About the Authors xi
Preface and Acknowledgments xiii
1 Introduction to Ethics 1
1.1 Religion and Ethics 6
1.2 Law and Ethics 9
1.2.1 Legal and Moral Rights 12
1.3 Ethical Relativism 13
1.4 Why be Ethical? 15
2 Ethical Theory 21
2.1 Virtue Ethics 21
2.2 Feminist Ethics 23
2.3 Utilitarian Ethics 25
2.4 Rule¢Based Ethics 29
2.5 ¢Georgetown Mantra¢ 30
2.5.1 Non¢Maleficence 31
2.5.2 Beneficence 31
2.5.3 Respect for Autonomy 31
2.5.4 Justice 32
2.6 Contract Theory 34
3 Basics of Bioethics 37
3.1 History and Scope of Bioethics 37
3.2 Who Can Claim to be a Bioethicist? 41
3.3 Organizations and Journals 43
3.4 Policy Advice 43
3.5 Common Arguments in Bioethics 45
3.6 Playing God 46
3.7 Unnatural and Abnormal 47
3.8 Dignity 48
3.9 Nazi Arguments in Bioethics 51
3.10 Slippery¢Slope Arguments 53
3.11 Treating Someone as a Means 55
4 Moral Standing: What Matters 59
4.1 Moral Standing and Moral Status 59
4.2 Species Membership 60
4.3 Sentientism 62
4.4 Capabilities 64
4.5 Biocentrism 64
4.6 Holism 65
4.7 The Future 66
5 Beginning of Life 69
5.1 Introduction 69
5.2 Ethical Arguments about Reproductive Rights and Responsibilities 70
5.2.1 Reproductive Autonomy and the Right to Reproduce 70
5.2.2 Consequentialism and Procreative Beneficence 71
5.2.3 ¢Do No Harm¢ and the Person¢Affecting Restriction 72
5.2.4 The Non¢Identity Problem 72
5.2.5 Virtue Ethics 73
5.2.6 Feminist Bioethics 73
5.3 Issues in Assisted Reproduction 74
5.3.1 Genetic Relatedness: How Important Is It? 75
5.3.2 Issues of Selection in Reproduction 77
5.4 Embryos, Fetuses and Abortion 79
5.4.1 Fetuses 80
5.4.2 Judith Jarvis Thomson and the Violinist 81
5.4.3 The ¢Future¢Like¢Ours¢ Argument 81
5.4.4 The Impairment Argument Against Abortion 82
5.4.5 Women¢s Character 82
5.4.6 Abortion and Fetal Transplants 83
5.4.7 Savior Siblings 84
5.4.8 Infants and Infanticide 85
5.4.9 Severely Disabled Infants 86
5.4.10 Acts and Omissions 87
5.4.11 Newborn Screening 88
6 Health Care Professional-Patient Relationship 91
6.1 Informed Consent 92
6.2 Paternalism 96
6.3 Deciding for Others 97
6.3.1 Deciding for Others: Advance Directives 97
6.3.2 Deciding for Others: Patients Who Never Had Capacity 98
6.3.3 Deciding for Others: Incapacitated Patients without Advance Directives 99
6.4 Truth Telling 102
6.5 Confidentiality 105
6.6 Conscience Matters 107
6.7 Duty to Treat 110
7 Research Ethics 115
7.1 Elements of Ethical Research 117
7.2 Clinical Research: The Basics 118
7.3 Animal Experiments 120
7.4 Informed Consent 121
7.5 Trial¢Related Injuries 122
7.6 Benefits 124
7.7 Benefiting from Evil 125
7.8 Ethical Issues Affecting Clinical Research Involving the Catastrophically Ill 127
7.9 Developing World 130
7.9.1 Utility of Research Question 130
7.9.2 Standards of Care 131
8 Genetics 135
8.1 Genetics and Genomics 135
8.1.1 Introduction ¢" Genetics, Genomics and Bioethics: Is Genetics Special? 135
8.1.2 Issues in Clinical Genetics: Genetic Testing and Counseling 137
8.1.2.1 Non¢Directiveness 137
8.1.2.2 Children 138
8.1.2.3 Genetic Screening 139
8.1.2.4 Direct¢to¢Consumer Testing 139
8.2 Gene Therapy: Somatic and Germline 140
8.2.1 Is There a Need for Germline Gene Therapy? 142
8.2.2 Risks and Irreversible Consequences 142
8.2.3 Future Generations and Lack of Consent 143
8.2.4 The Iconic Significance of the Germline 143
8.2.5 Gene Editing 144
8.3 Genomic Research 146
8.3.1 The Human Genome Project 146
8.3.2 Biobanks 147
8.3.3 Feedback of Findings 149
8.4 Personalized Medicine 150
8.4.1 Human Cloning ¢" Therapeutic Cloning 151
8.4.2 Reproductive Cloning 153
8.5 Other Issues in Genetics and Genomics 155
9 Enhancement 159
9.1 Introduction 159
9.2 Enhancement and Superhumans 159
9.3 The Meaning of Enhancement 161
9.3.1 Enhancement and Improvement 161
9.4 Alternatives to the ¢Improvement¢ Account 163
9.4.1 Therapy¢"Enhancement Distinction 163
9.4.2 Species¢Normal Functioning 164
9.4.2.1 Quantitative Account of Enhancement 164
9.4.3 Enhancement: The Umbrella View 165
9.5 Ethical Issues 166
9.5.1 Is Enhancement Necessary? 166
9.5.2 Enhancement is Inevitable 167
9.5.3 A Compromise Position? 168
9.5.4 Autonomy 169
9.5.5 The Habermasian Concern 169
9.6 Social Inequalities and Social Justice 170
9.6.1 Consequences for the Future of Humans 171
9.7 Moral Enhancement 173
9.8 Cognitive Enhancement 176
10 Mental Health 181
10.1 Mental Illness 182
10.2 Diagnosis 184
10.3 Autonomy and Capacity 186
10.4 Least Restrictive Option 187
10.5 Best Interests 188
10.6 Treatment and Detention 189
10.6.1 Detention for the Good of the Service User 189
10.6.2 Detention for the Protection of Others 191
11 End of Life 195
11.1 Do You Want to Live Forever? 195
11.2 Terminology 201
11.3 Case for the Decriminalization of Assisted Dying 203
11.4 The Case Against the Decriminalization of Assisted Dying 207
11.4.1 In¢Principle Reasons Against Assistance in Dying 207
11.4.2 Slippery¢Slope Reasons Against Assistance in Dying 208
11.4.2.1 Pereira v. Downie 210
11.5 Violation of Health Care Professional Values and Traditions 213
12 Justice and Health Care 217
12.1 Introduction 217
12.2 Types of Justice 218
12.2.1 Justice and Discrimination 218
12.2.2 Justice in Distribution 219
12.2.3 Procedural Justice 220
12.2.4 Justice and Exploitation 220
12.3 The Concept of Justice and its Connection With Equality 222
12.3.1 Justice and Equality: Equal Treatment and Equal Consideration 222
12.3.2 Justice, ¢Deserving¢, and Personal Responsibility 223
12.3.3 Justice is Giving People What They Need 225
12.4 Theories of Justice 225
12.4.1 Utility and Well¢Being 225
12.4.2 Respect for Persons: Rights to Health and Health Care 228
12.4.3 John Rawls and Norman Daniels 229
12.4.4 The Capabilities Approach 231
12.5 Special Cases 232
12.5.1 Personalized Medicine and Justice 233
13 Population Health 235
13.1 Global Health Issues 235
13.2 Health Aid Obligations 236
13.2.1 Allocation Priorities 238
13.3 Population Health and Public Health 240
13.4 Communicable Disease Control Challenges 243
13.4.1 Take One: Michael Johnson is Not Culpable 245
13.4.2 Take Two: Michael Johnson is Culpable 245
13.4.3 Take Three: Shared Responsibility 246
13.4.4 Deterrence 246
13.4.5 Private Acts and Social Consequences 247
13.4.6 Novel Coronavirus Pandemic 248
13.4.7 Vaccines 251
13.5 Public Health Promotion 253
13.5.1 Communicable Disease: HIV 254
13.5.2 Non¢Communicable Disease: Obesity 256
Bibliography 261
Further Reading 287
Index 295
