David DeGrazia

Enhancement technologies and human identity

As the Presidents Council on Bioethics emphasized in a recent report, rapid growth of biotechnologies creates increasingly many possibilities for enhancing human traits. This article addresses the claim that enhancement via biotechnology is inherently problematic for reasons pertaining to our identity. After clarifying the concept of enhancement, and providing a framework for understanding human identity, I examine the relationship between enhancement and identity. Then I investigate two identity-related challenges to biotechnological enhancements: (1) the charge of inauthenticity and (2) the charge of violating inviolable core characteristics. My thesis is that a lucid, plausible understanding of human identity largely neutralizes these charges, liberating our thinking from some seductive yet unsound objections to enhancement via biotechnology.

Moral enhancement, freedom, and what we (should) value in moral behaviour

The enhancement of human traits has received academic attention for decades, but only recently has moral enhancement using biomedical means – moral bioenhancement (MB) – entered the discussion. After explaining why we ought to take the possibility of MB seriously, the paper considers the shape and content of moral improvement, addressing at some length a challenge presented by reasonable moral pluralism. The discussion then proceeds to this question: Assuming MB were safe, effective, and universally available, would it be morally desirable? In particular, would it pose an unacceptable threat to human freedom? After defending a negative answer to the latter question – which requires an investigation into the nature and value of human freedom – and arguing that there is nothing inherently wrong with MB, the paper closes with reflections on what we should value in moral behaviour.

Common Morality, Coherence, and the Principles of Biomedical Ethics

The fifth edition of Beauchamp and Childresss Principles of Biomedical Ethics is distinguished by its emphatic embrace of common morality as the ultimate source of moral norms. This essay critically evaluates the fifth editions discussion of common morality and, to a lesser extent, its treatment of coherence (both the model of ethical justification and the associated concept). It is argued that the book is overly accommodating of existing moral beliefs. The paper concludes with three suggestions for improving this leading text.

An outcomes model of medical decision making

In the traditional ‘fix-it’ model of medical decision making, the identified problem is typically characterized by a diagnosis that indicates a deviation from normalcy. When a medical problem is multifaceted and the available interventions are only partially effective, a broader vision of the health care endeavor is needed. What matters to the patient, and what should matter to the practitioner, is the patients future possibilities. More specifically, what is important is the character of the alternative futures that the patient could have and choosing among them so as to achieve the best future possible, with the ranking of outcomes determined by the patients preferences. This paper describes the fix-it model, presents and defends the outcomes-based model, and demonstrates that the latter is useful in developing normative conceptions of informed consent and decision making and in establishing a basis for societal involvement in the decision making process. Finally, several shortcomings of the model will be acknowledged.

Ethical issues in early-intervention clinical trials involving minors at risk for schizophrenia.

Early-intervention clinical trials involving persons at risk for schizophrenia raise a variety of ethical issues. These issues range from some of the most general questions of ethical theory and research ethics to some very specific pragmatic questions about optimal procedures for protecting subjects. Giving special attention to minor subjects (and adult subjects lacking decision-making capacity), this paper aims to provide an overview of some leading ethical issues and concerns as well as a rights-based framework and several concrete suggestions for addressing these issues and concerns.

The Ethics of Animal Research: What Are the Prospects for Agreement?

Few human uses of nonhuman animals (hereafter simply “animals”) have incited as much controversy as the use of animals in biomedical research. The political exchanges over this issue tend to produce much more heat than light, as representatives of both biomedicine and the animal protection community accuse opponents of being “Nazis,” “terrorists,” and the like. However, a healthy number of individuals within these two communities offer the possibility of a more illuminating discussion of the ethics of animal research.

Relieving pain using dose-extending placebos: a scoping review.

Placebos are often used by clinicians, usually deceptively and with little rationale or evidence of benefit, making their use ethically problematic. In contrast with their typical current use, a provocative line of research suggests that placebos can be intentionally exploited to extend analgesic therapeutic effects. Is it possible to extend the effects of drug treatments by interspersing placebos? We reviewed a database of placebo studies, searching for studies that indicate that placebos given after repeated administration of active treatments acquire medication-like effects. We found a total of 22 studies in both animals and humans hinting of evidence that placebos may work as a sort of dose extender of active painkillers. Wherever effective in relieving clinical pain, such placebo use would offer several advantages. First, extending the effects of a painkiller through the use of placebos may reduce total drug intake and side effects. Second, dose-extending placebos may decrease patient dependence. Third, using placebos along with active medication, for part of the course of treatment, should limit dose escalation and lower costs. Provided that nondisclosure is preauthorized in the informed consent process and that robust evidence indicates therapeutic benefit comparable to that of standard full-dose therapeutic regimens, introducing dose-extending placebos into the clinical arsenal should be considered. This novel prospect of placebo use has the potential to change our general thinking about painkiller treatments, the typical regimens of painkiller applications, and the ways in which treatments are evaluated.

Animal ethics around the turn of the twenty-first century.

This article provides a narrative on the state of animal ethics in the 1990s and projections of where it might lead in the future. Three books that contribute substantially to philosophical animal ethics are reviewed and are contrasted with the authors own work. In addition, four questions are raised with regard to the future agenda for animal ethics: what will animal ethics learn from feminist theory; what are the respective roles of properties and relations in a determination of moral status; how much can virtue ethics illuminate practical issues involving animals; and what is the role of respect in animal ethics.

Moral Status, Human Identity, and Early Embryos: A Critique of the President's Approach

Underlying President Bushs view regarding stemcell research and cloning are two assumptions: we originate at conception, and we have full moral status as soon as we originate. I will challenge both assumptions, argue that at least the second is mistaken, and conclude that the Presidents approach is unsustainable.

Pain, suffering, and anxiety in animals and humans

We attempt to bring the concepts of pain, suffering, and anxiety into sufficient focus to make them serviceable for empirical investigation. The common-sense view that many animals experience these phenomena is supported by empirical and philosophical arguments. We conclude, first, that pain, suffering, and anxiety are different conceptually and as phenomena, and should not be conflated. Second, suffering can be the result — or perhaps take the form — of a variety of states including pain, anxiety, fear, and boredom. Third, pain and nociception are not equivalent and should be carefully distinguished. Fourth, nociception can explain the behavior of insects and perhaps other invertebrates (except possibly the cephalopods). Fifth, a behavioral inhibition system associated with anxiety in humans seems to be present in mammals and most or all other vertebrates. Based on neurochemical and behavioral evidence, it seems parsimonious to claim that these animals are capable of experiencing anxious states.