Timothy F. Murphy

In defense of irreligious bioethics.

Some commentators have criticized bioethics as failing to engage religion both as a matter of theory and practice. Bioethics should work toward understanding the influence of religion as it represents peoples beliefs and practices, but bioethics should nevertheless observe limits in regard to religion as it does its normative work. Irreligious skepticism toward religious views about health, healthcare practices and institutions, and responses to biomedical innovations can yield important benefits to the field. Irreligious skepticism makes it possible to raise questions that otherwise go unasked and to protect against the overreach of religion. In this sense, bioethics needs a vigorous irreligious outlook every bit as much as it needs descriptive understandings of religion.

RETRACTED: Ethical issues in surgical treatment and research

This article has been retracted at the request of the Editor-in-Chief and Author. Please see http://www.elsevier.com/locate/withdrawalpolicy . Reason: There are problems with this monograph. Multiple passages from the sections entitled, “Ethics and End-of-Life Issues” (pp. 357–379) and “Ethics and Research in Surgery” (pp. 379–398), authored by Rene Lafreniere were taken from the following sources without appropriate attribution given the original authors: (1) Jonsen AR, Siegler M, Winslade WD. Clinical ethics: a practical approach to ethical decisions in clinical medicine. New York: McGraw Hill, 1992. (2) Troidl H, McKneally MF, Towards a definition of clinical research, In: Troidl H, McKeally MF, Mulder DS, Wechsler AS, McPeek B, Spitzer WO, editors. Surgical Research, Basic Principles and Clinical Practice, 3rd Edition, New York: Springer-Verlag; 1998, pp. 3–7. (3) Macklin R. The ethical problems with sham surgery in clinical research. New Eng J Med 1999; 341: 992–996). (4) Medical Futility in End-of-Life Care: Report of the Council on Ethical and Judicial Affairs, American Medical Association. JAMA. 1999; 281:937–941. (5) Younger SJ and Shuck JM, Advanced directives and determination of death, in Surgical Ethics. Eds. McCollough LB, Jones JW and Brody BA. 1st Edition. New York, Oxford University Press, 1998, pp. 57–77. (6) Frader JE and Caniano DA, Research and Innovation in Surgery, in Surgical Ethics, Eds. McCollough LB, Jones JW and Brody BA. 1st Edition. New York, Oxford University Press, 1998, pp. 216–241. (7) Margo CE, Towards an Operational Definition of Human Research. J Med Ethics. 2001; 27: 40–43 This monograph is thus retracted with apologies to the authors of the unattributed works. Sincerely, Peter Angelos, MD, PhD; Rene Lafreniere, MD; Timothy F. Murphy, PhD; Wayne Rosen, MD; November 15, 2006

Ethics and the prohibition of donor gametes in fertility medicine.

Some countries and societies ban the use of donor gametes in IVF and other assisted reproductive treatments. Supporters of these bans maintain that third-party gametes damage marriage, pose dangers to children and families, put donors at risk, and endanger society at large, but these views are open to moral dispute. In particular, secular moral philosophy does not require couples to rely on their own gametes only to have children. Families can thrive even if children vary in their genetic relationships with parents and siblings. The use of donor gametes merits close attention in matters of safety and oversight, but there is no effect that is so damaging to children, donors or society that justifies closing off their use altogether. Moreover, bans on donor gametes can sometimes be evaded through reproductive tourism, which raises questions of justice for those unable to afford that option. According to one method of measuring moral progress - a method that relies on principles of humaneness and humanity - providing access to donor gametes makes important contributions to happiness and equality. These arguments suggest that the bans against donor gametes in fertility medicine should be reconsidered.

The Ethics of Fertility Preservation in Transgender Body Modifications

In some areas of clinical medicine, discussions about fertility preservation are routine, such as in the treatment of children and adolescents facing cancer treatments that will destroy their ability to produce gametes of their own. Certain professional organizations now offer guidelines for people who wish to modify their bodies and appearance in regard to sex traits, and these guidelines extend to recommendations about fertility preservation. Since the removal of testicles or ovaries will destroy the ability to have genetically related children later on, it is imperative to counsel transgender people seeking body modifications about fertility preservation options. Fertility preservation with transgender people will, however, lead to unconventional outcomes. If transgender men and women use their ova and sperm, respectively, to have children, they will function as a mother or father in a gametic sense but will function in socially reversed parental identities. There is nothing, however, about fertility preservation with transgender men and women that is objectionable in its motives, practices, or outcomes that would justify closing off these options. In any case, novel reproductive technologies may extend this kind of role reversal in principle to all people, if sperm and ova can be derived from all human beings regardless of sex, as has happened with certain laboratory animals.

The meaning of synthetic gametes for gay and lesbian people and bioethics too

Some commentators indirectly challenge the ethics of using synthetic gametes as a way for same-sex couples to have children with shared genetics. These commentators typically impose a moral burden of proof on same-sex couples they do not impose on opposite-sex couples in terms of their eligibility to have children. Other commentators directly raise objections to parenthood by same-sex couples on the grounds that it compromises the rights and/or welfare of children. Ironically, the prospect of synthetic gametes neutralises certain of these objections, insofar as they would ensure that children have parents whom they can know as their genetic parents, which outcome is not always possible when same-sex couples involve third parties as the source of gametes or embryos. Not all commentators in bioethics throw the use of synthetic gametes into doubt as far as same-sex couples are concerned, but even these commentators put parenting by gay men and lesbians at the conclusion of an argument rather than presupposing parental legitimacy from the outset. Synthetic gametes do raise questions of ethics in regard to parenthood for gay men and lesbians, but these are largely questions of access and equity, not questions of parental fitness and/or child welfare.

Parents' choices in banking boys' testicular tissue

Researchers are working to derive sperm from banked testicular tissue taken from pre-pubertal boys who face therapies or injuries that destroy sperm production. Success in deriving sperm from this tissue will help to preserve the option for these boys to have genetically related children later in life. For the twin moral reasons of preserving access and equity in regard to having such children, clinicians and researchers are justified in offering the option to the parents of all affected boys. However, some parents may wish to decline the option to bank tissue from their boys because the technique may seem too unfamiliar or unusual, but over time people may become more comfortable with the technique as they have done with other novel assisted reproductive treatments (ARTs). Other parents may wish to decline the option because of moral or religious reasons. A prominent natural law theory holds, for example, that the ARTs that would be involved in using sperm derived from banked tissue to produce a child are morally objectionable. Some parents might not want to bank tissue in order to shield their son from using ARTs they see as objectionable. Clinicians and researchers should respect parents who wish to decline banking tissue, but parents should ordinarily embrace choices that protect the possible interests their sons may have as adult men, including the wish to have genetically related children.

Electronic communication in ethics committees: experience and challenges

Experience with electronic communication in ethics committees at two hospitals is reviewed and discussed. A listserver of ethics committee members transmitted a synopsis of the ethics consultation shortly after the consultation was initiated. Committee comments were sometimes incorporated into the recommendations. This input proved to be most useful in unusual cases where additional, diverse inputs were informative. Efforts to ensure confidentiality are vital to this approach. They include not naming the patient in the e-mail, requiring a password for access to the listserver, and possibly encryption. How this electronic communication process alters group interactions in ethics committees is a fruitful area for future investigation.

Is AIDS a just punishment

There are religious and philosophical versions of the thesis that AIDS is a punishment for homosexual behaviour. It is argued here that the religious version is seriously incomplete. Because of this incompleteness and because of the indeterminacies that ordinarily attend religious argumentation, it is concluded that the claim may be set aside as unconvincing. Homosexual behaviour is then judged for its morality against utilitarian, deontological, and natural law theories of ethics. It is argued that such behaviour involves no impediment to important moral goals and is not therefore immoral. Where natural law might be used to condemn homosexual behaviour, it is argued that the theory itself is not well established. Consequently there is a prima facie reason for rejecting the philosophical version of the punishment thesis. This conclusion is further supported by noting the lack of proportion between the purported immorality of homosexuality and a punishment as devastating as AIDS.

Dignity, marriage and embryo adoption: a look at Dignitas Personae

The Catholic Churchs 2008 Dignitas Personae discusses the moral implications of respecting the dignity of all human beings, regardless of the stage of development. In that text, the Vaticans Congregation for the Doctrine of the Faith argues that respect for this dignity is incompatible with the conception of embryos outside marriage as well as assisted reproduction treatments and certain kinds of human embryonic research. Not only that, but the Congregation also rejects efforts at embryo adoption. As a matter of secular moral philosophy, this view of dignity is disputable and this article shows how an alternate view of dignity--one that depends on interests as against status--serves as a better foundation for decisions about ways in which to help people have children. This view of dignity is entirely compatible with a wide array of assisted reproduction treatments and research and is compatible with the conception of embryos for single parents or opposite-sex couples looking to have children. Using its notion of human dignity, the Congregation makes a case against embryo adoption, but that case is unconvincing given the permissible exercise of individual conscience and the presumptive importance of rescuing human lives where they can be rescued.

The Ethics of Multiple Vital Organ Transplants

In September 2001, the British medical journal Lancet published a retrospective report of nine British patients who received combined heart-lung-liver transplants between 1986 and 1999.1 In each of these cases, three vital organs went to a single recipient when they might otherwise have gone to as many as four. This kind of transplantation works against the received wisdom that transplantation works best when focused on a single vital system or at least no more than two. According to the study, four of the recipients lived no longer than four months after the transplant, three died after a period of years (2.5, 7.5, and 12), and two were still alive at the time of the report. The authors believe that different approaches could help control the infection that caused most of the sickness and death in the cases reviewed. Because five patients survived beyond the immediate posttransplant period for a time measurable in years, the authors recommend the procedure for patients of a certain kind, especially since it does not require new skills for experienced transplant teams. The procedure does require more organs, however, and not only for this reason raises many ethical questions that should be addressed before transplantation of this kind continues on any large scale. The report contains no information about how consent was obtained f om patients involved in this procedure. One hopes ha the informed consent procedure fully emphasized the risks of the intervention. Especially for these early attempts, on hopes that the experimental nature of the procedure was emphasized. Of course, in the United States, federal regulations do not require that physicians obtain prior review and approval for clinical innovations aimed at the care of a particular patient. This means that physicians in this kind of situation are under no obligation to submit their informed on ent process to the scrutiny of others. While the Belmont Report was not written for a British audience, its counsel is nonetheless wise about clinical innovat on. That 1976 report recommends that radical innovations should be made the object of formal investigation as soon as practical after first being tried. It seems to me that the time is more than ripe to treat multiple organ transplant as experim ntal in a formal sense and to subject it to scrutiny in regard to its procedures and informed consent process. I say this not to cast any aspersions on the practices of the physicians who were involved in the cases reported, about which no information is available. I say this because institutional review boards can, on balance, offer important assistance both