Sinead Prince

Genetic enhancement technologies are rapidly evolving, but discussions about their use for human enhancement are largely abstract and removed from the socioeconomic environments in which they would be administered. While some scholars engage in discussions about the fairness of distributing genetic enhancements, I argue that the oppressive social structures in which genetic enhancements will be administered categorically undermine our capacities to autonomously value and pursue such technologies. I will draw on long-standing feminist debates around the oppressive and empowering uses of cosmetic enhancements by women to argue that the oppressive nature of patriarchal beauty norms creates a social environment in which women are generally not free to autonomously evaluate their desires for and values of cosmetic enhancements. I then address the concern that declaring such a proposition is itself an unethical restriction on women’s autonomy and that cosmetic enhancements are generally, or presumptively, empowering. I conclude that, like cosmetic enhancements, genetic enhancements are morally harmful insofar as they are not categorically autonomously valued by people.

In 2025, an Australian couple asked to have their remaining embryos moved to another clinic, only to discover that the child they had birthed 2 years earlier had not come from their own embryos, but an embryo belonging to a different couple. These situations can lead to disputes about who is recognised as ‘the parents’ in the biological or social sense, as well as who has moral or legal claims to parental rights and responsibilities. In terms of specific legal disputes over custody or guardianship, the matter will generally be resolved in the best interests of the child. However, one of the considerations relevant to this child’s best interests is the question of biological relatedness, even if only due to the social weight it is often granted. This paper will argue that the current presumption in favour of genetics as determinative of biological relatedness is rebuttable in favour of the gestational relationship. Furthermore, there are other reasons to give weight to the moral, legal, or social claims of the gestational progenitors, such as bonds with the infant that have already been developed. However, such mix-ups will happen again and, in light of genomic technologies, may be discovered in vivo or immediately after birth, in which the courts may be ill-suited to determining the best interests. As such, legislative approaches to resolving parenthood in such cases must be proactively developed.

The relationship between cognitive enhancements (CE) and human autonomy or authenticity is generally positioned as how CE impact human autonomy or authenticity. But rarely, if ever, do we consider whether the value and pursuit of CE is an authentic one. In this paper, I will argue that the moral permissibility of cognitive gene enhancements is undone by the legitimate concern that the near universal value for such modifications is likely driven by oppressive norms for superintelligence and productivity. I argue that these norms derive from the capitalist meritocracy: an economic system that structures inclusion and success based on patriarchal and racist norms of intelligence and productivity. The claim that the use of such enhancements fits within the autonomous scope of individual power is thus far weaker than it claims to be, particularly within the context of genetic modification.

Although it is reasonable and valuable to seek explanations for decisions made by artificial intelligence (AI), it is simply not possible with black-box AI algorithms. However, these algorithms can produce highly beneficial and efficient outputs that could be extremely useful to patients, treating teams, hospitals, and funding bodies. This poses a dilemma: is black-box AI justifiable to use in healthcare? This article analyses the normative reasons that can defend and justify the use of black-box AI in healthcare; this analysis includes, but does not give lexical priority to, explainability. This is pertinent given the current prohibitions of black-box AI in healthcare, such as in Australia. This article defines justifiability as decisions based on robust reasons and thus identifies reasons that can justify the use of black-box AI in healthcare. These include the algorithms’ explainability and accuracy, the seriousness of the decision's consequences, any relevant bias, the context of the decision, and the level of human intervention. We argue that whilst each of these separate considerations is important, only accuracy and reliability are necessary, and to be sufficient, it is likely that some further reasons arising from the nature and context of the decision will be required.

Black-box AI cannot provide causal explanations for the decisions it makes, but medical AI has shown great promise as an accurate and reliable technology that both improves the quality of patient care and provides better access to healthcare for more patients. There is an ethical argument that to meet the informational requirements of patient autonomy, medical decision-making ought to be explainable to the patient. As such, there have been claims that black-box AI ought to be only minimally used in healthcare. This paper seeks to argue that black-box AI within the clinical context does not necessarily undermine patient autonomy, as defined in standard or relational accounts. Rather, patient autonomy is affected primarily by how AI tools are used.

On June 5, 2024, the Australian Capital Territory passed a law to permit voluntary assisted dying (“VAD”). The Australian Capital Territory became the first Australian jurisdiction to permit nurse practitioners to assess eligibility for VAD. Given evidence of access barriers to VAD in Australia, including difficulty finding a doctor willing to assist, the Australian Capital Territory’s approach should prompt consideration of whether the role of nurses in VAD should be expanded in other Australian jurisdictions. Drawing on lessons from Canada, which currently permits nurse practitioners to assess patient eligibility, we argue that the time has come for Australian jurisdictions to expand the role of nurses in VAD systems. This would be an important step in ensuring access to VAD for patients in practice. Attention, however, must also be paid to ensuring adequate remuneration of nurses (and doctors) if this goal of promoting access is to be achieved in practice.

Biobanking-the storage of human biological samples, including tissue, blood, urine, and genetic data-raises many ethical, legal, and social issues, including confidentiality and privacy. Pediatric biobanking is more complicated, with difficulties arising because children lack capacity to consent and acquire this capacity upon maturity when the research is still ongoing. Yet given the limited availability of pediatric samples, the translational nature of biobanking presents a unique opportunity to share samples and produce clinically necessary information about pediatric development and diseases. Guidance on navigating these legal and ethical difficulties is needed for those involved in pediatric biobanking-including researchers, participants, and families, and those involved in biobank governance. This paper seeks to map the current regulatory framework governing pediatric biobanking to determine what guidance is currently offered. Regulatory mapping of current international and national guidelines on pediatric biobanking addressing the ethical, legal, and social nuances of pediatric biobanking was undertaken. This paper finds that international guidelines around biobanking are mostly for adults, and even when pediatric-specific, documents are non-binding, inconsistent, or only limited guidance is offered on a range of important issues specific to pediatric biobanks. Conclusion: This paper shows a need for consistent, comprehensive, and clear regulation on pediatric biobanking so that research can more quickly, efficiently, and ethically be translated to useful information and treatment in pediatric care. What is Known: • Pediatric biobanking presents new opportunities to conduct valuable translational research to benefit pediatric populations. However, the storage of pediatric biological samples raises many ethical, legal and social issues-in part because child participants may be considered to lack capacity to consent but can acquire this capacity upon maturity when the research is still ongoing. Pediatric biobanks must grapple with issues of consent, confidentiality and privacy, and long-term participation regarding child participants. What is New: • Regulatory guidance on these ethical, legal, and social issues is needed for researchers, participants, and families and those involved in biobank governance. This paper identifies nationally specific and international guidance on biobanking and summarizes the guidance provided in relation to these pediatric specific issues. It finds that most guidance is non-binding and inconsistent between guidance documents and may offer only limited guidance to stakeholders. A need for consistent, comprehensive, and clear regulation on pediatric biobanking is needed at an international level to enable research.

Writers have debated whether germline genome‐editing is person‐affecting or identity‐affecting. The difference is thought to be ethically relevant to whether we should choose genome‐editing or choose preimplantation genetic diagnosis and embryo selection, when seeking to prevent or produce bad conditions (e.g., cystic fibrosis, or deafness) in the individuals who will grow from the embryo edited or selected. We consider the very recent views of three prominent bioethicists and philosophers who have grappled with this issue. We claim that both sides are right, but that the sense in which genome‐editing is person‐affecting is less important, morally, when the aim is to have healthy children. Since this is the predominant objective of engaging in embryo selection and genome‐editing, and since there are certain risks, at least for now, with genome‐editing, it remains better, morally, to engage in embryo selection than genome‐editing.

Ethical debates around genetic enhancement tend to include an argument that the technology will eventually be fairly accessible once available. That we can fairly distribute genetic enhancement has become a moral defence of genetic enhancement. Two distribution solutions are argued for, the first being equal distribution. Equality of access is generally believed to be the fairest and most just method of distribution. Second, equitable distribution: providing genetic enhancements to reduce social inequalities. In this paper, I make two claims. I first argue that the very assumption that genetic enhancements can be distributed fairly is problematic when considering our understanding of gene–environment interactions, for example, epigenetics. I then argue that arguments that genetic enhancements are permissible because the intended benefits can be distributed fairly as intended are misinformed. My first claim rests on the assertion that genetic enhancements do not enhance traits in a vacuum; genes are dependent on conducive environments for expression. If society cannot guarantee fair environments, then any benefit conferred from being genetically enhanced will be undermined. Thus, any argument that the distribution of genetic enhancements will be fair and that the technology is therefore morally permissible, is mistaken.