Medicine interacts with social, legal and political elements of life. For example, UK homelessness leads to a reduction of life-expectancy of around 30 years . This issue is a daily reality for practising clinicians. In research and research ethics, vulnerable groups, including socially vulnerable, are frequently excluded from research. Whilst there are good reasons for this, this can mean exclusion from benefits as well as from risks.
Sunstein and Thaler's book Nudge: Improving Decisions About Health, Wealth and Happiness1, described a fictional species, Econs. Econs are perfectly rational humans. They optimise their pensions, they read the small print, and they never procrastinate. They are the citizens governments dream of.
Conscientious objection in healthcare is the refusal by healthcare professionals (HCPs) to provide certain medical services on the basis of moral or religious beliefs. Conscience clauses in legislations regulating abortion and medical assistance to die typically exempt physicians from providing these services on conscience grounds. Conscientious objection often consists in a refusal to perform a certain medical activity; for example, a refusal by a Catholic physician to perform an abortion. However, some conscientious objectors claim a right to refuse to inform a patient about a certain therapeutic option and some others might refuse to refer a patient to a colleague for a medical procedure that they fi nd morally objectionable. It is not surprising that, in the past few decades, the issue of health professionals' conscientious objection has become a central topic of discussion in medical ethics.
Genetic engineering has been a topic of discussion for over 50 years, but it is only recently that gene editing has become a reality. CRISPR biotechnologies have made gene editing much safer, precise and feasible. We have witnessed the first cases of human germline genetic modification resulting in live births, conducted by He Jiankui. In this paper, we will analyse He Jiankui's case in relation to one of the most difficult problems in procreative ethics (or the ethics of future generations): the non-identity problem. We believe that this analysis will help us to understand the ethics involved in gene editing and hopefully allow for a better, more philosophically grounded legislation on CRISPR and other gene-editing technologies.
In order to prevent the rapid spread of COVID-19, governments have placed significant restrictions on liberty, including preventing all non-essential travel. These restrictions were justified on the basis the health system may be overwhelmed by COVID-19 cases and in order to prevent deaths. Governments are now considering how they may de-escalate these restrictions. This article argues that an appropriate approach may be to lift the general lockdown but implement selective isolation of the elderly. While this discriminates against the elderly, there is a morally relevant difference—the elderly are far more likely to require hospitalisation and die than the rest of the population. If the aim is to ensure the health system is not overwhelmed and to reduce the death rate, preventing the elderly from contracting the virus may be an effective means of achieving this. The alternative is to continue to keep everyone in lockdown. It is argued that this is levelling down equality and is unethical. It suggests that in order for the elderly to avoid contracting the virus, the whole population should have their liberty deprived, even though the same result could be achieved by only restricting the liberty of the elderly. Similar arguments may also be applied to all groups at increased risk of COVID-19, such as men and those with comorbidities, the obese and people from ethnic minorities or socially deprived groups. This utilitarian concern must be balanced against other considerations, such as equality and justice, and the benefits gained from discriminating in these ways must be proportionately greater than the negative consequences of doing so. Such selective discrimination will be most justified when the liberty restriction to a group promotes the well-being of that group (apart from its wider social benefits).
The COVID-19 pandemic currently wracking the world represents a crucial test for our ethical toolkit. Governments, institutions and individuals are suddenly called upon to make life and death decisions for which they typically ill-prepared. Vocabulary which has suddenly become so familiar—"flatten the curve"; "social distancing"; "R0"—was unknown to most of us a bare few weeks ago. Even for experts, every option continues to have huge uncertainties associated with it. When experts are divided and unsure, how are the rest of us responsibly to decide how to act and who to trust?
It may soon be possible to generate human tissues and organs inside of part-human chimeras via a technique known as interspecies blastocyst complementation. Using Australian legislation as a case study, we show why this technique of creating part-human chimeras falls within the gaps of existing legislation. We give an overview of the key ethical issues raised by part-human chimera research, and we describe how well these issues are met by a range of possible regulatory approaches. We ultimately argue that regulation of part-human chimera research should be (re)designed to balance two key aims: to facilitate ethical research involving part-human chimeras and to prevent unethical experimentation with chimeras that have an uncertain—and potentially substantial—degree of moral status.
While philosophers are often concerned with the conditions for moral knowledge or justification, in practice something arguably less demanding is just as, if not more, important – reliably making correct moral judgments. Judges and juries should hand down fair sentences, government officials should decide on just laws, members of ethics committees should make sound recommendations, and so on. We want such agents, more often than not and as often as possible, to make the right decisions. The purpose of this paper is to propose a method of enhancing the moral reliability of such agents. In particular, we advocate for a procedural approach; certain internal processes generally contribute to people's moral reliability. Building on the early work of Rawls, we identify several particular factors related to moral reasoning that are specific enough to be the target of practical intervention: logical competence, conceptual understanding, empirical competence, openness, empathy and bias. Improving on these processes can in turn make people more morally reliable in a variety of contexts and has implications for recent debates over moral enhancement.
The UK government has put Lateral Flow Antigen Tests (LFATs) at the forefront of its strategy to scale up testing in the coronavirus pandemic. However, evidence from a pilot trial using an LFAT to identify asymptomatic infections in the community suggests that the test missed over half of the positive cases in the tested population. This raises the question of whether it can it be ethical to use an inaccurate test to guide public health measures. We begin by explicating different dimensions of test accuracy (sensitivity, specificity, and predictive value), and why they matter morally, before highlighting key data from the Liverpool pilot. We argue that the poor sensitivity of the LFAT in this pilot suggests that there are important limitations to what we can expect these tests to achieve. A test with low sensitivity will provide false negative results, and in doing so generate the risk of false assurance and its attendant moral costs. However, we also suggest that the deployment of an insensitive but specific test could identify many asymptomatic carriers of the virus who are currently being missed under existing arrangements. Having outlined ways in which the costs of false reassurance could potentially be mitigated, we conclude that the use of an insensitive LFAT in mass testing may be ethical if (i) it is used predominantly to identify positive cases (ii) it is a cost-effective method of achieving that goal and (iii) if other public health tools can effectively prevent widespread false reassurance.
It is likely that gene editing technologies will become viable in the current century. As scientists uncover the genetic contribution to personality traits and cognitive styles, parents will face hard choices. Some of these choices will involve trade‐offs from the standpoint of the individual's welfare, while others will involve trade‐offs between what is best for each and what is good for all. Although we think we should generally defer to the informed choices of parents about what kinds of children to create, we argue that decisions to manipulate polygenic psychological traits will be much more ethically complicated than choosing Mendelian traits like blood type. We end by defending the principle of regulatory parsimony, which holds that when legislation is necessary to prevent serious harms, we should aim for simple rules that apply to all, rather than micro‐managing parental choices that shape the traits of their children. While we focus on embryo selection and gene editing, our arguments apply to all powerful technologies which influence the development of children.
Preimplantation genetic diagnosis (PGD) allows the detection of genetic abnormalities in embryos produced through in vitro fertilization (IVF). Current funding models in Australia provide governmental subsidies for couples undergoing IVF, but do not extend to PGD. There are strong reasons for publicly funding PGD that follow from the moral principles of autonomy, beneficence and justice for both parents and children. We examine the objections to our proposal, specifically concerns regarding designer babies and the harm of disabled individuals, and show why these are substantially outweighed by arguments for subsidizing PGD. We argue that an acceptance of PGD is aligned with present attitudes towards procreative decision making and IVF use, and that it should therefore receive government funding.
There is a burgeoning scientific and ethical literature on the use of biomarkers—such as genes or brain scan results—and biological interventions to predict and prevent crime. This literature on biopredicting and biopreventing crime focuses almost exclusively on crimes that are physical, violent, and/or sexual in nature—often called blue-collar crimes—while giving little attention to less conventional crimes such as economic and environmental offences, also known as white-collar crimes. We argue here that this skewed focus is unjustified: white-collar crime is likely far costlier than blue-collar crime in money, health, and lives lost. Moreover, attempts to biopredict and bioprevent blue-collar crime may entail adopting potentially unfair measures that target individuals who are already socio-economically disadvantaged, thus compounding pre-existing unfairness. We argue, therefore, that we ought to extend the study of bioprediction and bioprevention to white-collar crime as a means of more efficiently and fairly responding to crime. We suggest that identifying biomarkers for certain psychopathic traits, which appear to be over-represented among senior positions in corporate and perhaps political organisations, is one avenue through which this research can be broadened to include white-collar crime.
The link between parasite-stress and complex psychological dispositions implies that the social, political, and economic benefits likely to flow from public health interventions that reduce rates of non-zoonotic infectious disease are far greater than have traditionally been thought. We sketch a prudential and ethical argument for increasing public health resources globally and redistributing these to focus on the alleviation of parasite-stress in human populations.
In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds' availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) issued recommendations aimed at supporting physicians in prioritizing patients when the number of critically ill patients overwhelm the capacity of ICUs. One motivating concern for the SIAARTI guidance was that, if no balanced and consistent allocation procedures were applied to prioritize patients, there would be a concrete risk for unfair choices, and that the prevalent "first come, first served" principle would lead to many avoidable deaths. Among the drivers of decision for admission to ICUs, age, comorbidities, and preexisting functional status were included. The recommendations were criticized as ageist and potentially discriminatory against elderly patients. Looking forward to the next steps, the Italian experience can be relevant to other parts of the world that are yet to see a significant surge of COVID-19: the need for transparent triage criteria and commonly shared values give the Italian recommendations even greater legitimacy.
Background: Transcranial direct current stimulation (tDCS) is an experimental brain stimulation technology that may one day be used to enhance the cognitive capacities of children. Discussion about the ethical issues that this would raise has rarely moved beyond expert circles. However, the opinions of the wider public can lead to more democratic policy decisions and broaden academic discussion of this issue. Methods: We performed a quantitative survey of members of the US public. A between-subjects design was employed, where conditions varied based on the trait respondents considered for enhancement. Results: 227 responses were included for analysis. Our key finding was that the majority were unwilling to enhance their child with tDCS. Respondents were most reluctant to enhance traits considered fundamental to the self (such as motivation and empathy). However, many respondents may give in to implicit coercion to enhance their child in spite of an initial reluctance. A ban on tDCS was not supported if it were to be used safely for the enhancement of mood or mathematical ability. Opposition to such a ban may be related to the belief that tDCS use would not represent cheating or violate authenticity (as it relates to achievements rather than identity). Conclusions: The wider public appears to think that crossing the line from treatment to enhancement with tDCS would not be in a child's best interests. However, an important alternative interpretation of our results is that lay people may be willing to use enhancers that matched their preference for 'natural' enhancers. A ban on the safe use of tDCS for enhancing non-fundamental traits would be unlikely to garner public support. Nonetheless, it could become important to regulate tDCS in order to prevent misuse on children, because individuals reluctant to enhance may be likely to give in to implicit coercion to enhance their child.
