist maternity health professionals in this area.The main relevance of the RCOG …

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 …

Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance.